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.

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.

An educational clinical decision support (CDS) tool integrated within the Epic electronic health record via the AgileMD platform that provides evidence-informed recommendations for perioperative cardiovascular evaluation of adults undergoing urgent inpatient surgery. The tool includes guidance on appropriate cardiovascular testing, specialty consultation, and institutional workflows, based on American Heart Association perioperative recommendations adapted for the inpatient setting through multidisciplinary consensus among hospital medicine, cardiology, anesthesiology, and perioperative medicine stakeholders. The CDS tool is advisory only, does not automate orders or replace clinician judgment, and clinicians may follow, modify, or disregard its recommendations based on individualized patient assessment.

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

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