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

2026년 7월 13일 업데이트: Johns Hopkins University

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.

연구 개요

상태

아직 모집하지 않음

정황

개입 / 치료

행동: Educational Clinical Decision Support Tool

연구 유형

관찰

등록 (추정된)

3000

단계

해당 없음

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 연락처

이름: Phillip Wagner, MD
전화번호: 14128418522
이메일: pwagner6@jh.edu

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

성인
고령자

건강한 자원 봉사자를 받아들입니다

아니

샘플링 방법

비확률 샘플

연구 인구

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.

설명

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

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

그룹/코호트 수

코호트 및 개입

그룹/코호트
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.

그룹/코호트

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.

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정	측정값 설명	기간
Rate of preoperative tests and consult orders 기간: 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.	From Presentation to the ED to 6 months post presentation

2차 결과 측정

결과 측정	측정값 설명	기간
Major Adverse Cardiac Events (MACE) 기간: 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)	From presentation at the ED to 6 months post presentation
Time to OR 기간: 0 hours to 5 days	Time from Presentation at the ED to start of Surgery	0 hours to 5 days

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

Johns Hopkins University

협력자

Patient-Centered Outcomes Research Institute

Agency For Healthcare Research & Quality

수사관

수석 연구원: Phillip Wagner, MD, Johns Hopkins University

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작 (추정된)

2026년 12월 1일

기본 완료 (추정된)

2027년 12월 1일

연구 완료 (추정된)

2028년 6월 1일

연구 등록 날짜

최초 제출

2026년 7월 2일

QC 기준을 충족하는 최초 제출