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

N/ANot Yet RecruitingNCT07692503

Johns Hopkins University3,000 enrolled

Overview

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 Type

OBSERVATIONAL

Enrollment

3,000

Conditions

Major Adverse Cardiovascular Events Cardiovascular Testing and Consultation Intensity

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

Rate of preoperative tests and consult orders

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

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

Secondary Outcomes

Major Adverse Cardiac Events (MACE)

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

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

Time to OR

Time from Presentation at the ED to start of Surgery

Time frame: 0 hours to 5 days