How Institutional Guidelines for Urgent Inpatient Surgeries Affect Intensity of Perioperative Cardiovascular Testing

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.

NCT Number	NCT07692503
Lead Sponsor	Johns Hopkins University Collaborators: Agency For Healthcare Research & Quality, Patient-Centered Outcomes Research Institute
Conditions	Major Adverse Cardiovascular Events, Cardiovascular Testing and Consultation Intensity
Enrollment	3,000 participants
Start Date	2026-12
Primary Completion	2027-12 (estimated)
Study Completion	2028-06 (estimated)
Updated on ClinicalTrials.gov	2026-07-14