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How Institutional Guidelines for Urgent Inpatient Surgeries Affect Intensity of Perioperative Cardiovascular Testing
Sponsor: Johns Hopkins University
Summary
This study will evaluate the impact of implementing an educational clinical decision support (CDS) tool designed to guide perioperative cardiovascular evaluation for adults undergoing urgent inpatient surgery. The CDS tool, integrated within the Epic electronic health record via AgileMD, provides evidence-informed recommendations regarding perioperative cardiac testing and specialty consultation based on American Heart Association guidance and multidisciplinary institutional consensus. The investigators will conduct a retrospective and prospective pre-post observational cohort study comparing perioperative cardiovascular testing intensity, consultation patterns, time to operating room, and clinical outcomes before and after implementation of the tool among adult patients admitted through the emergency department at Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center who undergo urgent surgery. Data will be obtained from the Core for Clinical Research Data Acquisition (CCDA) and Epic electronic health record, with case-level chart review performed as needed to validate rare outcomes such as major adverse cardiac events.
Official title: PERLHS: How Institutional Guidelines for Urgent Inpatient Surgeries Affect Intensity of Perioperative Cardiovascular Testing: A PrePost Study
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
3000
Start Date
2026-12
Completion Date
2028-06
Last Updated
2026-07-09
Healthy Volunteers
No
Interventions
Educational Clinical Decision Support Tool
An educational clinical decision support (CDS) tool integrated within the Epic electronic health record via the AgileMD platform that provides evidence-informed recommendations for perioperative cardiovascular evaluation of adults undergoing urgent inpatient surgery. The tool includes guidance on appropriate cardiovascular testing, specialty consultation, and institutional workflows, based on American Heart Association perioperative recommendations adapted for the inpatient setting through multidisciplinary consensus among hospital medicine, cardiology, anesthesiology, and perioperative medicine stakeholders. The CDS tool is advisory only, does not automate orders or replace clinician judgment, and clinicians may follow, modify, or disregard its recommendations based on individualized patient assessment.