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  1. Article ; Online: A Nonintrusive, Normative Nudge Intervention to Reduce Four Low-Value Tests in a Large Safety Net System.

    Cho, Hyung J / Poeran, Jashvant / Alaiev, Daniel / Tsega, Surafel / Israilov, Sigal / Krouss, Mona

    Journal of general internal medicine

    2023  Volume 38, Issue 13, Page(s) 3086–3089

    MeSH term(s) Humans ; Safety-net Providers ; Unnecessary Procedures
    Language English
    Publishing date 2023-07-24
    Publishing country United States
    Document type Letter
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-023-08339-5
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    Zs.A 2205: Show issues Location:
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  2. Article ; Online: Things We Do for No Reason™: Tumor markers CA125, CA19-9, and CEA in the initial diagnosis of malignancy.

    Israilov, Sigal / Cho, Hyung J / Krouss, Mona

    Journal of hospital medicine

    2021  Volume 17, Issue 4, Page(s) 303–305

    MeSH term(s) Biomarkers, Tumor ; CA-125 Antigen ; CA-19-9 Antigen ; Carcinoembryonic Antigen ; Humans ; Neoplasms/diagnosis
    Chemical Substances Biomarkers, Tumor ; CA-125 Antigen ; CA-19-9 Antigen ; Carcinoembryonic Antigen
    Language English
    Publishing date 2021-08-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2233783-0
    ISSN 1553-5606 ; 1553-5592
    ISSN (online) 1553-5606
    ISSN 1553-5592
    DOI 10.12788/jhm.3645
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  3. Article ; Online: A Survey Assessing the Vaping Habits of Patients Undergoing Surgery.

    Feinstein, Max M / Schlosberg, Ira / Israilov, Sigal / Sison, Matthew / Katz, Daniel

    Respiratory care

    2022  Volume 67, Issue 10, Page(s) 1332–1334

    MeSH term(s) Electronic Nicotine Delivery Systems ; Habits ; Humans ; Surveys and Questionnaires ; Vaping
    Language English
    Publishing date 2022-06-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.09830
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  4. Article ; Online: In reply to "inpatient folate testing at an academic cancer center: single-year experience".

    Israilov, Sigal / Dimitrova, Irina / Cho, Hyung J

    Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

    2020  Volume 28, Issue 11, Page(s) 5051–5052

    MeSH term(s) Folic Acid ; Humans ; Inpatients ; Neoplasms
    Chemical Substances Folic Acid (935E97BOY8)
    Language English
    Publishing date 2020-03-24
    Publishing country Germany
    Document type Letter ; Comment
    ZDB-ID 1134446-5
    ISSN 1433-7339 ; 0941-4355
    ISSN (online) 1433-7339
    ISSN 0941-4355
    DOI 10.1007/s00520-020-05418-9
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    Zs.A 3697: Show issues Location:
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  5. Article ; Online: How Co-Creation Helped Address Hierarchy, Overwhelmed Patients, and Conflicts of Interest in Health Care Quality and Safety.

    Israilov, Sigal / Cho, Hyung J

    AMA journal of ethics

    2017  Volume 19, Issue 11, Page(s) 1139–1145

    Abstract: Co-creation is health professionals' and systems' development of health care together with patients and families. Such collaborations yield an exchange of values, ideas, and priorities that can individualize care for each patient. Co-creation has been ... ...

    Abstract Co-creation is health professionals' and systems' development of health care together with patients and families. Such collaborations yield an exchange of values, ideas, and priorities that can individualize care for each patient. Co-creation has been discussed interchangeably with co-production and shared decision making; this article explores co-creation through the lens of quality improvement. Although there are barriers to co-creation including physician autonomy, patient overwhelm, and conflicts of interest, co-creation has been shown to promote patient engagement, peer learning, and improved outcomes. Further research is needed in co-creation for systems improvement.
    MeSH term(s) Conflict of Interest ; Cooperative Behavior ; Decision Making ; Humans ; Learning ; Patient Participation ; Physicians ; Power (Psychology) ; Quality Improvement ; Quality of Health Care
    Language English
    Publishing date 2017-11-01
    Publishing country United States
    Document type Journal Article
    ISSN 2376-6980
    ISSN (online) 2376-6980
    DOI 10.1001/journalofethics.2017.19.11.mhst1-1711
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  6. Article ; Online: Engagement in Eliminating Overuse: The Argument for Safety and Beyond.

    Pasik, Sara / Korenstein, Deborah / Israilov, Sigal / Cho, Hyung J

    Journal of patient safety

    2018  Volume 16, Issue 4, Page(s) 313–315

    Language English
    Publishing date 2018-04-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2394324-5
    ISSN 1549-8425 ; 1549-8417
    ISSN (online) 1549-8425
    ISSN 1549-8417
    DOI 10.1097/PTS.0000000000000487
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    Zs.A 6583: Show issues Location:
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  7. Article ; Online: Nudging to select single-lumen over multiple-lumen peripherally inserted central catheters (PICCs) in a large safety net system - CORRIGENDUM.

    Alaiev, Daniel / Krouss, Mona / Israilov, Sigal / Musser, Lara / Talledo, Joseph / Mestari, Nessreen / Uppal, Amit / Madaline, Theresa / Cohen, Gabriel / Bravo, Nathaniel / Cervantes, Marialeah / Contractor, Daniel / Manchego, Peter Alacron / Chandra, Komal / Zaurova, Milana / Tsega, Surafel / Cho, Hyung J

    Infection control and hospital epidemiology

    2023  , Page(s) 1

    Language English
    Publishing date 2023-04-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2023.80
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    Zs.A 1714: Show issues Location:
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  8. Article ; Online: SEE the DIFFerence: Reducing unnecessary C. difficile orders through clinical decision support in a large, urban safety-net system.

    Krouss, Mona / Israilov, Sigal / Alaiev, Daniel / Tsega, Surafel / Talledo, Joseph / Chandra, Komal / Zaurova, Milana / Manchego, Peter Alacron / Cho, Hyung J

    American journal of infection control

    2022  Volume 51, Issue 7, Page(s) 786–791

    Abstract: Background: Clostridioides difficile (C. difficile) is a hospital-acquired infection. Overtesting for C. difficile leads to false positive results due to a high rate of asymptomatic colonization, resulting in unnecessary and harmful treatment for ... ...

    Abstract Background: Clostridioides difficile (C. difficile) is a hospital-acquired infection. Overtesting for C. difficile leads to false positive results due to a high rate of asymptomatic colonization, resulting in unnecessary and harmful treatment for patients.
    Methods: This was a quality improvement initiative to decrease the rate of inappropriate C. difficile testing across 11 hospitals in an urban, safety-net setting. Three best practice advisories were created, alerting providers of recent laxative administration within 48 hours, a recent positive test within 14 days, and a recent negative test within 7 days. The outcome measures were the number of C. difficile tests per 1,000 patient days, as well as the rate of hospital onset C. difficile infection was compared pre- and post-intervention. The process measures included the rate of removal of the C. difficile test from the best practice advisory, as well as the subsequent 24-hour re-order rate.
    Results: The number of C. difficile tests decreased by 27.3% from 1.1 per 1,000 patient days preintervention (May 25, 2020-May 24, 2021) to 0.8 per 1,000 patient days postintervention, (May 25, 2021-March 25, 2022), P < .001. When stratified by hospital, changes in testing ranged from an increase of 12.5% to a decrease of 60%. Analysis among provider type showed higher behavior change among attendings than compared to trainees or advanced practice providers. There was a 12.1%, nonsignificant decrease in C. difficile rates from preintervention, 0.33 per 1,000 patient days compared to postintervention, 0.29 per 1,000 patient days, P=.32.
    Conclusions: Using only an electronic health record intervention, we successfully decreased C. difficile orders after 72 hours of admission in a large, safety-net system. Variation existed among hospitals and by provider type.
    MeSH term(s) Humans ; Clostridioides difficile ; Clostridioides ; Decision Support Systems, Clinical ; Clostridium Infections/diagnosis ; Clostridium Infections/prevention & control ; Clostridium Infections/drug therapy ; Hospitalization
    Language English
    Publishing date 2022-11-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392362-9
    ISSN 1527-3296 ; 0196-6553
    ISSN (online) 1527-3296
    ISSN 0196-6553
    DOI 10.1016/j.ajic.2022.11.003
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    Zs.A 1773: Show issues Location:
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  9. Article ; Online: Choosing wisely initiative for reducing urine cultures for asymptomatic bacteriuria and catheter-associated asymptomatic bacteriuria in an 11-hospital safety net system.

    Krouss, Mona / Alaiev, Daniel / Shin, Da Wi / Talledo, Joseph / Israilov, Sigal / Chandra, Komal / Zaurova, Milana / Manchego, Peter Alacron / Tsega, Surafel / Cohen, Gabriel / Bravo, Nathaniel / Kupferman, Tania / Madaline, Theresa / Cho, Hyung J

    American journal of infection control

    2023  Volume 51, Issue 4, Page(s) 461–465

    Abstract: Background: Treatment of asymptomatic bacteriuria (ASB) is common. Overtreatment of ASB leads to harm, including adverse effects from antibiotics, antibiotic resistance, and increased length of stay.: Methods: This quality improvement initiative ... ...

    Abstract Background: Treatment of asymptomatic bacteriuria (ASB) is common. Overtreatment of ASB leads to harm, including adverse effects from antibiotics, antibiotic resistance, and increased length of stay.
    Methods: This quality improvement initiative targeted inappropriate urine cultures across 11 hospitals in a safety-net setting. A mandatory prompt for appropriate indications for urine culture orders and a best practice advisory (BPA) for urine culture on patients with urinary catheters were created. Urine culture ordering was compared pre-intervention (6/2020 to 10/2021) to post-intervention (12/2021 to 8/2022). Catheter associated urinary tract infections (CAUTI) was compared pre- and post-intervention. Variation in urine culture ordering and CAUTI rates in hospitals were assessed.
    Results: Inpatient urine cultures decreased by 20.9% (p<0.001). Inpatient urine cultures on patients with urinary catheters decreased by 21.6% (p<0.001). CAUTI rates remained unchanged post-intervention. High variation in urine culture ordering and CAUTI rates was seen among hospitals.
    Conclusions: This initiative successfully decreased urine cultures in a large, safety-net system. Further study is needed in assessing variation among hospitals.
    MeSH term(s) Humans ; Bacteriuria/diagnosis ; Bacteriuria/drug therapy ; Bacteriuria/etiology ; Urinary Tract Infections/etiology ; Anti-Bacterial Agents/therapeutic use ; Hospitals ; Urinary Catheters/adverse effects ; Catheter-Related Infections/etiology
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-03-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392362-9
    ISSN 1527-3296 ; 0196-6553
    ISSN (online) 1527-3296
    ISSN 0196-6553
    DOI 10.1016/j.ajic.2023.01.005
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  10. Article ; Online: Choosing Wisely and reducing the simultaneous ordering of erythrocyte sedimentation rate and C-reactive protein testing in a large safety net system.

    Cho, Hyung J / Talledo, Joseph / Alaiev, Daniel / Israilov, Sigal / Chandra, Komal / Tsega, Surafel / Garcia, Mariely / Shin, Da Wi / Zaurova, Milana / Alarcon Manchego, Peter / Krouss, Mona

    American journal of clinical pathology

    2023  Volume 160, Issue 6, Page(s) 585–592

    Abstract: Objectives: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are commonly used inflammatory markers. C-reactive protein is more sensitive and specific for monitoring acute inflammation. However, it is commonly co-ordered with ESR ... ...

    Abstract Objectives: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are commonly used inflammatory markers. C-reactive protein is more sensitive and specific for monitoring acute inflammation. However, it is commonly co-ordered with ESR despite recommendations against this. Our objective was to reduce unnecessary ESR orders and ESR/CRP co-ordering rates across a large safety net health system.
    Methods: This was a quality improvement project that used a quasi-experimental pre- and postintervention interrupted time-series regression analysis. Patients with a positive COVID-19 test were excluded. We designed a nonintrusive, normative nudge within the ESR order that recommended against co-ordering ESR and CRP. In addition, a best practice advisory triggered when ESR and CRP were simultaneously ordered. The outcome measures were ESR order rates per 1000 patient days in the inpatient setting and per 1000 patient encounters in the outpatient setting, as well as ESR/CRP co-ordering rates.
    Results: Inpatient ESR orders decreased from 12.02 preintervention to 5.61 per 1000 patient days (-53.3%, P < .001). Outpatient ESR orders decreased from 6.09 to 4.07 per 1000 patient encounters (-33.2%, P < .001). Relative co-ordering rates decreased by 50%.
    Conclusions: This electronic health record initiative successfully reduced ESR testing across 11 hospitals and 70 ambulatory centers in a safety net setting.
    MeSH term(s) Humans ; C-Reactive Protein/analysis ; Blood Sedimentation ; Biomarkers ; Electronic Health Records
    Chemical Substances C-Reactive Protein (9007-41-4) ; Biomarkers
    Language English
    Publishing date 2023-09-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2944-0
    ISSN 1943-7722 ; 0002-9173
    ISSN (online) 1943-7722
    ISSN 0002-9173
    DOI 10.1093/ajcp/aqad093
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