Guide to Surgery at Health & Wellness - Akron General Medical Center

YourGuide toSurgery4125 Medina Road, Suite 104Akron, OH 44333330-665-8120www.akrongeneral.org

Welcome to The Surgery CenterWelcome to The Surgery Center at Akron General Health& Wellness.Thomas L. “Tim” Stover, MDThe Surgery Center is a freestanding, outpatient surgeryfacility. In one day, you can have high-quality surgical careand recover in the convenience of your home that evening.Our highly skilled staff, using state-of-the-art equipment,provides you with the excellent medical attention youdeserve. The Surgery Center is a joint venture with AkronGeneral Medical Center and its physicians.We hope you find this booklet helpful. It contains important information aboutyour surgery. The goal of The Surgery Center staff is to make your visit as pleasantas possible. If you have a particular concern, please mention it to your nurseor bring it to the attention of the Director of Nursing at The Surgery Center bycalling 330-665-8122.Thank you for choosing The Surgery Center at Akron General Health & Wellness.We hope your experience here is a pleasant one. On behalf of Akron General,I wish you a speedy recovery.Sincerely,Thomas L. “Tim” Stover, MD, President, Outpatient Services, Akron GeneralPlease Pre-RegisterFor all Surgery Center pre-surgical tests and procedures, call330-665-8032, Monday - Friday, from 6 a.m. - 5 p.m.When calling, please have your insurance information available.The Surgery Center will bill your insurance company based on theinformation you have provided and will copy your insurance cardupon arrival to the facility. Please provide a copy of your LivingWill or Durable Power of Attorney with the insurance information.Tobacco Free Policy: Smoking and the use of tobacco productsare prohibited any place on the Health & Wellness Center campusincluding vehicles.

Guiding You Through YourSurgery/ProcedureYour health and comfort are important to us. We have prepared this bookletwith information and instructions about your pre-surgical testing and surgery.Name: ____________________________________________________________________________Day of Pre-Surgical Testing:Date: _____________ Day: _____________ Time: _____________ AM/PMDay of Surgery/Procedure:Date: _____________ Day: _____________ Time: _____________ AM/PMArrival Time: ____________________________________________________________________________• If your pre-surgical testing and/or surgery date needs to be re-scheduled,please notify your surgeon.• Within 30 days of your surgery, your surgeon may determine – based onyour health history – that you need pre-surgical testing. Your surgeon will callThe Surgery Center to schedule the appointment and will indicate the teststo be completed prior to your surgery (to be scheduled with Surgery).• If pre-surgical testing is not required by your surgeon, you will be receivinga call from The Surgery Center staff approximately one week before yourscheduled surgery date. Your health history, medications and pre-operativeinstructions will be reviewed. If you are unavailable at the time of the call,please return the call to 330-665-8124 between 6:30 a.m. and 2:30 p.m.,Monday through Friday, at your earliest convenience.• Testing will be completed at The Surgery Center at Akron General Health& Wellness, suite 104, located at 4125 Medina Road in west Akron. Pleaserefer to the map on the inside back page of this booklet.• Park in the designated lot at the west end of the Health & WellnessCenter - West where the overhead sign reads “SURGERY.”• For directions to the Health & Wellness Center – West, call330-344-2900 (see inside back page of this booklet). 3

Preparing for Your Surgery –Important Information• It is important to inform your surgeon if you develop a sore throat,rash, flu or elevated temperature, or if you have been exposed to acontagious disease prior to your surgery.• Any breaks in the skin integrity near the operative site must bereported to your surgeon. This includes cuts, scratches, insect bitesand poison ivy.• Please DO NOT shave the operative site! The Surgery Center staff willprepare you for your surgery as ordered by your physician.• If you are having surgery on your knee or foot, please contactyour surgeon regarding the need for crutches post-operatively, ifnot already discussed. This issue will need to be addressed priorto the day of surgery.• For your personal safety you will not be allowed to drive or take ataxi home alone. Please make arrangements for someone to driveyou or accompany you home in a taxi.• If you take daily prescription medications, consult your primary carephysician or follow the instructions given by The Surgery Center staff asto what medications should be taken the day of surgery.• If you have diabetes and/or an insulin pump, please obtain day ofsurgery instructions from the physician that manages your diabetes.Day Prior to YourSurgery/Procedure• DO NOT drink alcoholic beverages for 24 hours before your surgery/procedure. Alcohol may cause an undesired reaction when mixed withanesthetic agents or other drugs.4

• Please DO NOT smoke before or after your surgery. Smoking may causeanesthetic problems and increase carbon monoxide in the blood stream.Nicotine also interferes with healing.• DO NOT eat or drink after midnight the night before your surgery/procedure unless otherwise instructed by your physician (thisincludes water).• All females with childbearing potential will be required to bring a firstmorningurine on the day of surgery for pregnancy testing. You mayuse a clear leak-proof container labeled with your name.• If applicable, complete your prep as instructed by your physician.• Practice coughing and deep breathing exercises and pain controltechniques (see page 10).• Please plan to arrive two hours before your scheduled surgery time. Ifyour pre-surgical testing was completed on an earlier date, you mayarrive 90 minutes before your surgery scheduled time.• Endoscopy patients should arrive 90 minutes prior to scheduledprocedure time.• The arrival times above allow time for you to have any additionalregistration/clerical concerns addressed, laboratory tests done, talkwith anesthesia personnel and be prepared for your surgery by ournursing staff.• You will NOT be able to drive after your surgery/procedure. Prepareto provide a phone number of your driver, who is immediately availableto drive you home.• Perform your normal morning routines such as showering and brushingyour teeth.• Wear comfortable loose-fitting clothes. DO NOT bring any valuables(cash, checks, credit cards, cell phones, etc.). You may not wear anyjewelry (including body piercing), wigs, hairpins, glasses, contact lenses,false eyelashes, nail polish or make-up in the operating room.5

Day of Surgery (On Arrival)• Upon arrival, please enter the Health & Wellness Center at The SurgeryCenter entrance located at the west end of the building and proceed tosuite 104. Sign in with the receptionist. As surgery times and preparationsfor surgery vary with each patient, you may be taken out of order inwhich you registered. Please have your current insurance card, driver’slicense or photo ID available.• Unfortunately, emergencies or cancellations cannot be predicted andcan affect your estimated surgery time. If this happens to you, we ask foryour patience. The surgical staff will make every attempt to keep you andyour family informed of changes as they occur.• The Surgery Center now offers a patient tracking system to provideprompt and confidential patient updates for family members and friendsin our Surgery Waiting Room. To ensure patient confidentiality, a special,individualized one-day code is assigned to each patient.• For friends and/or family members accompanying you, SubwayRestaurant is located at the east end of the building and serves foodfrom 7 a.m. to 8 p.m.• Because of limited space, we ask that there be no more than two visitorsper patient. Additional visitors are welcome in the main lobby. Childrenunder the age of 12 are not permitted in the Pre-Surgical Unit. LifeStylesmay be contacted at 330-665-8134 for babysitting services between thehours of 8 a.m. and 8:30 p.m. We recommend you contact LifeStylesdirectly and prior to the scheduled surgery/procedure to make sureservices are available.• Cell phone usage is prohibited anywhere in The Surgery Center.• There are multiple checks in place to confirm your surgical site tominimize the risk of errors. If your surgery involves the left or rightside, your doctor will initial the correct operative site with a markingpen on the day of surgery.6

Before the Procedure• Your temperature, pulse and blood pressure will be taken, along withan interview assessment. A nurse will review any allergies and thespecific names of any medications you are taking.• You will be asked to change into a gown.• Dentures, glasses and other prostheses will be removed in thepre-operative area and returned to you in the recovery room.• The nurse may start an intravenous line to administer fluids andmedication during your procedure.Understanding Your Procedure• Make sure you understand what will happen if you are having aprocedure. Research has shown that patients who are informed abouttheir procedure can better work with their doctors to make the rightdecisions. Your doctor and you will have discussed the possible benefitsand risks involved in the procedure you are about to have.AnesthesiaOn the day of your surgery, members of the Anesthesia Department willreview you health and anesthesia history with you. The final decision as tothe anesthetic technique to be used will be decided at that time. You willbe scheduled for one of the following types of anesthesia:• General anesthesia causes you to be asleep (unconscious) during thesurgical procedure.• Regional anesthesia (epidural, spinal, axillary block) causes the area ofthe body, which includes the surgery site, to be numb.• Monitored anesthesia care (MAC) combines local anesthesia at thesurgical site (administered by the surgeon) and significant intravenoussedation and monitoring provided by the anesthesia personnel.• Blocks and medications may be used alone or in combination forpost-op pain control.7

In addition to the preceding types of anesthesia, there are two other formsthat may be used:• Local anesthesia is performed by the surgeon at the surgical site.• Moderate sedation is given at the discretion of the doctor andadministered by the registered nurse.After Your SurgeryYou will be taken to Phase 1 recovery room, where an RN will closely observeyou until you are able to sit up and take fluids. Then, you will be transferredto Phase 2 recovery room where you can relax in a recliner (lounge chair)until discharge. Small snacks will be available for you during this period.• Family or companions may join you in Phase 2 recovery.• The nurse will review your discharge instructions with you and yourcompanion at this time.• For those patients requiring additional time, your physician may arrangefor an extended/overnight stay in our Short-Term Observation Unit(STO), located in the Emergency Department directly adjacent toThe Surgery Center.After Your ProcedureYou will be given medications during your surgery/procedure that mayaffect your ability to remember what happened. Therefore, you may notrecall that your doctor and anesthesiologist talked with you after yourprocedure. Your family will be informed when your procedure is over.You may call your doctor or discuss the results at the first office visit.8

Home Care InstructionsWe care about your safety and comfort after surgery and urge you to followthese instructions regarding your recovery, unless otherwise instructed byyour doctor.• To control your pain, your doctor may give you a prescription forpain control.• Arrangements must be made prior to your surgery for someone todrive you home when you are ready to leave recovery. We prefer thatperson stay in The Surgery Center during your surgery, if possible. Ifnot, a name and phone number needs to be given to the receptionistwhen you check in. At that time, the person driving you home will betold approximately what time they will need to return.• Arrange for someone to stay with you for 24 hours after surgery.Your surgery may be canceled if no one is available to stay with you.• Progress gradually from fluids to solid foods.• Do not drink alcoholic beverages for at least 24 hours after surgery.• Take deep breaths to keep your lungs clear.• Move around according to your instructions.• Do not drive or operate machinery for 24 hours after surgery or if takingnarcotic pain medications.• Do not make important decisions or sign any important documentswithin 24 hours after surgery.You will receive a patient satisfaction survey upon discharge. Please help usevaluate our care by completing and returning the survey. We appreciateany suggestions you may have to improve patient and family care.If you have any questions, please refer to your instructions or call your doctor.9

Additional Home CareInstructions After Your SurgeryCoughing and Deep BreathingCoughing and deep breathing will help prevent pneumonia, decrease pain,improve the oxygen in your blood and remove the anesthetic from yourbody. You will be asked to take three or four deep breaths followed byone cough, 10 times every hour. Deep breathing and coughing can beaccomplished in a sitting or lying down position.• Breathe out normally.• Clasp your hands over your abdomen.• Breathe in until you feel your abdomen push out.• Breathe out slowly.• Rest a few seconds.• Repeat three to four times then cough 1-2 times.• Relax and breathe normally.• Repeat technique 10 times every hour.ActivityMovement and walking will decrease the chance of blood clots forming inyour legs. You will be taught ankle pumps. When lying down, point yourtoes on both feet to you chin and stretch them out by pushing them awayfrom your chin. Do this 10 times an hour. Flex your knees. Do not lie in oneposition. You may wake up with pumps on your feet or inflatable stockingson your legs. These help pump blood from your legs back to your heart.Pain ControlTo help control your pain, your doctor may order medication for you. Aftersurgery, we may not be able to stop all your pain, but we will help you tobe as comfortable as possible so you can rest and sleep. You will be askedto rate your pain on a scale of 0 to 10, with 0 being no pain and 10 beingsevere pain. Reporting your pain as a number helps the doctors and nursesknow how well your treatment is working and indicates whether changes10should be made. Pain control will help you cough, deep breathe,exercise and recover more quickly.

Depending on the location and type of surgery performed on you, theanesthesiologist may administer a block for post-op pain control.What method will be used to give you pain relief medicines?• Medicines given by mouth are either in tablet or liquid form. Most painmedicine is taken by mouth; however, these medicines cannot be used ifyou can take nothing by mouth or if you are nauseated or vomiting.• Injections into muscle or skin are medicines given by shots.• Injections given into a vein are medicines given through a small tubecalled an intravenous (IV) catheter. The tip of the tube stays in the vein.Injections given into the spine are medicines given through a smalltube into your back called an epidural or intrathecal catheter.• Rectal suppositories are medicines that are placed in the rectum andare absorbed by the body.• Patches are medicines that are placed on a patch and then the patch isplaced on the skin so the medicine can be absorbed into the body(transdermal patches).There are several non-drug pain relief methods that are very effective:Relaxation techniques1. Get in a comfortable position.2. Breathe in slowly while counting to three.3. Breathe out slowly while counting to three.4. Continue breathing in and out in same manner.Imagery1. Get in a comfortable position.2. Imagine you are in a place you have found to be relaxing (e.g. beach,mountains).3. Breathe in and out slowly while picturing this in your mind.Music1. Get in a comfortable position.2. Listen to “easy listening” music or your favorite type of music with youreyes closed.Massage and cold or hot packs.11

Financial ResponsibilityYour doctor is a member of the hospital’s medical staff and willsupervise your care. Your doctor will arrange for your tests, medications,diet and completion of a history and physical. Your doctor may call in otherspecialists for consultation or assistance.Physicians at Akron General are independent contractors, not employees,and have the right to separately bill for their services. These doctors includeattending and consultant doctors and members of group practicesincluding, but not limited to: General Emergency Medicine Specialists, Inc.(GEMS); Radiology and Imaging Services, Inc.; Anesthesiology Associatesof Akron, Inc.; Akron Pathology Associates, Inc.; and other hospital-basedor affiliated groups. Additionally, you will receive a bill from Akron GeneralMedical Center.Most insurance companies require pre-certification of surgical procedures.Your physician office is required to obtain pre-certification if required.If there are no requirements listed on your card, please contact youremployer or health insurer for the requirements. We also ask that youbring your insurance card(s), along with your driver’s license or photo ID,with you.The Surgery Center has patient account representatives for financialcounseling Monday-Friday, 7:30 a.m. to 4 p.m., to answer your questionsabout insurance coverage, Medicare and other financial concerns. If youneed assistance, please call 330-344-4188.12

Our Patient Care Partnership:Understanding Expectations, Rights and ResponsibilitiesPatients have the right to:• Receive information about theirrights.• Considerate and respectful careregardless of race, sex, nationalorigin, religion, sexual orientationor source of payment.• Be involved in care decisions.• Receive necessary informationfrom their physicians to giveinformed consent prior to the startof any procedure or treatment.• Consent prior to recording orfilming for purposes other thanidentification, diagnosis ortreatment.• Receive information about thepersons responsible for their care.• Refuse care within the law.• Advance Directives concerningtreatment permitted by law andwithin hospital policy to addressend-of-life issues agreeablewithin the patient’s plan of care.• Be informed about outcomes ofcare or services that have beenprovided, including unanticipatedoutcomes.• Effective communicationsincluding that of interpretivelanguage services.• Have their complaints addressedand receive resolution within atimely, reasonable and consistentmanner.• Confidentiality, privacy andsecurity.• Care rendered in a clean and safeenvironment that preservesdignity and a positive self-image.• Be free from mental, physical,sexual and verbal abuse, neglectand exploitation.• Pain management.• Access protective and advocacyservices.• Consent to or decline to participatein research studies.• Have the opportunity to work ifover a 30-day hospital stay.• Have their cultural, psychosocial,spiritual and personal values,beliefs and preferences respected.• Be informed about, along withfamily as appropriate, the outcomesof care, treatment and services,including unanticipated outcomes.Patients have the responsibility to:As a patient at Akron General, weask for your cooperation with thefollowing:• Provide information about pastillness, hospitalizations,medications and other mattersrelated to health status.• Inform care providers whether ornot explanations of diagnosis,treatment and care options havebeen understood.13

• Follow the recommendations andadvice prescribed by healthcareproviders and to provideinformation about unexpectedcomplications that arise.• Accept the outcomes if they donot follow the care, service ortreatment plan.• Provide complete and accurateinformation about insurance andtheir abilities to meet any self-paybalances.• Be considerate and to respectthe rights and property of otherpatients, visitors and healthcareproviders.For a grievance, patients have theright to:• Discuss concerns with theirattending physicians, registerednurses, or patient care advocate –if they believe their rights havebeen violated – by calling330-344-6711.• File a grievance with a state agencythat has licensure responsible forhospitals. For the State of Ohio,the contact is the Ohio Departmentof Health, 800-342-0553, or theJoint Commission, 800-669-3534.Advance DirectivesYou have the option of completingAdvance Directives. AdvanceDirectives are decisions you makeabout life-sustaining treatments.They include a Living Will andDurable Power of Attorney forHealth Care. A Living Will allows youto indicate preference regardingwithdrawal of life-sustaining treatmentif you are terminal. Durable Power ofAttorney for Health Care allows youto appoint someone to make healthcare decisions for you if you are notable. If you have chosen to haveAdvance Directives, please have yourpaperwork completed prior to yourday of surgery. The day of surgery isnot the appropriate time to completea Advance Directives. Pleasecomplete in advance and bring acopy with you to be included in yourmedical record. Additionally, pleasebring a copy of your Power of Attorneywith you on the day of surgery.If you have questions aboutAdvance Directives or need furtherassistance, please call 330-344-6880or visit Akron General’s Web site atwww.akrongeneral.org to obtainmore information.Questions?If you have any questions orconcerns regarding your surgery orthe information contained in thebooklet, please call 330-665-8124.14

4125 Medina Road, Suite 104Akron, OH 44333330-665-8120Please park on thewest end of thebuilding nearThe Surgery Centerentrance at AkronGeneral Health &Wellness - West,where theoverhead signreads “Surgery.”15

4125 Medina Road, Suite 104Akron, OH 44333330-665-8120