How Doctor Report Cards Cut Unneeded Antibiotics in the ER

Antibiotic resistance is a growing threat. Hospitals must create their own rules for treating common infections. These rules are called facility-specific guidelines. They help doctors pick the right drug. But having rules is not enough. Doctors have to follow them.

At a large military hospital the emergency department writes the most antibiotic prescriptions. Urinary tract infections and skin infections top the list. For years the ER staff rarely followed the hospital's own UTI guidelines. The guidelines were easy to find. Still adherence stayed low.

Researchers tried a new approach. They gave each doctor a monthly report card. The card showed how that doctor's prescribing compared to their peers. It was private feedback. No names were shared publicly. The idea was simple. People often change behavior when they see how they stack up against colleagues.

The study ran from July 2023 through June 2024. It used a stepped design. That means the intervention rolled out in stages. Urinary tract infections were the main focus. Skin infections were also tracked. Pneumonia cases served as a control group. No report cards went out for pneumonia.

Early data suggests the report cards worked. Doctors who saw their peer rankings started following UTI guidelines more often. Broad-spectrum antibiotic use dropped. Those drugs kill more bacteria types and drive resistance faster. The control syndrome showed no similar change. This hints that peer comparison not just time or other factors drove the improvement.