In most health care institutions, physician peer review is the primary method for maintaining and measuring physician competency and quality of care issues. However, many teaching hospitals do not have a method of tracking resident trainees' involvement in adverse cases. At the study institution, Code R was introduced as a measure to capture resident trainee involvement in the hospital-wide peer review process. The authors conducted a retrospective review of all peer review cases from January 2008 to December 2011 in an academic medical center and determined the quantity and type of resident errors that occurred compared to attending faculty. The Accreditation Council for Graduate Medical Education's core competencies served as a framework to categorize quality of care errors. The addition of Code R to the peer review process can be readily adopted by other institutions to help improve resident education, facilitate faculty supervision, and potentially improve patient safety.

Hospital medical errors that result in patient harm and death are largely identified as system failures. Most hospitals lack the tools to effectively identify most system errors. Traditional methods used in many hospitals, such as incident reporting (IR), departmental morbidity and mortality conferences, and root cause analysis committees, are often flawed by under reporting. We introduced the Code S designation into our hospital's ongoing physician peer review process as an additional and innovative way to identify system errors that contributed to adverse clinical outcomes. The authors conducted a retrospective review of all peer review cases from January 2008 to December 2011 and determined the quantity and type of system errors that occurred. System errors were categorized based on a modified 5M model which was adapted to reflect system errors encountered in healthcare. The Code S designation discovered 204 system errors that otherwise may not have previously been identified. The addition of the Code S designation to the peer review process can be readily adopted by other healthcare organizations as another tool to help identify, quantify and categorize system errors, and promote hospital-wide process improvements to decrease errors and improve patient safety.