Designed for the patient in good health who can undergo special surgical experience and return home all in the same day. Ambulatory Staging is a time and cost saving alternative to inpatient hospitalization. Our Ambulatory Staging is a 38-bed specialized unit staffed by nurses who are specially-educated in ambulatory surgery and who have the complete back-up of a full-service hospital. Hours of operation are Monday - Friday, 5 a.m. - 9 p.m.

Preparing for Your Operation (Back to Top)

You're going to have an operation. You may be feeling somewhat nervous about being in the hospital for surgery, but this is a very normal feeling. We have prepared this booklet to help ease your fears and to give you a preview of what you can expect before and after surgery. We would like your stay to be as pleasant as possible, and our staff is ready to assist you. We encourage you to ask questions about your care while you are a patient at Parkwest Medical Center.

If you must cancel your operation, please notify your surgeon or, if after office hours, you may call the Surgery Department at Parkwest Medical Center: 373-1928.

Preadmission (Back to Top)

The pre-admission process consists of preregistration, pre-admission testing, and evaluation service for patients scheduled for surgery. Pre-admission testing is urged because it provides timely, unhurried preparation for your surgery. Your doctor may order appropriate tests that he/she feels are essential for you to have before your surgery.

Some of the most frequent tests are:

• Electrocardiogram (ECG or EKG) - A graph of how the heart beats.
• Chest X-ray - Taken to help evaluate the condition of your lungs and heart.
• Blood tests and urine specimens - Taken to help check your overall health.

Additional testing may be required by the anesthesia department, depending on your health history and age. This will be decided by the pre-admission testing nurse when he/she evaluates your health history.

Be sure to inform your physician if you regularly take aspirin or other blood thinning medications. You may need to stop taking these medications several days before the surgery.

If you have been unable to complete preadmission testing, a nurse will contact you and ask questions regarding your medical history, explain tests you need or have had, and provide you with necessary instructions. Our healthcare professionals are genuinely interested in your well-being and will be happy to answer any questions you might have regarding your surgery or admission. If you should have additional questions about your scheduled test(s) or surgery, you may call our pre-admission testing department at 373-1421.

Where Can I Find Preadmission Testing? (Back to Top)

At Parkwest Medical Center, pre-admission testing is located inside, near the main entrance to the hospital. Hospital volunteers will take you directly to the PAT department.

You may call 373-1421 to schedule an appointment... hours of operation: Monday - Friday, 8 a.m. to 5 p.m.

What Should I bring to Preadmission Testing? (Back to Top)

For your visit to the pre-admission testing area, bring the following information:

• Orders or instructions from your physician
• Copies of health records, lab tests, EKG, or X-ray reports. Previous blood tests are accepted for 30 days and X-rays and EKGs are accepted for six months prior to surgery.
• Medic blood bank cards
• Medication list and dosages
• Allergy list
• Insurance information

Let your physician's office know when you plan to have pre-admission testing to ensure your orders are there when you arrive.

Preoperative Instructions  (Back to Top)

It is important that you not eat or drink anything, including water, after midnight the evening before your surgery. (This means no coffee, hard candy, gum, or food of any kind.)

Check with your physician regarding information about any medications your are taking at the time of surgery. Take your medications on the morning of your procedure if you are told to do so by the preadmission testing nurse or your physician. You may have just enough water to swallow your medications.

If you are ill, (i.e. sore throat, cough, fever, or infection) you should contact your physician’s office on the day prior to surgery and let them know.

Arrange for a relative or adult friend (over age 18) to drive you home, since you will not be allowed to drive yourself. A bus or cab is not acceptable unless a responsible adult over age 18 is with you.

Persons with diabetes need to check with the preadmission testing nurse prior to the surgery date for any special instructions regarding their medications.

If there is any possibility you are pregnant, tell your physician.

The Day of Surgery (Back to Top)

On the day of your surgery, please remember to:

• Be on time.
• Bring healthcare records, test results, blood bank cards, and allergy and medication lists, unless these items were given to the nurse for preadmission testing.
• Do not eat or drink anything, including water, after midnight the evening before your surgery. (This means no coffee, hard candy, gum or food of any kind.) The anesthesia care provider will talk to you the morning of your surgery.
• Take your medications on the morning of your procedure if you are told to do so by the preadmission nurse or physician. (You may have just enough water to swallow your medications.)
• Bathe or shower and brush your teeth before you leave home. This reduces the chance of infection.
• Wear casual, loose-fitting clothing and flat shoes. All underwear and socks should be all cotton.
• Bring your glasses and/or contact lens case. All types of contact lenses and glasses must be removed before surgery. Please give these to your family prior to surgery.
• Wear no make-up. You may wear light or clear nail polish. Acrylic nails with light polish do not have to be removed.
• Remove all jewelry before you arrive at the hospital. This includes: rings, wedding rings, watches, earrings, necklaces, hair clips, hair pins, body jewelry and piercings, etc.
• Leave all valuables, such as money, credit cards, etc., at home.
• If you are scheduled to be admitted after your surgery, you should pack a small bag containing toilet articles, a robe, pajamas, slippers, and other supplies that you may need. We suggest leaving your bag in your car and having it brought to you once you have been assigned a hospital room following surgery..

No Smoking (Back to Top)

It is very important that you try NOT to smoke before your operation. This is because after you have general anesthesia, secretions tend to build up in your lungs. Smoking further irritates the lungs and causes more mucus and fluid buildup. Therefore, the less you smoke before the operation, the better your chances for reduced congestion afterward. Lung congestion can contribute to the development of pneumonia. Smoking is prohibited inside the facility.

Arriving at the Hospital (Back to Top)

Parking: Free valet parking at the main entrance of the hospital is provided for your convenience.

The Ambulatory Staging Unit (Back to Top)

As a surgical, outpatient, or invasive procedure patient, you will be given a time to arrive at the hospital where you will be admitted to the ambulatory staging unit. Once on the unit you will be given a hospital gown and a plastic bag for your clothing. Patients will be asked to remove all jewelry, dark nail polish, hairpins, glasses, and dentures. Give your valuables to your family or friends for safekeeping (or ask your nurse for assistance).

A nurse will check your temperature, pulse, blood pressure, respiratory rate, weight and height; these are called vital signs. You will be asked to empty your bladder because you will not be allowed out of bed after you receive your preoperative medication.

If you brought paperwork with you, please give it to the nurse so she can make sure it is attached to your medical record.

Pre-Surgical Assessment Holding Area (PSA) (Back to Top)

About an hour before your operation is scheduled, you will be taken by stretcher to the holding area in the surgery department where a nurse will check to make sure everything is in order for your surgery (depending on your procedure, you may be taken to the holding area earlier).

An operating room nurse will interview you. Please let the nurse know any special needs you have (hearing aid, glasses, pillow for under your legs, etc.). You will talk with an anesthesia care provider who will review your anesthetic plan with you.

In the PSA, an intravenous needle (IV) will be inserted in a vein in your arm. This IV will be used as a pipeline for giving you medicine and fluids that your body needs during and after surgery. You may be given medication to help you relax. Other medications such as antibiotics may also be given. Your length of stay in the PSA will be about an hour.

Operating Room (Back to Top)

You will relax and rest in the holding area until you are taken to the operating room by the nurse who will care for you during surgery. You will be asked to move onto the operating room bed, and be connected to any monitors that are required to ensure your safety during anesthesia and your operation. The doctors, nurses and technicians will be wearing masks, gowns and gloves. The room will be full of equipment that may look strange to you, but it is important for a safe and effective surgery. Before you know it, you will be asleep.

After Your Operation (Back to Top)

Postanesthesia Care unit (PACU/Recovery) You will be taken to the post-anesthesia care unit (recovery) immediately following your operation. The nurses and anesthesia staff will watch you closely as you wake up. Your blood pressure, pulse, and breathing will be observed. An oxygen mask may be placed over your mouth and nose until you are awake and warm blankets will be provided. Medication may be given if you are having discomfort or nausea. You may expect to stay in the recovery room approximately 1-2 hours. There may be exceptions depending on individual circumstances. Your family will be notified if your stay will be longer. Once you have recovered from your anesthesia and your bed is ready, you will return to the ambulatory staging unit where your family may visit. Your nurse will make sure you are comfortably settled and review your personalized care plan for your hospital stay.

Outpatient Information (Back to Top)

On the Ambulatory Staging Unit If you are going home after your surgery, you will return to the ambulatory staging unit, where you may have one (1) family member stay with you. Your nurse will make sure you are comfortable and will review take-home instructions for your care. The time you need to stay on the unit after your operation varies depending on the type of operation, anesthetic and your medical history. After a sufficient recovery period, when you are able to get up and walk a short distance (unless your operation or medical condition prevents you from walking), you will be ready to change into your street clothes and leave for home. You will be discharged when you and the ambulatory staging nurse feels you are ready to go home.

You will be given written discharge instructions to follow after you get home and may be given prescription(s) your doctor wants you to take. Be sure to follow your physician's instructions regarding rest, medication and diet. You will be assisted to your vehicle where a responsible adult (over age 18) must be available to drive you home. You cannot drive yourself home after your operation. A bus or cab is not acceptable unless a responsible adult (age 18 or older) is with you.

Pain Management (Back to Top)

It is normal to have some pain and discomfort after your operation. This is due to swelling around the operative area and disturbance of bone, muscle, and tissue. Pain and discomfort will decrease during the healing process. Most of the pain and discomfort exists during the first three days after your operation. People once thought that pain was something they just had to live with. Now, with new medications and ways to administer them, you can work with your doctor and nurse to minimize your discomfort during this period.

Methods of pain management include: pills, shots, epidural catheters, and Patient Controlled Analgesia (PCA). The PCA is a machine that allows you to push a button to give yourself pain medicine whenever you are having discomfort. If you are interested in any of these methods, discuss it with your surgeon and anesthesiologist.

Family/Companion Instructions (Back to Top)

Before your operation:

• A family member or companion may accompany you to the ambulatory staging unit.
• Other family members or companions should check in with the receptionist in the surgery waiting room or main lobby of the hospital.

After your operation:

• Your surgeon will speak with your family or companion in the surgery waiting room.
• If you are an inpatient, your family will be informed by the surgery waiting room receptionist when you are going to your hospital room.
• If you are going home, your family member or companion will be able to see you when you return to the ambulatory staging unit area.

Questions at Home (Back to Top)

A nurse from the ambulatory staging unit will call you after your surgery. For problems or questions, see your discharge instruction sheet. Remember, if you have concerns or questions when you are at home, you can contact your physician.

Recovery at home (Back to Top)

Written instructions will be given to you. However, here are some general reminders:

• Limit your activities at home for at least 24 hours after your operation.
• Do not drive for at least 24 hours after your operation.
• Begin meals with clear liquids and progress to solid foods as they are tolerated.
• You may have some urinary retention and may not be able to urinate for 8 to 12 hours. If you feel uncomfortable and cannot urinate, call your surgeon.
• You may have minimal nausea.
• You may have some pain.
• The medication you received during your operation may affect your memory and mental judgment for 24 hours following anesthesia.

Avoid the following activities during this period:

• climbing ladders
• handling boiling water
• using electric appliances
• operating machinery
• signing legal documents, etc.

Postoperative Exercises (Back to Top)

Deep Breathing:
After any operation it is important to prevent the onset of pneumonia. You will need to deep breathe, cough, and turn at least every two hours. We realize that the discomfort caused by operating may make it hard to deep breathe and cough. The following suggestions may ease the discomfort.

How to Deep Breathe and Cough

1. Get into a comfortable sitting position.
2. After abdominal surgery, you may wish to hold your incision with a pillow or folded blanket.
3. Close your mouth and take in a very slow deep breath through your nose. Let your stomach swell out and inhale until your lungs feel full.
4. Breathe out very slowly through slightly parted lips, and press in your stomach.
5. Repeat this for two more breaths. After you breathe three times, cough three times in a row. Do not just clear your throat, cough down deep. Stick your tongue forward, and feel your stomach muscles tighten each time you cough. Do deep breathing and coughing exercises every two hours during the day and every four hours during the night until you are up and about.

Special Note:
Remember, no one can breathe or cough for you. Performing the breathing and coughing exercises after your operation is your part in getting yourself well. Frequent practice of these exercises before your operation will prepare you for this responsibility.

Exercising Your Legs The following leg exercises will help prevent blood clots and relieve aching legs and abdominal muscles.

How to Exercise Your Legs while in Bed:

1. Tighten the muscles in your calves. Relax. Tighten. Relax.
2. Push the toes of both feet forward. Relax both feet. Pull toes toward the chin. Relax both feet.
3. Rotate both ankles, first to the right then to the left. Repeat three times. Relax.
4. Lift your legs up and down.
5. Exercise your legs every two hours.

INPATIENT SURGICAL SERVICES

Parkwest's surgery department is designed to accommodate surgical patients of all complexity levels. A staff of surgical nurses and surgical technologists specially educated to provide comprehensive care for surgical patients. A full range of specialty procedures are supported, 24-hours per day, by scheduled staff or by on call teams. These staff members have full support of a dedicated surgical services management team, one of which is on call to the area 24- hours a day, 7 days a week. A full complement of anesthesia staff is also available to provide comprehensive anesthesia service support. All surgical specialties, with the exception of major pediatrics, are supported by this department.

The surgery department is comprised of twelve operating rooms and one cysto room. The operating room operates Monday - Friday, 7:30 a.m. - 11 p.m., and Saturday, 7:30 a.m. - 3 p.m. After-hours emergency cases are handled by on-call coverage available 24-hours a day, seven days a week. Comprehensive services and surgeries available include arthroscopy, general, GYN, laparoscopy, laser, neurological, open heart, orthopedic, ENT, plastic, thoracic, urological and vascular.

Pre-admission Testing
Location: First floor, Riverstone
Phone: 373-1421

Pre-admission testing is a part of the evaluation process for surgery patients that may include EKG, chest X-ray, lab work-ups and evaluation by an anesthesiologist. Hours of operation are Monday - Friday, 7 a.m. - 6 p.m.