Outpatient Surgery Guide

Welcome

Welcome and thank you for choosing the Cleveland Clinic as your healthcare provider. As you get ready for surgery, you may have a lot of questions. This booklet will help you know what to expect before, during and after surgery.

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.

Preparing for Surgery

• To reduce your risk of respiratory and anesthesia complications after your operation we strongly recommend you stop smoking. Please contact the Cleveland Clinic Tobacco Treatment Center at 216.444.8111 for assistance. Please bring a list of all prescribed and over-the-counter medications you take, including dosage and strength.
• Please bring a list of all prescribed and over-the-counter medications you take, including
  dosage and strength.
• Arrange for a person responsible for your care and to drive you home after your surgery or accompany you on public transportation. You will not be allowed to drive yourself home after same-day surgery. If using a ride share (i.e. taxi, Uber, Lyft, etc.), we require a person responsible for your care to accompany you.

Notes for Parents: One parent/legal guardian needs to stay on site at all times during their child’s surgical experience. We suggest younger siblings stay at home due to long waiting periods, and siblings under 16 are not permitted in the recovery room.

Advance Directives

What are advance directives?

Advance directives are legal documents that provide instructions about who should oversee your medical treatment and what your end-of-life wishes are, in case you are unable to speak for yourself. Learn more about Advanced Directives.

• Notification of Advanced Directive and Do Not Resuscitate Policies

If You Haven’t Completed Advance Directives

Ohio law recognizes an Order of Decision Makers if you are unable to make health care decisions for yourself. If the state has appointed a guardian, this person is the first decision maker. If not, your legal next of kin have the right to make decisions for you. Ohio recognizes this order of your decision makers: legal guardian (if applicable), spouse, majority of adult children, parents, majority of adult siblings, or other nearest relative.

Insurance Coverage

Many insurance companies require preauthorization 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. Carry your insurance and prescription drug cards with you at all times.

• Find our complete list of accepted insurances at Cleveland Clinic

Questions?

If you have questions about your insurance approval, you may contact the insurance company directly or you may call the preauthorization financial service office at:

Confirming Arrival Time

You will be contacted before 4 p.m. the day before your procedure to confirm your arrival time. If your procedure is scheduled for a Monday, you will receive a call on the prior Friday. If you are unable to answer the phone, we will leave a message with this information.

• Please be aware that emergency situations arise that may delay or change your surgical time. We will notify you if possible when this happens. We regret any inconvenience, but please understand that each patient is given every bit of time that they need. This makes scheduling inherently less precise.

If you have not been called by 4 p.m. please call the location at the number listed below:

Before Surgery

• Do not eat or drink anything (including gum, mints or candy) two hours before your arrival time. Teeth may be brushed.
• Do not consume alcohol 24 hours prior to surgery.
• You can drink up to 8 ounces of absolutely clear liquids (i.e. black coffee or tea no cream or sugar) up to 2 hours before your arrival time.
• Please remove all nail polish. To ensure accurately monitoring of oxygen levels during surgery please remove tips, wraps, gels etc. from at least one finger on each hand.
• Please do not make any marks on your skin to indicate the surgical site. Your physician along with your participation will mark the surgical site prior to your surgery.
• If you develop a cold, persistent cough, sore throat, fever or any other illness within two days of surgery, your surgeon needs to be notified.
• Obtain ambulatory aides needed after surgery such as crutches and knee rollator and practice using them before surgery.
• You can obtain your crutches/knee rollator and crutch training through your surgeon’s office.

Day of Surgery

• We encourage you to wear loose fitting clothing and low heeled shoes. If staying overnight, bathrobe and slippers are suggested. Please leave your suitcase in the car until your room is assigned. Please leave all valuables including jewelry and body piercings, money and credit cards at home.
• Please bring your insurance card, photo ID and your copay (if applicable) to your visit.
• Remove all piercings.
• You may wear hearing aids on the day of surgery.
• Please bring your contact lens and solution and/or glasses case.
• Please avoid the use of hairclips, pins and bands that bind your hair. Do not use hairspray. A head cover will be provided on the way to the operating room to contain hair.
• Remove all makeup and refrain from wearing perfume.
• You will be instructed in advance as to which of your routine medications you should take on the day of your surgery. If you use an inhaler, you can use it on the morning of surgery, but bring it with you to the surgery center. If you use CPAP, please bring your device with you.

Pre-Operative Unit

• A urine sample maybe required.
• You will change into a hospital gown. Your clothing will be placed in a bag. Please give all valuables (including cell phones) to your family member.
• A representative from anesthesia and nursing will meet with you and answer any questions that you have at this time.
• Your surgeon will also visit you prior to your surgery. This is an opportunity to ask any remaining questions.
• 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.
• While you are in the pre-operative area, you may be asked several times to state your name, your birthdate, and what type of surgery you are having.
• Before you are transported to the operating room, your surgeon will mark your operative site with a surgical marking pen. This is part of our safety policy- to verify that we have the correct site.
• 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, correct history and physical, anesthesia assessment, availability of x-rays, blood product (when indicated), and specific implants. All of these measures are in place for patient safety.
• Please be aware that surgery times are approximate, the nurse or receptionist will inform you and your family of any delays or unexpected interruptions. Delays, although inconvenient, can happen. We appreciate your understanding and cooperation.

In The Operating Room

• Your care, comfort and satisfaction are our priorities. Many feel concerned about undergoing surgery, and your nurse is there to answer any questions and they will be there with you throughout the procedure.
• The surgical team will move you from the Pre-Op area to the Operating Room, assisting you onto the operating room bed to ensure your comfort and safety.
• Your blood pressure, pulse, and breathing will be monitored and you will be covered and draped so only the operative area is exposed. The team will also be monitoring your heart rate and rhythm throughout your surgery.
• The lights may seem bright and the temperature cool in the Operating room. Warm blankets are available for your comfort.
• An additional aspect of our Culture of Safety is called the surgical huddle. In this safety measure, we confirm that we have the following before surgery begins:
  • The correct patient
  • The correct side and site of marking
  • The correct procedure
  • The correct implants, special equipment, and x-rays (when applicable)

In the Post Anesthesia Care Unit (PACU)

After surgery you will be taken to the post-anesthesia care unit (PACU) otherwise known as the recovery room. There you will be monitored closely for an hour or more as the anesthesia wears off. You may feel confused and groggy as the anesthesia wears off, and children may cry or scream (this is normal). During this time the nurses will check and monitor your heart rhythm, blood pressure, temperature, pulse and breathing. They will also inquire about your level of pain and provide medications as necessary. The surgeon may meet with your family in the surgical center’s consult room. Once you are more awake, your vital signs are stable, and your pain is under control, your family will be able to visit with you to begin preparation for your return home.

Before discharge from the Surgical Center

Your nurse will:

• Review homecare instructions including supportive equipment (i.e ice packs, arm slings, and drains).
• Remove any unneeded medical devices (example: IV’s).
• Instruct you about caring for your incision and signs and symptoms that would need to be reported to your doctor immediately (example: infection, bleeding, severe pain).
• Review your medications and inquire regarding your pain status.
• Inform you about scheduling a follow up visit with your surgeon if this was not previously scheduled.
• Prescriptions maybe given to you by your provider or e-scripted to your preferred pharmacy.
• If you have any questions once you arrive home, write them down. You may call your surgeon during normal business hours.

Going Home

At Cleveland Clinic we care deeply about your safety and comfort, we urge you to follow these instructions and all instructions you receive from your doctor/nurse regarding your recovery.

• A person responsible for your care must listen to discharge instructions and accompany you when you leave the Surgery Center. Your surgery will be cancelled if no one arrives with you.
• It is recommended to have a person responsible for your care stay with you for 24 hours after surgery.
• Progress gradually from drinking fluids to eating solid foods.
• Take deep breaths to keep your lungs clear.
• Do not drive or operate machinery for 24 hours after surgery.
• Do not drink alcohol while on prescription drugs.
• Narcotics will cause constipation so you may wish to purchase an over-the-counter remedy in anticipation of this issue.
• Do not make important decisions or sign any legal or important documents within 24 hours after surgery.
• The following business day, a member of your healthcare team will call you. 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.

Locations

Beachwood Ambulatory Surgery Center

Patients can be dropped off at the front entrance of the Beachwood Family Health and Surgery Center. Valet service is available. The patient can then proceed to the 3rd floor via the North building elevators (across from the pharmacy) and check in at the Ambulatory Surgery Center.

Fairview ASC: Westlake Medical Campus

Patients can be dropped off at the Main Entrance. There is NO valet parking at this location. The patient can then proceed to the ASC via the elevator to the lower level (Suite 001) and check in at the Ambulatory Surgery Center.

Lorain Ambulatory Surgery Center

Patients can be dropped off at the front entrance. Valet parking is not available at this site. The ASC is located on first floor immediately left of front entrance doors. Patient can check in at the ASC front desk.

Marymount ASC Sports Health Center

Marymount ASC Sports Health Center patients can be dropped off at the front door. Valet parking is not available at this site. The patient can proceed to the second floor elevator and check in at the Ambulatory Surgery Center front desk.

Medina Park West Surgery Center

Patients can be dropped off at the front entrance. Valet parking is not available at this site. The patient can then proceed to the ASC via elevator to the second floor, suite #260. Turn right off the elevator and check in at the ASC front desk.

Strongsville Ambulatory Surgery Center

Patients can be dropped at the front entrance of the Strongsville Family Health and Surgery Center. Valet service is available. The patient can then proceed to the second floor via elevators and check in at the front desk of the Ambulatory Surgery Center.

Twinsburg Ambulatory Surgery Center

Patients can be dropped off at the front entrance of the Family Health and Surgery Center. Valet service is available. The patient can then proceed to the second floor via elevator. Upon exiting the elevator, turn left and check in at the Ambulatory Surgery Center desk.

Information for Families

• Please inform the receptionist if you need to leave the surgery waiting area.
• Cleveland Clinic is a smoke-free institution therefore smoking at the Surgery Center is prohibited
• Free Wi-Fi is available at the Surgery Centers. Please be respectful to others and use headphones when watching movies or listening to music.
• Your family, friend, relative or significant other will be able to track your progress throughout your stay on our electronic tracking board in the waiting area. The receptionists in the Surgery Center will explain the icons on the board.