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

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Major Adverse Cardiovascular Events; Cardiovascular Testing and Consultation Intensity
• Intervention / Treatment: Behavioral: Educational Clinical Decision Support Tool

• Study Type: Observational
• Enrollment (Estimated): 3000
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Phillip Wagner, MD; Phone Number: 14128418522; Email: pwagner6@jh.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• 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.

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 Outcome Measures

Outcome Measure	Measure Description	Time Frame
Major Adverse Cardiac Events (MACE)	Major Adverse Cardiac Events (MI, Cerebrovascular Accident, Unstable Arrhythmia, Myocardial Injury after Non-cardiac Surgery (MINS), Sudden Cardiac Death)	From presentation at the ED to 6 months post presentation
Time to OR	Time from Presentation at the ED to start of Surgery	0 hours to 5 days

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Collaborators: Patient-Centered Outcomes Research Institute; Agency For Healthcare Research & Quality
• Investigators: Principal Investigator: Phillip Wagner, MD, Johns Hopkins University

Study record dates

Study Major Dates

• Study Start (Estimated): December 1, 2026
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): June 1, 2028

Study Registration Dates

• First Submitted: July 2, 2026
• First Submitted That Met QC Criteria: July 2, 2026
• First Posted (Actual): July 9, 2026

Study Record Updates

• Last Update Posted (Actual): July 14, 2026
• Last Update Submitted That Met QC Criteria: July 13, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Perioperative Care; Preoperative Care; Clinical Decision Support Systems; Hospital Medicine; High Value Care; Testing intensity
• Other Study ID Numbers: IRB00554070; AHRQ-PCORI LHS P30 H5029772 (Other Grant/Funding Number: PCORI)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No