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

NCT07692503 | Not Yet Recruiting

• 2 other identifiers: IRB00554070AHRQ-PCORI LHS P30 H5029772
• Study Type: observational
• Target: 3,000
• Locations: 0 countries
• Sites: N/A

Brief 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.

Conditions

Major Adverse Cardiovascular Events; Cardiovascular Testing and Consultation Intensity

Keywords

Perioperative Care; Preoperative Care; Clinical Decision Support Systems; Hospital Medicine; High Value Care; Testing intensity

Outcome Measures

Primary Outcomes (1)

• Rate of preoperative tests and consult orders

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

  From Presentation to the ED to 6 months post presentation

Secondary Outcomes (2)

• Major Adverse Cardiac Events (MACE)

  From presentation at the ED to 6 months post presentation

• Time to OR

  0 hours to 5 days

Study Arms (2)

Cohort 2: Perioperative Cardiovascular Clinical Decision Support

Participants receive standard perioperative care in a health system where an educational clinical decision support tool is available within the Epic electronic health record. The CDS tool provides evidence-informed, multidisciplinary recommendations regarding perioperative cardiovascular testing, specialty consultation, and institutional workflows for urgent inpatient surgery. The tool is advisory only, does not automate orders or replace clinician judgment, and clinicians may override or disregard its recommendations at any time.

Cohort 1: Usual Care

Participants receive standard perioperative evaluation and management according to existing institutional practice prior to implementation of the clinical decision support tool. Clinical decisions regarding cardiovascular testing and specialty consultation are made at the discretion of the treating clinicians without access to the study CDS tool.

Interventions

Educational Clinical Decision Support Tool

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adults admitted through the Emergency Department to Johns Hopkins Hospital (JHH) Downtown or JHH Bayview Medical center above the age of 18 who require surgery during the stay.

You may qualify if:

• 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

You may not qualify if:

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

Sponsors & Collaborators

• Patient-Centered Outcomes Research Institute: collaborator
• Johns Hopkins University: lead
• Agency For Healthcare Research & Quality: collaborator

Study Officials

• Phillip Wagner, MD

  Johns Hopkins University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Phillip Wagner, MD

CONTACT

14128418522; pwagner6@jh.edu

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 2, 2026
• First Posted: July 9, 2026
• Study Start (Estimated): December 1, 2026
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): June 1, 2028
• Last Updated: July 14, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share