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.

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Key information

Conditions

Major Adverse Cardiovascular Events Cardiovascular Testing and Consultation Intensity

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Adults age 18 years or older
Admitted through the Emergency Department at Johns Hopkins Hospital or Johns Hopkins Bayview Medical Center Undergoing urgent inpatient surgery during the index hospitalization

Exclusion criteria

Elective surgeries,
Outpatient procedures,
Procedures followed only by observation or extended-stay recovery rather than inpatient admission,
Patients younger than 18 years old

Treatment and study plan

Primary outcomes

Rate of preoperative tests and consult orders

Time frame: From Presentation to the ED to 6 months post presentation

Cardiovascular Testing and Consultative Intensity. Rate of preoperative tests and consult orders per patient per admission.

Secondary outcomes

Major Adverse Cardiac Events (MACE)

Time frame: From presentation at the ED to 6 months post presentation

Major Adverse Cardiac Events (MI, Cerebrovascular Accident, Unstable Arrhythmia, Myocardial Injury after Non-cardiac Surgery (MINS), Sudden Cardiac Death)
Time to OR

Time frame: 0 hours to 5 days

Time from Presentation at the ED to start of Surgery

Study contacts

Contact information is provided by the study sponsor or research team.

Phillip Wagner, MD

CONTACT

[email protected]

14128418522

Sponsors and collaborators

Lead sponsor

Johns Hopkins University

Other

Collaborators

Agency For Healthcare Research & Quality
Patient-Centered Outcomes Research Institute

Registry information

Official study title

PERLHS: How Institutional Guidelines for Urgent Inpatient Surgeries Affect Intensity of Perioperative Cardiovascular Testing: A PrePost Study

Important dates

Study start: 2026
Primary completion: 2027
Study completion: 2028
First posted: Jul 9, 2026
Registry last updated: Jul 14, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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