Your Hospital Stay

Day of surgery

Morning of surgery (before leaving home)

Take ONLY the medications that the preadmission nurse or preoperative physician has instructed you to take with the smallest sip of water.

Arrival at the hospital

Please arrive on time. Upon arrival, you will meet members of our team, and our staff will ask you to provide the name and cell phone number of your designated contact (likely your “coach”).

All four hospitals are equipped with free WiFi.

Lankenau Medical Center
100 Lancaster Avenue, Wynnewood, PA 19096
Come to the main hospital, Fankel Lobby. The registration desk will guide you to your destination.

Bryn Mawr Hospital
130 South Bryn Mawr Avenue, Bryn Mawr, PA 19010
Come to the warden lobby entrance (830 old Lancaster road) and proceed to the buck atrium to sign in at the registration desk. the surgical waiting area is on the ground level in the buck atrium.

Paoli Hospital
255 West Lancaster Avenue, Paoli, PA 19301
Come to the department of surgery desk in the atrium lobby. the atrium lobby is where you will check in.

Riddle Hospital
1068 West Baltimore Pike, Media, PA 19063
Come to whichever entrance you were instructed by the person who called you the day before surgery.

Checking into hospital

At check-in, you'll be escorted to the holding area, where you'll be for one to two hours. A nurse and anesthesia team member will:

• Discuss final preparations for surgery
• Measure your vital signs
• Have you remove your clothing and undergarments
• Cleanse your skin with antibacterial wipes and (depending on procedure being performed) swab your nose to prevent infection
• Change into a gown
• Place an intravenous line to administer antibiotic and pain medications

For safety, the surgeon will ask you to confirm your type of surgery (for example, shoulder replacement) and surgical site (for example, right shoulder), before marking the site and confirming your consent. You will meet with the anesthesiologist regarding your anesthesia options (general, interscalene block, etc.)

In the operating room

After surgical prep, you will be transported to the operating room where we will:

• Apply leads for monitoring
• Administer anesthesia

The surgeon will then perform the procedure. A member of the anesthesia team will monitor and remain with you during the entire procedure. At the completion of your procedure, you will be taken to the Recovery Room/Post Anesthesia Care Unit (PACU).

After surgery

After surgery you will meet the nurse who will care for you during your stay in the PACU. The nurse will:

• Apply monitors
• Take vital signs every five to 15 minutes
• Make sure you can feel your hands and wiggle them
• Monitor your pain level (on a 0–10 scale)
• Medicate you as needed

Addressing your pain: Staff will use a 0–10 scale to assess your pain level

If you are staying overnight, you will be taken to your new room after you recover from anesthesia. You will be cared for by an entire team of professionals under the direction of your surgeon. After surgery, you may be seen by the surgeon, resident, nurse practitioner and/or physician assistant to monitor and assure the best possible recovery and care from your surgery. The surgeon will update your coach after your surgery while you are in PACU.

In your room

When you arrive in your room you will:

• Receive a nursing assessment
• Your vital signs will be taken more often initially after surgery, then less often as you become more awake and alert
• Be given clear liquids and advanced to solid food as per your surgeon
• Be asked about pain

Your nurse will partner with you to always control your pain using the pain scale (0–10) as was done in the recovery room. The nurse will also assess your surgical dressing, drains and pumps, and orient you to your room and unit (for example, the nurse call light).Members of the care team will instruct you on how to perform exercises that will speed your recovery.

In your room you will also do exercises, such as:

• Ankle pumps: 10 times each hour while awake
• Cough and take deep breaths: 10 times each hour while awake
• Incentive spirometer exercises: 10 times, every hour while awake

Fluid can collect in the lungs after any surgery. Using the spirometer will help you breathe in and out correctly. The staff will instruct you on how to use this effectively.

Members of the care team will be visiting you frequently throughout your stay to check on your well-being and comfort.

Post-surgery

Pain medication and monitors

You may be connected to a monitor to ensure you are breathing fully. In order for you to be comfortable and start the recovery process you will receive different types of pain medications after surgery. Pain is to be expected. For some, pain begins as anesthesia wears off later on the day of surgery, but for others pain may increase the day after surgery. Pain is a normal part of healing after surgery caused by surgical inflammation. It varies for everyone, but all will have some amount of discomfort after as anesthesia wears off, so it is important to prevent pain from worsening.

The first 72hrs are crucial for managing your comfort and keeping pain low enough so that you are still able to move and follow your exercise program. While some pain is normal, too much pain will prevent you from doing your exercise program and will limit your healing/recovery potential. Some patients try to avoid stronger pain medications for several reasons. However, this early period after surgery and surgical type of pain is what they are used for. By taking it in advance of worsening pain, patients find they are in better control of pain from the start and may need less medicine overall.

Patients after surgery will be on a combination of medications that are referred to as a multi-modal pain management approach. You will be sent home with prescriptions that will vary in purpose. You will also be instructed to take some over the counter medications that are generally safe and help relieve pain in different ways. You will be given instructions on how and when to these medications.

Following the first 72 hours, many patients will notice pain and the need for pain medication will start to lessen slightly each day. You will not need it as frequently or regularly as right after surgery and will be able to wean or use less. Many surgeons expect their patients to be off of all opioids as soon as they no longer need them typically within the first several weeks.

Preventing blood clots

Early walking after surgery is key to preventing blood clots. The nurses and physical therapists will assist you with walking after your surgery.

• Your surgeon may or may not recommend medication for prevention of blood clots. Be sure to follow your discharge instructions.
• Your surgeon may or may not order the use of sequential compression devices (SCD) to reduce blood clot formation.

What you might need after surgery

Based on your physician's protocol, you MAY also have any of the following:

• Oxygen therapy via nasal cannula or mask
• Incision covered with a dressing
• Blood pressure monitor
• Pulse oximeter and or carbon dioxide monitor
• Drain at surgical incision—reduces swelling, drains residual blood and will generally be removed as per your surgeon's orders prior to discharge
• Sling to immobilize and protect your surgical arm

Hand washing and hygiene

• To minimize the risk of infection, we encourage good hand hygiene and other sanitary practices. After your procedure, we encourage you to:
• Remind doctors, nurses and caregivers to wash their hands.
• Wash your hands after going to the bathroom and before and after eating. Cleanliness is key. Ask for help if needed!
• Wash your hands before and after therapy.

Physical and occupational therapy

A therapist or a nurse will have you up and walking the day of surgery. A therapist will perform exercises the day after surgery at surgeon's recommendation. Studies have shown, that this early activity results in better recovery outcomes and returns patients home sooner with greater independence. This helps us keep you safer from surgery complications and the risks of being in a hospital longer than necessary.

Therapy will occur once daily, beginning on the day after surgery to help you recover your mobility, strength, range of motion and independence.

Therapy will include:

• Moving in bed
• Standing up from a chair, bed or toilet, and transferring in and out of seats
• Climbing stairs
• Walking 50-200 feet
• Bathe, groom and get dressed
• Get in and out of a car

You may or may not need a sling or immobilizer after surgery. Your surgeon will inform you if one is required. If it's required, the staff will instruct you on the correct application and wearing of it.

After surgery, you will be given specific instructions regarding your activity restrictions depending on the type of surgery you had performed.

Therapists will educate you about equipment, if needed, to help you resume normal activities. This may include equipment such as a reacher to pick up things off the floor along with other long-handled devices. They will also educate you on any motion you are allowed to do with that surgical arm, and any precautions from your surgeon.

Discharge planning

The responsibility of the care manager is to work with your treatment team to plan for a safe discharge from the hospital to home. The discharge planner works in your best interest with your health insurance company to obtain authorization and arrange services and equipment you may need immediately after discharge upon going home. This person also communicates with your physicians, nurses and therapists about your medical progress.

Many factors determine your individual recovery and equipment needs:

• General medical condition
• Progress in meeting occupational/physical therapy goals
• Ability to manage the activities of daily living such as bathing, dressing, steps, and transfers in and out of a car
• Home environment
• Insurance guidelines

Timing of discharge varies depending on the type of shoulder surgery you have had. There are several things that need to happen medically and physically to make sure you are safe to discharge. Upon discharge, you should expect to go home to continue your recovery.

When you go home

Make a follow-up appointment with your surgeon. Please call to arrange if an appointment is not already listed on your discharge instructions or papers from your surgeon's office.

Follow discharge instructions for post-op primary care appointments. You'll receive instruction on activity restrictions, new medications/prescriptions and when to safely restart home medications and over the counter medications. Information about homecare visits or outpatient therapy (if required by your surgeon) may also be found on these instructions.

Have someone pick up any home medications and new prescriptions. Once home you may want to have someone stay with you or be available to check on you for the week following surgery.

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