ASPs using peer pressure in EDs!

Reviewed by: Cynthia T. Nguyen, PharmD; University of Chicago Medicine

A peer comparison intervention reduced unnecessary discharge antibiotic prescriptions in the emergency department. A single-center VA study compared the discharge oral antibiotic prescribing rate before and after peer comparison. Individual emails were sent describing each ED clinician’s ‘Antibiotic Index,” defined as the discharge oral antibiotic prescribing rate normalized by the total number of ED visits. Monthly antibiotic prescriptions decreased throughout the baseline and intervention periods and the rate of reduction was numerically higher after the intervention (10.4 versus 0.46 prescriptions per 1000 ED visits, p=0.07). In a subgroup analysis of randomly selected prescriptions, there was a significant reduction in unnecessary prescriptions during the intervention period (55.6% versus 38.7%, p=0.003). 


Buehrle DJ, Phulputo RH, Wagener MM, Clancy CJ, Decker BK. Decreased Overall and Inappropriate Antibiotic Prescribing in a Veterans Affairs Emergency Department Following A Peer-Comparison-Based Stewardship Intervention. Antimicrob Agents Chemother. 2020 Oct 5:AAC.01660-20. 

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