Even with a pullback in the pandemic, hospitals are a scary labyrinth of bureaucracy and dangers. New systems such as electronic health records and “hospitalists” theoretically improve things but are far from infallible. Steps to take whether you are going for a planned surgery or other procedure…
Presurgery/Preprocedure Consult
This crucial meeting gives your doctor information about you and your medical history to help your procedure go well and informs you about how to best prepare for it. It typically is held about one week before…but schedule it farther out if you have a serious medical problem, such as COPD or uncontrolled blood pressure or blood sugar. At this meeting…
Review the hospital’s electronic health record (EHR), updating your current medication and supplement list as well as filling in missing information, such as an omitted specialist, dietary restrictions and emergency contacts.
Bring a written snapshot of your medical history. This information may not be in your EHR if the doctor doing the surgery or procedure, the hospital/surgical center and your primary medical doctor are not all in the same network. Include…
Smart: Also bring copies of this snapshot to the hospital for your anesthesiologist and other medical personnel.
Ask these key questions at this procedure consult…
Can I have an early-morning time slot? The operating staff will be fresher, and you’ll have less time to feel hungry or anxious. Also, avoid scheduling surgery in July, when new med-school grads begin their hands-on hospital learning.
Which medications and supplements should I take the morning of my procedure? And how far in advance should I stop others, such as low-dose aspirin, blood thinners or fish oil, due to bleeding concerns? Don’t start anything new to avoid potential interactions with medications you’ll be given at the hospital.
Should I donate blood in case I need a blood transfusion? This will depend on whether you’re healthy enough to do so and the potential for blood loss.
What will my recovery be like? Ask for an honest assessment of the healing process…whether you’ll need special rehab or equipment at home…and any likely side effects.
Am I a candidate for bupivacaine (Exparel)? This local, time-released anesthetic injection now is approved for use during many surgical procedures. It may eliminate the need for post-op opioids.
What is the hospital/facility policy regarding patient advocates or companions? Having someone with you is ideal, but in this time of COVID-19, many facilities allow only the patient to enter.
Getting Ready
You know not to drink alcohol the night before a surgery and often you can’t eat after midnight. It’s also important not to overeat. You don’t want bloating and discomfort to spoil your sleep. Your stress levels will be much higher if you don’t rest well the night before.
Skip all cosmetics and skin-care products the morning of the procedure. Makeup could get on the surgical team’s gloves and into your body. Nail polish could prevent a fingertip pulse oximeter from accurately measuring the oxygen in your blood. Body lotion could keep surgical tape from adhering. Note: If your skin is thin or frail, ask that paper tape be used.
Pack smart. For better sleep—thereby better healing—bring eyeshades, ear plugs, your favorite pillow and a white-noise machine. Personal items, from body wash and lip balm to a tablet computer loaded with books and other diversions, can make the hospital stay less unpleasant. Bring throat lozenges to soothe any soreness from the breathing tube during sedation. Many people feel nauseous after surgery, so consider a wearable antinausea device such as Relief Band or ginger supplements (get the doctor’s OK before using).
At the Hospital
During check-in, review your EHR again. Yes, it’s redundant but still worthwhile.
When you meet with your anesthesiologist before your procedure, alert him/her to reactions you’ve had to narcotics such as sedatives, your typical pain threshold and any allergies. The more information you provide, the better he can tailor your anesthesia. Ask about possible side effects and how to get relief. Make him aware of loose teeth, crowns and other dental work, and if you’re used to sleeping with your head on two or more pillows—lying flat for a long time could cause breathing difficulties.
After Your Procedure
Answering the same questions every time a staff member enters your room is tedious but helps avoid mistakes, including administering wrong tests and medications. To stay on top of your care…
Get to know your care givers. Hospitalists are doctors who work exclusively for the hospital and may be responsible for your post-op care rather than your primary doctor. Chances are you won’t meet the hospitalist until you’re in your hospital room. Some hospitals rotate hospitalists, so you may have more than one. Engage doctors and staff in pleasant conversation so that they relate to you as a person rather than by your ailment.
There are more staffing shortages than ever before, and some tasks may have been offloaded to untrained nurse assistants—their badges might read “patient care associate” or “patient care partner.” Make sure that only qualified nurses insert IVs, catheters and gastric tubes, change sterile dressings, treat damaged skin and give injections.
Don’t be shy. When an unfamiliar staffer enters your room, check his/her badge and ask about his credentials and why he’s there. If you have a legitimate concern, politely but firmly say, “I’d like to speak with my doctor first to be sure this is something I’m supposed to have.”
Confirm that you’re getting the right doses of the right meds—generics of your daily medications can look different from what you take at home. Any time you’re given a medication, ask what it is and why. Also, remind the doctor or nurse about any allergies. Write down the drug name, dosage and frequency for your records.
If many doctors are involved in your care, when one orders a major procedure or changes your treatment, make sure the hospitalist(s) and your own doctor are notified.
Watch when your dressings are changed so you’ll know how to care for yourself at home.
Ask if telemedicine can be used to contact specialists at other institutions if your case needs an expert consult and also for your follow-up visits.
Transition to recovery at home as soon as you can. Even before COVID-19, hospitals were hotbeds of germs. A silver lining of the pandemic is that many safety practices, such as frequent handwashing, single-use gloves, gowns and face masks or shields are now standard, but ask all staff to follow these measures if they aren’t.
