Preoperative Appointments

Preoperative Appointments

Once you have decided to have surgery, you may be asked to complete a computerized health questionnaire (HealthQuest®) in your surgeon's department. Your surgeon or one of the surgical team members will review the results and determine if additional testing is needed prior to your surgery.

If necessary, you may be given an appointment in the IMPACT (Internal Medicine Perioperative Assessment, Consultation and Treatment) Center for further medical evaluation. The IMPACT Center is staffed with physicians whose 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. By taking this step, you can lessen your risks of developing complications as a result of surgery.

Please remember to bring the following items to your appointment at the IMPACT Center.

  • 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 A Building - Crile Building at Cleveland Clinic's main campus. 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.

Insurance Coverage

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.

The 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.

Locations

  • Fairview Hospital – 18101 Lorain Avenue, Cleveland, Ohio 44111
  • Fairview Ambulatory Surgery Center – 850 Columbia Road, Westlake, Ohio 44145
Confirming Your Arrival Time

Confirming Your Arrival Time

If you are scheduled at Fairview Hospital:

  • You will receive a call the day before surgery to inform you of what time you should arrive. Sometimes this call will come from your surgeon’s office. 
  • If have questions please call 216.476.7145.

If you are scheduled at the Fairview Surgery Center:

  • You will receive a call the day before regarding your arrival time.
  • Any questions regarding your arrival time please call 440.808.4000.

Please be aware that emergency situations arise which may delay or change your surgical time.  We will notify you as soon as possible and regret any inconvenience.

Day of Surgery

Day of Surgery

Arrival at Fairview Hospital

  • Once you arrive please go to Registration, located on the first floor to be registered for the surgical procedure. You will need to bring your ID and Insurance card. After registering, you will be instructed to proceed to the first floor surgery waiting desk for additional instructions, as we have operating rooms on both the first and second floor.

Arrival at Fairview ASC

  • Please enter the building through the Main Entrance and proceed to the elevator, which you will take to the Lower Lever (LL) of the building. Fairview ASC is through the glass doors directly across from the elevator. Proceed to the front desk for check in.

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 you safety and therefore, NO EXCEPTIONS will be made.

Do not bring any valuables, including cellphones or mobile devices with you on your day of surgery.

Pre Op

Only you, the Patient, will be taken 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.

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 bring any valuables or electronic devices.

While you are in the perioperative area, you may be asked several times to state your name 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 will mark your surgical site with an indelible marker or use use an orange wrist band to confirm the side your surgery is on. This is part of our safety policy - to verify that we have the correct side. 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.

Once the patient admission process is completed we will make every effort to bring one family member or friend in pre-op for a short visit. Parents of pediatric patients will remain with their child until they leave the pre-op room. We strongly suggest young children stay at home due to long waiting periods. 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. To protect your privacy, your name will not be shown on the Family View screen. You will receive you own personal identification number from the receptionist at the surgery waiting desk. Your family or friend will then use this number to monitor milestones such as when you enter the Operating Room (OR), the start and end of the procedure and your transfer into the Post Anesthesia Care Unit (PACU) / Recovery Room, for recovering after surgery. Once the patient is transferred out of the PACU, the status of the patient is no longer on the Family Viewing screen.

Please notify the surgery waiting / reception desk if you leave the area at any time during the day.

Amenities at Fairview Hospital

  • Pharmacy and gift shop are located in the main lobby on the first floor
  • A coffee shop is located on the first floor across from the surgery waiting desk
  • The flower shop is located on the first floor near the outpatient radiology department
  • Cafeteria is located on the first floor past the main elevators
  • Public WiFI access is available

Amenities at Fairview Hospital ASC

  • There is no cafeteria or snack shop
  • Public WiFi access is available
  • Parents may not leave the waiting room while the child is in Surgery
Operating Room

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

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 Assistant or Certified Nurse Anesthetist. 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.

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. It entails placing medicine around a nerve or group of nerves to block the feeling at the spot 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 thing 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

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.
After Your Surgery

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. Depending on time of completion of your surgery, it is not uncommon for patients to stay overnight in the recovery area. Some patients need more or less time to recover. 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 2 hour time period and is dependent on the activity and safety issues in the PACU and is at the discretion of the PACU nurse. No children will be permitted to visit in the PACU.

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 to our Short Stay Nursing Unit to stay 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. 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 P20 (Surgical Center) information 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.

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.

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. The Center for Integrative Medicine offers a variety of services during your stay as well. You can get more information by calling, 216.986.4325.

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. – 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
If You Are Admitted to the Hospital

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.

Going Home

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. To place a page call, dial 216.444.2200 and ask for the page operator. 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?

Plan for any assistive devices your surgeons office may recommend:

Crutches, walkers, Rollators for orthopedic leg, foot and ankle procedures.  Please confirm with your physician if you will be non-weight bearing.

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.

This information is provided and endorsed by:

  • The Society for Healthcare Epidemiology of America
  • Infectious Disease Society of America
  • American Hospital Association
  • Association for Professionals in Infection Control and Epidemiology, Inc.
  • Centers for Disease Control
  • The Joint Commission
Additional Information

Additional Information

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.

Personal Belongings and Valuables

Leave personal items and valuables at home.