Code R

Abstract

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.

Code S: Redesigning Hospital-Wide Peer Review Processes to Identify System Errors

“…In January 2008, we began assigning Code S as well as Code R (resident) designations to our peer reviews, a process we still utilize today. We selected this date range to coincide with our prior Code R study focusing on potential errors involving resident trainees [14]. The study was reviewed by the RUHS Institutional Review Board and was designated a quality improvement project, which did not require formal review.…”

“…In 2008, Riverside University Health System -Medical Center (RUHS-MC) modified its hospitalwide physician peer review process to better capture system errors, an approach that RUHS-MC still uses today. All physician peer reviewers were required to report system errors that may have contributed to an unexpected or adverse event [14]. Code S (for "Systems") designation was given to physician peer review cases that identified a contributing system error(s).…”