“ A near miss” or “close call” -WHO

“ A near miss” or “close call” is a serious error or mishap that has the potential to cause an adverse event, but fails to do so by chance or because it was intercepted. It is assumed (though not proven) that the underlying systems failures for near misses are the same as for actual adverse events. Therefore, understanding their causes should lead to systems design changes that will improve safety.A key advantage of a near miss reporting system is that because there has been no harm the reporter is not at risk of blame or litigation. On the contrary, he or she may be deserving of praise for having intercepted an error and prevented an injury. This positive aspect of reporting of near misses, has led some to  recommend near miss systems for internal reporting systems within health-care organizations or other
health-care facilities where a blaming culture persists. However, any hospital that is serious about learning will also invite reports of near misses.