Near-miss events in surgical processes: healthcare workers’ experiences, risk factors, and prevention strategies

This is the authors' abstract. We don't add key points for this paper.

Aims: Complex workflows, time pressure, and communication problems within surgical teams pose significant risks to patient safety during surgical care processes. Near-miss events are critical incidents that reveal underlying safety problems within a system before patient harm occurs. This study aimed to evaluate healthcare workers’ experiences with near-miss events, associated risk factors, and perspectives on prevention strategies in surgical settings.Methods: This single-center, cross-sectional survey study included healthcare workers involved in surgical care processes at Elazığ Fethi Sekin City Hospital. Electronic questionnaires were administered between May 1 and 13, 2026. Data were analyzed using descriptive statistical methods. Results: A total of 221 healthcare workers participated in the study. Overall, 72.9% of the participants reported experiencing at least one near-miss event within the previous 12 months. Near-miss events were most frequently encountered in communication-related situations (44.8%), equipment/material problems (41.2%), and medication administration (29.4%). The main contributing factors were heavy workload (67.0%), distraction (55.7%), insufficient staffing (53.8%), time pressure (48.9%), fatigue or sleep deprivation (48.4%), and communication deficiencies (45.2%). In the single-choice analysis, heavy workload was the most prominent risk factor. Participants identified heavy workload, fear of blame, and time constraints as the main barriers to near-miss event reporting. Among the prevention strategies, the highest mean effectiveness score was assigned to reducing and balancing workload (3.63/5), followed by strengthening team communication and ensuring strict adherence to standardized protocols. Conclusion: Near-miss events in surgical processes are common and largely preventable patient safety issues. Reducing workload, strengthening team communication, and developing accessible and non-punitive reporting systems appear to be key strategies for improving surgical safety.