205. Reduction of Antibiotic Prescribing within a Veterans Affairs Emergency Department through Peer Comparison
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall

Reduction in inappropriate antibiotic use in Emergency Departments can have a major impact on overall outpatient antibiotic use. Peer comparison has been used to successfully reduce antibiotic prescribing in primary care clinics at our hospitals and others.


An educational session was held for Emergency Department physicians (EDPs) at VA Pittsburgh. EDPs were then sent monthly comparison charts of their oral antibiotic prescribing rates as well as peer rates. An intervention period of January–March 2018 was compared with a seasonal baseline of the same months in 2017. A random sample of oral antibiotic prescriptions was reviewed in-depth for adherence to consensus guidelines.


During the baseline period of Jan-March 2017, 427 oral antibiotic prescriptions were written by 16 EDPs during a total of 3722 patient encounters, with an antibiotic prescription index of 114.1 per 1000 patient encounters. In comparison, 301 prescriptions were written by the same 16 EDPs during 4874 patient encounters in the post-intervention period (Jan-March 2018), with an antibiotic prescription index of 61.7 per 1000 patient encounters (45.9% decrease; p<0.0001)). Azithromycin and fluoroquinolone indices decreased from 29.6 to 16.6 (43.9%; p<0.0001) and 10.5 to 8.0 (23.8%; p=0.2) per 1000 encounters, respectively. Among randomly reviewed prescriptions, there was a trend toward a decrease in inappropriate antibiotic prescribing from 47.6% (20/42) to 30% (9/30) (p=0.15). Among the randomly reviewed prescriptions that were indicated, there were non-significant decreases in the percentages of guideline-discordant agents (22.7% (5/22) to 14.2% (3/21; p=0.7)), and in the percentage of guideline-concordant agents given for a guideline-discordant duration (29.4% (5/17) to 22.2% (4/18; p=0.7)). Likewise, there were non-significant decreases in inappropriate antibiotic prescribing for URIs (94.1% (16/17) to 75% (3/4); p=0.35).


In an emergency department setting, initial education followed by monthly peer comparison of overall antibiotic prescribing rates significantly reduced overall antibiotic prescribing. Ongoing data review will reveal if trends toward reductions in inappropriate antibiotic prescribing are significant.

Rameez Phulpoto, MD1, Nathan R. Shively, MD2, Deanna J. Buehrle, PharmD3, Cornelius J. Clancy, M.D.1,3 and Brooke K. Decker, MD, CIC1,4, (1)Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, (2)Infectious Diseases, Division of Infectious Disease Allegheny Health Network, Pittsburgh, PA, (3)Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, (4)Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA


R. Phulpoto, None

N. R. Shively, None

D. J. Buehrle, None

C. J. Clancy, None

B. K. Decker, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.