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

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

Status

Not yet recruiting

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT07692503

Enrollment

3000

Registered

2026-07-09

Start date

2026-12-01

Completion date

2028-06-01

Last updated

2026-07-14

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Cardiovascular Testing and Consultation Intensity, Major Adverse Cardiovascular Events

Keywords

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

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.

Interventions

None listed

Study design

Observational model

COHORT

Time perspective

PROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

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

Design outcomes

Primary

Measure	Time frame	Description
Rate of preoperative tests and consult orders	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

Measure	Time frame	Description
Major Adverse Cardiac Events (MACE)	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	0 hours to 5 days	Time from Presentation at the ED to start of Surgery

Contacts

CONTACTPhillip Wagner, MD

pwagner6@jh.edu14128418522

PRINCIPAL_INVESTIGATORPhillip Wagner, MD

Johns Hopkins University

Outcome results