Perceived reporting-system function, reporting barriers, and formal near-miss reporting among operating room nurses in China: a cross-sectional study
- 1Department of Anesthesiology, Nanchong Central Hospital, Nanchong, Sichuan, China
Abstract
Background: Near-miss reporting provides an early signal of perioperative system failure, yet formal reporting remains limited in operating rooms. This study examined correlates of formal near-miss reporting among operating room (OR) nurses at a two-campus tertiary hospital in China.
Methods: In this cross-sectional study, 2,281 OR nurses returned a structured questionnaire and 2,200 were analyzed, covering self-reported 12-month near-miss observation and reporting, four safety-culture indices, workload, and professional characteristics. Exposures were purpose-built indices rather than validated scales. Multivariable logistic regression, with a prespecified parsimonious model as the principal specification, examined factors associated with formal reporting among observers (Model A) and, as an exploratory aim, near-miss observation in the full sample (Model B).
Results: Of 2,200 OR nurses, 1,551 (70.5%) observed at least one perioperative near-miss during the preceding 12 months, yet only 478 (30.8%) formally reported an event; the remaining 1,073 (69.2%) made no report, a nurse-level rather than event-level measure. Count discrepancies predominated (47.3%). In the principal model, perceived reporting-system function was the strongest correlate of formal reporting (aOR: 2.19 per 1-SD increase, 95% CI: 1.84–2.60), whereas greater barrier burden was inversely associated (0.67, 0.57–0.79); speaking-up and safety climate, which overlapped substantially, were not independently associated. The reporting-system association persisted after removal of the feedback item, which may reflect earlier reporting, and ordinal modeling of reported event volume reproduced both associations. Model A discrimination was acceptable (AUC 0.741). In the full sample, higher time pressure was associated with near-miss observation (1.14, 1.03–1.25), but this exploratory model discriminated poorly (AUC 0.600).
Conclusion: Perioperative near misses were commonly observed but seldom documented. These cross-sectional, self-reported associations cannot establish direction, but they are consistent with formal reporting depending on accessible, easy-to-use reporting systems and on reduced hierarchy-related and relational barriers, rather than on willingness to speak up alone.
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BibTeX
@article{li2026perceived,
title = {{Perceived reporting-system function, reporting barriers, and formal near-miss reporting among operating room nurses in China: a cross-sectional study}},
author = {PingPing Li and Lixue Zhang and Qin Cao and Xin Tan and Yanling Fan and Hui Hu},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1997500},
url = {https://doi.org/10.3389/fmed.2026.1997500},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Perceived reporting-system function, reporting barriers, and formal near-miss reporting among operating room nurses in China: a cross-sectional study
AU - PingPing Li
AU - Lixue Zhang
AU - Qin Cao
AU - Xin Tan
AU - Yanling Fan
AU - Hui Hu
PY - 2026
DA - 2026/10/13
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1997500
UR - https://doi.org/10.3389/fmed.2026.1997500
AB - Background: Near-miss reporting provides an early signal of perioperative system failure, yet formal reporting remains limited in operating rooms. This study examined correlates of formal near-miss reporting among operating room (OR) nurses at a two-campus tertiary hospital in China. Methods: In this cross-sectional study, 2,281 OR nurses returned a structured questionnaire and 2,200 were analyzed, covering self-reported 12-month near-miss observation and reporting, four safety-culture indices, workload, and professional characteristics. Exposures were purpose-built indices rather than validated scales. Multivariable logistic regression, with a prespecified parsimonious model as the principal specification, examined factors associated with formal reporting among observers (Model A) and, as an exploratory aim, near-miss observation in the full sample (Model B). Results: Of 2,200 OR nurses, 1,551 (70.5%) observed at least one perioperative near-miss during the preceding 12 months, yet only 478 (30.8%) formally reported an event; the remaining 1,073 (69.2%) made no report, a nurse-level rather than event-level measure. Count discrepancies predominated (47.3%). In the principal model, perceived reporting-system function was the strongest correlate of formal reporting (aOR: 2.19 per 1-SD increase, 95% CI: 1.84–2.60), whereas greater barrier burden was inversely associated (0.67, 0.57–0.79); speaking-up and safety climate, which overlapped substantially, were not independently associated. The reporting-system association persisted after removal of the feedback item, which may reflect earlier reporting, and ordinal modeling of reported event volume reproduced both associations. Model A discrimination was acceptable (AUC 0.741). In the full sample, higher time pressure was associated with near-miss observation (1.14, 1.03–1.25), but this exploratory model discriminated poorly (AUC 0.600). Conclusion: Perioperative near misses were commonly observed but seldom documented. These cross-sectional, self-reported associations cannot establish direction, but they are consistent with formal reporting depending on accessible, easy-to-use reporting systems and on reduced hierarchy-related and relational barriers, rather than on willingness to speak up alone.
SN - 2296-858X
ER -