Perceived reporting-system function, reporting barriers, and formal near-miss reporting among operating room nurses in China: a cross-sectional study

BackgroundNear-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.MethodsIn 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).ResultsOf 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).ConclusionPerioperative 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.