Hillcrest Hospital Surgery Guide

Insurance Coverage

Many insurance companies require pre-authorization for hospital admissions. Please make sure we have the most current and complete insurance information. Confirm with your insurance company that all necessary paperwork has been completed prior to your admission. Please remember to carry your insurance and prescription drug cards with you at all times. If you have questions about your insurance approval, please call the pre-authorization customer service office at 216.444.4811 from 8 a.m. - 4:30 p.m.

For corrective billing purposes, plan to attend your Admitting Interview prior to your day of surgery. The desk location will be noted on your schedule.

Cleveland Clinic will bill your insurance carrier for the charges associated with your stay. Any balance not covered by your insurance company will be billed to you.

Preoperative Appointments

Your surgeon or one of the surgical team members will complete a questionnaire to determine if additional testing is needed prior to your surgery.

If necessary, you will be given an appointment in PACC (Preoperative Anesthesia Consultation Clinic) for further medical evaluation. The main focus is to gather important medical information about your health before surgery to ensure you are in the best physical condition possible to undergo surgery. At this appointment, your medical records and previous anesthetic experiences will be reviewed. In addition, the risks and benefits of the various anesthetic options available to you will be discussed. By taking this step, you can lessen your risks of developing complications as a result of surgery. Patients may ask their surgeons office to schedule a PACC appointment or you may call 216.444.6612 to schedule.

Please remember to bring the following items to your appointment at PACC.

• Any medications you are taking or a list of current medications.
• If you have received care at another facility, please bring a copy of your medical records and tests. Any x-rays and results from cardiology tests, such as stress tests and electrocardiograms (EKGs, ECGs), are especially important.

For your convenience, we try to keep most of your preoperative appointments within the same location of your procedure. A virtual PACC appointment may also be appropriate based on criteria provided by the anesthesiologist.

Any routine testing that needs to be done before your surgery, such as blood tests, chest X-rays or electrocardiograms (EKG), often will be done in this building. The admitting interview process, which includes providing your insurance information, is also conducted at this time. When possible, this appointment can coincide with your preoperative visit with your surgeon.

Confirming Your Arrival Time

You will receive a call the day before surgery from the Perioperative Services team to inform you of what time you should arrive. This call will be between 2:30 p.m. and 5 p.m.  If your surgery is scheduled for Monday, you will receive a call on Friday between 2:30 p.m. - 5 p.m.  If you have not been reached by 5 p.m., please call the Perioperative Services department at 440.312.4694. Please be aware that emergency situations arise which may delay or change your surgical time. We will notify as soon as possible and regret any inconvenience.

Day of Surgery

Your Arrival

Once you arrive, please report to the Surgery Center desk W1-1 or the Registration desk, which is located on the 1^st floor, near the atrium at the front of the building. You will be given the location to report in your Preoperative arrival call with time and location of arrival. Valet parking is available for a fee.

When checking in for surgery, the receptionist will ask for the name of a family member or friend that status updates will be shared with. The designated person will receive a pager or text message if requested that will keep them updated on the patient’s progress throughout the day. This pager works throughout Hillcrest Hospital.

Please remember:

A responsible driver on the day of your surgery will need to be in attendance to assist in your discharge process. Due to the anesthesia/sedation used and for your safety you will not be permitted to drive or work for 24 hours. For your safety, taxi cabs, Uber, Senior transportation, or Provide-a Ride ARE NOT acceptable responsible drivers unless you are accompanied by another responsible person that will stay with you.

This is for your safety and therefore, NO EXCEPTIONS will be made. 

Do not bring any valuables with you on the day of surgery.

Pre Op

You will be called to the preoperative area where you will have a lengthy interview about your current health status and your current medications will be reviewed. You will need to provide the date and time you last took your medications. Please leave all medications at home unless instructed to do otherwise from your physician.

Upon arrival, a urine sample pregnancy test is required for all menstruating females as well as those females who have had their last period within the year.

You will be given a hospital gown to wear, and your blood pressure, pulse and temperature will be taken. An intravenous (IV) line may be started to provide you with fluids. Later, the IV may be used to provide anesthesia or other medications as needed. All undergarments, glasses, dentures, jewelry and piercings will need to be removed. Please do not being any valuables or electronic devices.

While you are in the perioperative area, you may be asked several times to state your name, date of birth and what type of surgery you are having. Do not be alarmed by this. It is our way of ensuring your safety.

Before you are transported to the operating room, a member of the surgical team privileged to perform your surgery may mark your surgical site with an indelible marker. This is part of our safety policy - to verify that we have the correct site/limb. During the pre-operative process, there may be other items that we routinely check before going to the operating room, such as (but not limited to) informed consent, current history and physical, an anesthesia assessment, availability of x-rays, blood products (when indicated), and specific implants. All of these measures are in place to help keep you safe.

One or two of your family members or friends may stay with you until you go into surgery. Parents of pediatric patients will remain with their child until they enter the operating room. We strongly suggest young children stay at home due to long waiting periods. The surgical waiting area is equipped with a television, magazines. Family members may wish to bring a book, pillow, blanket or other materials from home to help pass the time. Please be mindful that hospital linens are for patient use only. Bringing a sweater or jacket is recommended as rooms can be cool.

Surgery Waiting Area

To follow the patient’s progress throughout surgery, the Family View screen displays real time updates of surgical milestones. You will receive your own personal code from the Surgery Center receptionists upon checking in at the Surgical Center. Although each patient’s name is coded, please notify the receptionist if the patient would prefer not to be listed on the Family View screen. Enter OR - is the time the patient enters the operating room. PACU stands for Post Anesthesia Care Unit, or recovery room, for recovering after surgery. Outpatient recovery is for patients going home the day of surgery.

Please notify the reception desk if you leave the hospital grounds area at any time during the day.

Amenities at Hillcrest Hospital

• A café and pharmacy are available in the Atrium
• WiFi access is available
• A cafeteria is located on the lower level of the hospital.
• A gift shop is located on the first floor

Operating Room

In the Operating Room

You are the most important person in the operating room, and your care, comfort and satisfaction are our priority. Many people are concerned about undergoing surgery, so your nurse will answer any questions and will be there with you throughout the procedure.

You will be asked questions to verify your name, the surgical procedure and the site throughout the surgical process. Patient identification is verified by name and date of birth. You will then state the surgical procedure to be performed followed by confirmation of the marked surgical site.

You may notice a lot of activity in the operating room. The lights may seem bright and the temperature cool. Warmed blankets are available for your comfort. Please notify a nurse or surgical personnel if you are uncomfortable.

An additional aspect of our culture of safety is called the “time out.” In this safety measure, we confirm that we have the following before surgery begins:

• The correct patient
• The correct side and site marking
• The correct procedure
• The correct position on the operating table
• The correct implants, special equipment, and x-rays (when applicable)

Anesthesia

In the operating room, your surgeon may administer your anesthetic, if you are having a procedure performed under "local" anesthesia only. Otherwise, an Anesthesia Care Team will care for you the entire time you are in the operating room. The Anesthesia Care Team consists of a staff physician anesthesiologist with either an anesthesia resident, Certified Registered Nurse Anesthetist, or Certified Anesthesia Assistant. The Anesthesia Care Team ensures you have both a smooth and safe anesthetic. They will constantly monitor your vital signs, including your heart rate and rhythm, blood pressure, and amount of oxygen in your blood. Should you require special monitoring for your safety, these monitors may be placed either before or after you enter the operating room. The type of anesthesia you receive will depend upon the surgery you are having and your state of health. All of your questions and concerns will be addressed in a conversation prior to ensuring a safe start to your procedure.

Either during your PACC Clinic appointment or just before surgery, the options for anesthesia will be discussed with you by a member of your Anesthesia Care Team. The following is a brief description of these anesthetic options.

General Anesthesia

This is the most common type of anesthesia performed for surgery. You will be made unconscious during your surgery with the use of intravenous medications. When your surgery is finished, the medications are stopped, and you will begin to awaken from anesthesia.

Regional Anesthesia

  This type of anesthesia is somewhat similar to what you may experience at the dentist's office. With regional anesthesia, only the area of the body on which surgery is being performed is numbed. Spinal or epidural anesthesia is commonly used for surgery of the legs or for some gynecologic procedures. Peripheral nerve blocks may be used for arm, shoulder, and foot or knee surgery. This entails placing medicine around a nerve or group of nerves to block the feeling at the location where the surgeon is operating. It can be used for anesthetic purposes during the surgery as well as for a method of pain control after your surgery. If this method is chosen, it can be done either prior to going into the operating room or after your surgery in the recovery room. It can be done as a one-time injection or it can be done as a continuous flow of pain medicine through a very thin tube called a “catheter”. An advantage to having a nerve block prior to surgery is that patients usually need less anesthetic medicine during their surgery which can decrease the chance of side effects happening.

Transversus Abdominis Plane (TAP) Blocks

 TAP blocks involve injection of local anesthetic medication in a specific layer between your abdominal wall muscles. This area contains many nerves that supply sensation from your abdomen, so numbing these nerves can reduce pain from your surgery, typically lasting 1-2 days. TAP blocks will not stop all pain but will work with other medications to help control your surgical pain. A TAP block is usually done by a physician anesthesiologist prior to your surgery so you will wake up more comfortably. Often, mild sedation is given to help you be more comfortable during the procedure. The procedure does not take long and involves one or two injections on each side of your abdomen after numbing the skin where the injections happen.

Monitored Anesthesia Care (MAC)

During this type of anesthetic, the Anesthesia Care Team gives you medications intravenously to make you drowsy and comfortable while monitoring your vital signs. Your surgeon provides “local" anesthesia to the site of surgery.

Local Anesthesia

Occasionally, your surgeon may prefer to perform a procedure in the operating room that requires only local anesthesia. This involves numbing only a specific area and will be administered by your surgeon.

Surgical Site Infections

A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. However, infections develop in about 1 to 3 of every 100 surgical patients.

Some common symptoms of surgical site infection are:

• Redness and pain around the area where you had surgery
• Drainage of cloudy fluid from your surgical wound
• Fever

Can SSis be treated?

Yes. Most surgical site infections can be treated with antibiotics. The antibiotic given to you depends on the bacteria (germs) causing the infection. Sometimes patients with SSis also need another surgery to treat the infection.

What are some of the things that hospitals are doing to prevent SSis?

To prevent SSis, doctors, nurses, and other healthcare providers:

• Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery.
• Clean their hands with soap and water or an alcohol-based hand rub before and after caring for each patient.
• May remove some of your hair immediately before your surgery using electric clippers if the hair is in the same area where the procedure will occur. They should not shave you with a razor.
• Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean.
• Give you antibiotics before your surgery starts. In most cases, you should get antibiotics within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery.
• Clean the skin at the site of your surgery with a special soap that kills germs.

What can I do to help prevent SSis?

Before your surgery:

• Tell your doctor about other medical problems you may have. Health problems such as allergies, diabetes, and obesity could affect your surgery and your treatment.
• Quit smoking. Patients who smoke get more infections. Talk to your doctor about how you can quit before your surgery.
• Do not shave near where you will have surgery.
• Shaving with a razor can irritate your skin and make it easier to develop an infection.

At the time of your surgery:

• Speak up if someone tries to shave you with a razor before surgery.
• Ask why you need to be shaved and talk with your surgeon if you have any concerns.
• Ask if you will get antibiotics before surgery.

After your surgery:

• Make sure that your healthcare providers clean their hands before examining you, either with soap and water or an alcohol-based hand rub. If you do not see your healthcare providers clean their hands, please ask them to do so.
• Family and friends who visit you should not touch the surgical wound or dressings.
• Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, please ask them to do so.

Anxiety after Surgery

Studies show that recovery from surgery can be stressful and lead to unnecessary anxiety. A variety of practices such as breathing exercises, imagery, affirmations, hypnosis, and biofeedback have been shown to be beneficial in decreasing the effects of anxiety on the body and inducing improved health and well-being. Especially when preparing for a medical procedure such as surgery, it is very important to minimize the negative effects and maximize the healthy, healing aspects of your mind/body connection.

The rationale for this is very simple. Situations that we perceive as being potentially dangerous cause activation of the sympathetic nervous system. This causes our heart rate to increase, breathing to become rapid and shallow, and blood pressure to rise. This response can have detrimental effects on our body if it persists inappropriately. It can cause muscle tension, pain and insomnia, increased susceptibility to infection, and decrease our natural healing mechanisms. Thus, we urge you to begin practices prior to surgery that reverse the sympathetic nervous systems and bring about the relaxed, calm state that is more favorable for healing.

A wide variety of practices are known to be effective in such situations. Guided imagery audio programs used for several days before and after surgery, relaxation, music therapy or breathing practices all can be started prior to your hospitalization to improve your post-operative period.

After Your Surgery

Your Hospital Stay After Your Surgery

You will be taken to the recovery area (PACU, Post Anesthesia Care Unit) or, if medically necessary, the Intensive Care Unit (ICU) when your surgery is complete. During that time, your surgeon will talk with your family members.

Your recovery time will depend upon the type of procedure you have undergone and the anesthesia used. However long the recovery period may be, please be assured you will be receiving the best care and personal attention from our staff. Visitation may be allowed in the PACU after a 1 hour time period and is dependent on the activity and safety issues in the PACU and is at the discretion of the PACU nurse.

If you have an outpatient procedure, it is unlikely you will need to spend the night in the hospital. Or, your physician may have discussed/planned with you to be admitted overnight, but less than a 24 hour stay. Regardless, you will be admitted for an overnight stay if your medical condition necessitates.

For patients admitted to the hospital, you will be notified of your loved one’s hospital room location by pager or text message. Once paged, please allow at least 30 minutes for the nurse to complete a head-to-toe patient assessment.

If it is a surgery requiring a hospital stay, your family will be able to visit you once you have been transferred to a hospital room. If you have a special visiting request or unusual situation, please speak to the information desk receptionist.

Remember, the receptionist at the Surgery Center desk is the link between you and your family. To keep that link, your family must inform the receptionist if they are leaving the waiting area. If more than two hours in the recovery area pass without any update, check with the receptionist.

Hospital Room Choices

The Cleveland Clinic has semi-private rooms for patient care. A limited number of private rooms are available for those patients whose medical needs require isolation.

Pain Management

Effective pain management is an important part of your care. Every effort is made to minimize your pain; however, it is normal to experience some discomfort following surgery. Communication of unresolved pain is necessary to make you as comfortable as possible. You will be asked about your level of pain upon admission, and this will continue throughout your stay. You will be asked to "rate" your pain on a scale from 0-10. "0" being no pain at all, "5" being moderate pain, and "10" being the worst possible pain. This score will be used to select the correct pain medicine to treat your pain. This is all done in an effort to maximize your pain management. The doctors and nurses will ask you how the pain medicine is working and adjust it as needed. Please see more details about pain management in the Patient Education Materials section.

Reducing Your Risk of Falls

We want to make sure you are safe during your hospital stay, so we have prepared these guidelines for you to help prevent a fall. We don't want your recovery time to take longer than expected.

A fall is more likely to occur in an environment that is unfamiliar to you, such as a hospital room. If you are at risk for falling, we will place a yellow wristband on your arm. This will notify the staff members to be alert that you may need extra assistance during your hospital stay.

If You Are Admitted to the Hospital

Most rooms are semi-private with two patients per room. As a courtesy to all patients and families, please respect the needs of your roommate and keep visitors, noise level and TV volume to a minimum. This will help promote a restful environment.

The Cleveland Clinic Foundation embraces a philosophy of open and flexible patient visitation that encourages and welcomes family/significant others involvement in patients’ care. Recommended visiting hours may be posted on units to support patient privacy and condition status.

Cleveland Clinic Linen Policy

To ensure your comfort and health as well as environmental conservation efforts, Cleveland Clinic follows these guidelines:

Fresh bed linens are provided before your arrival. Pillowcases are freshened each day. All bed linens are changed on Mondays, Wednesdays, and Saturdays and/or when soiled.

Linen changes can be more frequent at your request. Please let your nurse know how we can best meet your needs during your stay with us.

Help Us Support Healing (HUSH)

Rest is a key element in healing. Please help us provide a restful, healing environment by following these guidelines, especially between the hours of 9 p.m. and 7 a.m.:

• Use a headset (available from your nurse) when watching TV.
• Remember to use your "inside" voice in conversations and when using the telephone.
• Let your nurse know if the noise level in your room is too loud.

Going Home

Instructions for Going Home

Because we care about your safety and comfort, we urge you to follow these instructions regarding your recovery:

• A friend or a relative must accompany you when you leave the Surgical Center.
• Have a responsible adult stay with you for 24 hours after surgery.
• Progress gradually from fluids to solid foods.
• Take deep breaths to keep your lungs clear. For more information, please see the Incentive Spirometer handout in the Patient Education section.
• Do not drive or operate machinery for 24 hours after surgery.
• Do not drink alcoholic beverages for 24 hours after surgery.
• Do not make important decisions or sign any important documents within 24 hours after surgery.

If you have questions, write them down on the form provided in this booklet. You may call your surgeon's office during regular business hours. Reaching your surgeon or assistant after hours varies by department and will be discussed in your pre-op teaching.

For outpatient procedures, a member of your health care team will call you a few days after surgery. This is a routine call to check on your progress. We believe that answering your questions at this time is an important part of providing you with excellent care. Please call us at any time with your questions.

What do I need to do when I go home from the hospital?

Before you go home, your doctor or nurse should:

• Explain everything you need to know about taking care of your wound. Make sure you understand how to care for your wound before you leave the hospital.
• Always clean your hands before and after caring for your wound.
• Before you go home, make sure you know who to contact if you have questions or problems after you get home.
• If you have any symptoms of an infection, such as redness and pain at the surgery site, drainage, or fever, call your doctor immediately.

If you have any additional questions, please ask your doctor or nurse.

Additional Information

Foreign Language Interpreters

A Global Patient Services (GPS) provides both language interpreters and American Sign Language interpreters at no charge to patients and their companions 24 hours a day, 7 days a week. Language interpreters are provided either through the phone or by on-site interpreters. American Sign Language interpreters are provided either through a Video Remote Interpreter deaf cart or by an on-site sign language interpreter. Family and friends of the patient are not expected to act as a medical interpreter for the patient. GPS Dispatch provides interpreters for in-patient hospitalizations and out-patient appointments. Call 216.445.7044 any time, day or night.

Latex Safe

Cleveland Clinic health system is latex safe, which means every reasonable effort was made to remove highly allergenic latex sources. This will reduce direct exposure to patients and employees. With less exposure to latex, our patients and employees will have reduced risk of developing an allergy. Please remember, with the latex safe initiative, only Mylar balloons are permitted at Cleveland Clinic.

Medications from Home

Patients are encouraged to send all medications home. Your doctor will prescribe medications dispensed through the hospital pharmacy. Talk with your physician or nurse about this.

Ombudsman

Have a concern about your hospital services? The staff in the Ombudsman Department is available to help resolve issues about services that cannot be solved through other channels. Hours: 8 a.m. to 5 p.m., weekdays

Online Personalized Health Connection

eClevelandClinic MyChart® is a secure, online tool that connects you to personalized health information from the privacy of your home at any time, day or night. eClevelandClinic MyChart® also alerts you to important, health-related reminders to help you better manager your ongoing healthcare.

Personal Belongings and Valuables

We strongly encourage you to leave personal items and valuables at home.

Lost and Found/Storage of Valuables

These services are provided by the Security Service Center located in the lower level of the hospital. Call 440.312.3390, or, ext. 23390 from a house phone, for assistance

Smoking Policy

Cleveland Clinic is committed to the good health of all our patients, visitors and employees. Therefore, smoking, including electronic cigarettes, is strictly prohibited.

Special Services for Patients with Disabilities

We provide special services for hospitalized patients with disabilities. Sign language interpreters, closed-caption TV converters and portable teletype equipment are available. During your admission process, let the registrar know if you will need any of these services.