Never Events
Never Events — formally Serious Reportable Events (SREs) — are egregious, largely preventable patient safety incidents that should never occur in a healthcare setting, for which CMS and most payers provide zero reimbursement for any resulting care.
What are Never Events?
The National Quality Forum (NQF) defines 29 Never Events across seven categories: surgical/invasive procedure events (wrong patient, wrong site, wrong procedure, retained foreign object, intraoperative death in an ASA Class 1 patient), product or device events (contaminated drug or device, use of device other than intended), patient protection events (discharge of incapacitated patient, patient elopement, patient suicide), care management events (death from medication error, iatrogenic hypoglycemia, intravenous air embolism, transfusion incompatibility), environmental events (patient burn, fall causing serious injury, electric shock from facility equipment), radiologic events (metal object in MRI field causing serious injury), and criminal events. CMS's non-payment policy means hospitals cannot bill Medicare — or the patient — for care directly resulting from a Never Event. Most states require mandatory public reporting of Never Events. The Joint Commission designates them as Sentinel Events, requiring a root cause analysis and corrective action plan. The average medical malpractice settlement for a Never Event exceeds $1.4 million, not counting remediation and investigation costs.
Why It Matters for Healthcare Analytics
Never Events have zero reimbursement, mandatory reporting obligations, and litigation exposure that collectively make them among the most financially and reputationally damaging events in healthcare. Tracking near-misses, incident reports, and precursor indicators — such as wrong-site verification non-compliance rates or medication reconciliation failure rates — provides the leading-indicator data needed to prevent Never Events before they occur.
How Vizier Tracks Never Events
Upload your incident report data and quality metrics, then ask "What is our trend in near-miss events by event category this quarter?" — Vizier identifies precursor patterns and tracks protocol compliance rates that serve as leading indicators for Never Event risk.