Introduction
& About Your Surgery
Welcome to The New York
Eye and Ear Infirmary. We take pride in providing the highest quality care to
all our patients. This guide will provide important information on how to
prepare for your surgery, what to expect once you arrive, and how to plan for
your care after surgery. Your surgeon will talk with you about the type of
surgery you are having, and how long you are expected to stay in the hospital.
There are two types of
surgery. Inpatient surgery means that you will be admitted to
the hospital (usually on the same day of the procedure) and will remain in the
hospital after your operation for one, two or more days until you are ready to
go home. Outpatient surgery, also called ambulatory surgery,
means that you will go home the same day. Many of the patient instructions
will be the same for both types of procedures, as this booklet will describe.
Please take a moment to
read through this information. If you have any questions about your upcoming
surgery or your hospital stay, do not hesitate to ask your physician. Our goal
is to make your stay at The New York Eye and Ear Infirmary as pleasant and safe as possible.
Therefore, we ask that you take the time to read these instructions and
complete necessary paperwork and testing before arriving at the hospital. This
will help to minimize delays on the day of your surgery. Our health care team
is dedicated to ensuring your experience is a positive one.
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About
The New York Eye and Ear Infirmary The
New York Eye and Ear Infirmary (NYEE), a member of Continuum Health Partners,
Inc., is a specialty hospital uniquely qualified to handle the most
complicated cases. It serves as a national referral center with a commitment
to high-technology based patient care, teaching and research. The Ambulatory
Surgery Center of NYEE is designed to provide same day surgery in a setting
that is both comfortable and efficient, with advanced surgical equipment and
instrumentation. Over 20,000 ambulatory surgery procedures and 1,500 inpatient
surgeries are performed here each year. Founded
in 1820 with the mission of bringing eye care to the underserved of New York,
The New York Eye and Ear Infirmary of today offers services in Ophthalmology, Otolaryngology, and
Plastic and Reconstructive Surgery with an attending staff of more than 600
board-certified surgeons from all five boroughs and the tri-state region. In
addition to its heritage of quality patient care, NYEE is a center of
excellence in residency training and continuing medical education and is an
affiliated teaching hospital of New York Medical College.
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Continuum
Health Partners, Inc.
Continuum Health
Partners, Inc. brings together the outstanding clinical resources, commitment
to research and medical education, and strong service traditions of Beth
Israel Medical Center, St. Luke's and Roosevelt Hospitals, Long Island College
Hospital and The New York Eye and Ear Infirmary. As a partnership, Continuum
delivers inpatient care through nearly 3,100 beds located in seven major
hospital facilities in Manhattan and in Brooklyn. Continuum providers also see
patients in group and private practice settings and ambulatory centers in New
York City and in Westchester County.
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Patient
Policies Patient
Rights You
will be given a copy of the Patients' Bill of Rights, which explains your
rights as a patient according to New York State law. If you have not received
one, ask your physician's office, nurse or the registrar in Admitting for a
copy. The New York Eye and Ear Infirmary is compliant with all applicable rules, regulations and
laws regarding patients' rights. Patient
Safety Patients
play a vital role in making their health care safe. We urge you to get
involved in your care. Advance
Medical Directive The New York Eye and Ear Infirmary honors patients' advance directives to the full extent permitted by
law. These include living wills, health care proxies and oral statements. If
you have an advance medical directive, please bring it with you. An advance
directive enables you to give written or oral instructions to doctors and
other health care professionals regarding the type of medical care you would
want or name the person you would wish to make health care decisions for you
if you could no longer speak for yourself. Upon advance directive appointing a
family member or friend to make treatment decisions on your behalf, you should
discuss your intentions with the individual appointed to act on your behalf.
At the time of admission, you will receive a copy of the New York State health
care proxy form. No
Smoking Policy / Fire Safety The New York Eye and Ear Infirmary is a smoke-free environment. Smoking is prohibited by the staff,
patients and visitors in all areas of the hospital. As part of NYEE's
comprehensive safety program, fire alarms are tested routinely and fire drills
held regularly.
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Procedures
in Children
Hospitals can be
frightening places for children. In order to make your child's stay here as
smooth as possible, we ask that you follow these suggestions:
- Follow your doctor's
orders about not giving your child anything to eat or drink before
surgery. We realize this is very difficult with small children, but it is
essential in order to give them anesthesia and perform the scheduled
procedure safely. If your child does have fluids or food after the
recommended time, the surgery will have to be rescheduled.
- Please feel free to
bring one of your child's favorite toys to the hospital. It will help your
child feel more secure if he or she has a familiar toy for company.
- Only the parents or
one parent and one escort should accompany the child. Bringing other
relatives to the hospital may upset the child and also makes it difficult
for our staff to do their jobs.
- One person must stay
at the hospital during surgery. you will be allowed to be with your child
at all times on the unit and in the operating room before anesthesia. A
parents' waiting room is available for convenience and comfort. The
nursing staff will let you know as soon as you can rejoin your child in
the Peri Anesthesia Care Unit (PACU).
- For your child's
safety, we will not discharge him or her to anyone other than a parent or
legal guardian.
- If you are escorting
a child and driving, it is necessary to have a second adult present who is
free to give the help and attention that are needed to bring a child home
after surgery.
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Before
Your Surgery Speak
up if you have any questions or concerns about your health care. Consent
for Medical Procedures Your
surgeon will discuss the details of your operation with you prior to your
surgery. Please feel free to ask any questions regarding your procedure, and
follow your surgeon's advice before and after your surgery. Before any major
medical procedure can be initiated, you or an authorized member of your family
will be asked to sign a consent form. You are entitled to a full explanation
of your diagnosis, treatment plan and prognosis, as well as the risks,
benefits and alternatives associated with your care. If you do not understand
what is being recommended, or if you are uncertain about whether you want the
procedure, as your physician or nurse. Pre-Admission
Forms Your
physician will give you instructions an pre-admission forms. It is very
important that you complete these forms, and that your physician return them
to the Admitting Office at least 7 days before your scheduled surgery. If
additional information is needed, The New York Eye and Ear Infirmary Admitting Office will call
you. Presurgical
Testing A
complete set of instructions about your presurgical testing requirements will
be given to you by your doctor. NYEE requires your medical history and the
results of a physical examination completed within 30 days prior to the date
of your surgery. In some cases, you may need an EKG (also done within 30 days)
and /or a chest X-ray taken within the last six months. Your surgeon or
internist will arrange for your physical examination and any necessary
diagnostic tests. Your doctor may request same-day surgery testing. This will
be completed after your admission and prior to surgery. Insurance
Carrier Remember
to contact your insurance company 7 to 10 days prior to the date of surgery to
advise them of your scheduled surgery and to confirm coverage. You should
check for and verify any co-pays and/or deductibles you will have to pay at
the time of your admission. If you have any questions regarding your insurance
coverage, please call the Financial Screening Office at (212) 979-4311 or
4309. Interpreter
Services If
you need an interpreter, both foreign language and sign language interpreters
are available. Please call (212) 979-4306 if you need a foreign
language interpreter, or (212) 979-4473 if you need a sign language
interpreter. ADA-compliant
telephones can be made available to patients while in the
hospital. Please
notify the Admitting Office at (212) 979-4306 in advance. What
to Tell Your Physician In
order to assure your safe care, it is important for you to provide the
following information to your physician prior to surgery:
- Allergies: Do you
have any allergies to foods or medications or dyes used in diagnostic
tests?
- Latex allergy: Have
you ever reacted to latex products, such as gloves, rubber balloons or
other items?
- Do you take
medications regularly? This includes over-the-counter medications (e.g.,
aspirin and ibuprofen), herbal remedies (e.g., St. John's Wort),
nutritional supplements, pain medication and/or prescription medication.
Please know the name(s) and dosage(s) of these medication(s). Bring them
with you on the day of surgery.
- Do you smoke?
- Do you drink alcohol?
- Do you use
recreational or "street" drugs?
- Do you have other
health problems, such as diabetes, heart problems or high blood pressure?
- Have you had surgery
before?
- Have you had
anesthesia before? How did you react?
- Is it possible that
you are pregnant?
Nutrition
Counseling
When you are admitted,
you receive an assessment and nutritional screening. When indicated, you will
get a referral for a consultation with the Registered Dietitian. Your doctor
or nurse can also request nutritional counseling. A referral and appointment
are needed. Call the office of Nutrition and Food Service at (212) 979-4338.
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Preparing
for Surgery
Preoperative
Instructions
Your surgeon's office
may call you prior to the scheduled date or surgery to review your medical
history and preoperative instructions. If you have any questions or concerns,
please call our Ambulatory Surgery Center nursing staff at (212) 979-4360
or 4165, Monday through Friday, 7 am to 8 pm, or redial the main
switchboard at (212) 979-4000 and ask them to page the Nursing
Supervisor.
Please follow your
physician's instructions carefully. It is extremely important to understand
and follow these directions. They are for your safety. If these instructions
are not followed, it could result in the cancellation of your surgery.
- Do not eat or drink
after 12 midnight preceding surgery, unless instructed otherwise by your
physician. Do not suck on hard candy or lozenges.
- Tell us if you have
any allergies.
- If you take daily
medications, consult with both your internist and surgeon regarding
whether you should take them on the day of surgery, and if so, at what
time.
- Bring any medication
you may be taking with you in its prescription bottle.
- If you take
anti-depressants, anti-inflammatory medications (such as aspirin, Aleve,
ibuprofen or Motrin), or anti-coagulants, ask your physician if you should
stop them for a period of time prior to surgery.
- If you develop a
cough, cold or fever, please call your surgeon.
- Do not smoke or drink
alcohol 12 hours prior to an following surgery.
- Remove nail polish
and nail wrapping from all fingers prior to coming to the hospital.
- Do not apply any
makeup, cream or aftershave lotion the day of surgery.
- Please shower and
wash your hair the night before or the morning of surgery.
If Illness
Develops
If you develop a cold,
virus, sore throat or other illness during the week before your scheduled
surgery, please contact your physician immediately. Your physician will
determine whether your procedure should be rescheduled.
Escort
If you are coming in for
ambulatory surgery (i.e., going home the same day of the procedure), you will
require an escort to bring you home.
A Call to Confirm
If you have not been
contacted by 8pm the night before your surgery, please call the Admitting
Office at (212) 979-4306 up until 10 pm to receive your admission time.
What to Bring
Presurgical Forms
and Insurance Information - Please complete and bring with you all the
forms that you received in your physician's office, as well as your
insurance cards and/or forms.
Medications and
Allergies - Bring a list of all your medications, times taken and
dosages, as well as a list of allergies to medications, foods or other
substances. Bring your medications with you.
Advance Medical
Directive - Please bring any documents regarding advance medical
directives, such as health care proxy form and a living will.
Guardianship - All legal guardians of a
minor child under the age of 18, a mentally compromised adult or a foster
child undergoing surgery must bring all legal/court documentation verifying
his or her legal guardianship of the patient. Without legal proof of
guardianship, the surgery will have to be rescheduled. All court/legal
documents must be originals; copies will not be accepted. The originals will
be immediately returned to you.
Clothing
- If you will be staying
overnight in the hospital, bring an overnight bag with pajamas, robe, slippers
and toiletries.
If you are coming for
ambulatory surgery, we recommend that you wear casual, comfortable,
loose-fitting clothing that buttons or zips down the front and is easy to take
off and put back on after surgery. Shoes should be flat and without laces.
Valuables and
Personal Belongings - Leave all valuables and
jewelry, including wedding rings, at home since The New York Eye and Ear Infirmary cannot assume
liability for personal property. Limited locker space will be made available
for your belongings. NYEE is not responsible for items which are lost or
misplaced.
Dentures, contact
lenses, glasses and hearing aids may have to be removed prior to surgery.
Since these personal items can easily be misplaced, please keep them in
appropriate cases or containers (that won't be mistaken for trash) when not in
use and store them in your bedside table or give them to the person escorting
you. If requested, your nurse can provide special denture cups. Do not leave
your dentures and/or eyeglasses on your meal tray or bed.
Discharge Planning
As a part of your total
care, the team of physician, nurse, social worker and others evaluates the
kinds of care you may need after discharge. Your discharge plan may include
home health care services. A member of the team will make referrals to home
health agencies on your behalf. You may have a preference for, or prior
experience with, a specific home care agency, and may wish to utilize its
services, or your insurance company may have determined the agency for you. If
you do not have a preference, a member of the NYEE staff will make a referral
to an agency. We have no control over the quality of care given at these
agencies and neither recommend nor discourage your use of them.
Your participation in
your care planning is important and will help assure a positive outcome.
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Your
Surgery
Canceling a
Procedure
If you find yourself in
a situation that makes it necessary to cancel your surgery, please call your
physician as soon as possible.
Checking In
Please arrive on time
for your procedure to help avoid delays. All surgical patients should first go
to the Admitting Office Reception Desk on the first floor of the main building
at 310 East 14th Street. You will have a hospital identification (ID) bracelet
put on your wrist.
If you are coming for
ambulatory surgery, you will then proceed to the Ambulatory Surgery Center of
the fifth floor, North Building. After signing the register, you will be
directed to the waiting area. A nursing assistant will call you and take you
to the dressing room, where you will get a locker. You will be given a
hospital gown and robe to wear.
After you have changed,
the nursing assistant will take you to Area A, our pre-surgical area. A
registered nurse will assist you in all your needs. A medical consultant may
examine you if your surgeon has requested medical clearance. If presurgical
testing has not been done, the physician's assistant may perform a history an
physical. Electrocardiogram (EKG) and blood work may be done or repeated as
needed. You will also be seen by an anesthesiologist, if necessary. The
surgical site will be marked with an X by a nurse to avoid confusion.
We ask that your family
member, friend or escort wait in the TV room/waiting area. We will call them
if needed and will be happy to answer their questions. We strongly recommend
that you not bring children as we do not have facilities or personnel to
adequately supervise them.
Cafeteria
The cafeteria is open
6:30 am to 3 pm daily. It is located in the basement of the North Building.
For light snacks and beverages, there are vending machines available next to
the cafeteria at all hours.
Private Duty
Nursing
NYEE provides
professional staff to meet your clinical needs, but if you would like personal
nursing care to supplement the care by our staff during your hospital stay,
you may want to arrange for a private duty nurse. Private duty nurses are
engaged directly by patients or their families. These nurses are not employees
of The New York Eye and Ear Infirmary, but are hired through us from reputable outside agencies.
Please note, they do not provide care in the PACU (Recovery Room). To make
arrangements for private duty nursing, call (212) 979-4353.
Anesthesia
The anesthesiologist or
certified registered nurse anesthetist (CRNA) is responsible for your comfort
and well-being before, during and after your surgical procedure. Prior to
surgery, the anesthesiologist/CRNA will meet with you, if necessary, to
discuss your anesthesia and answer any questions you may have. If you have had
any experiences in the past with anesthesia, please inform the
anesthesiologist. In the operating room, the anesthesiologist/CRNA will manage
your anesthesia and monitor vital signs. In the Peri Anesthesia Care Unit (PACU),
the anesthesiology staff ensures that all patients remain stable following
surgery. There are several ways to administer anesthesia. The anesthetic
choice is related to your general condition and medical history, as well as
the surgery or procedure being done.
General Anesthesia
uses medicines to put you to sleep and medical gases to keep you asleep.
With this technique, anesthesiologists will often use medicines to relax
muscles and techniques that support your breathing.
Regional Anesthesia
means injection of medicine through a small needle to "numb"
specific areas of the body. Also known as a nerve block, an epidural or a
spinal.
Local Anesthesia
can provide loss of pain sensation over the areas where surgery is
performed. It may be combined with sedation to induce a light sleep.
Monitored
Anesthesia consists of local injections, as well as the use of
medications to make you drowsy (e.g., conscious sedation). You will be able
to communicate with the staff during this type of anesthesia.
Before going to the
operating room (OR), you may be given a sedative to help you relax. A nursing
assistant will then take you to the OR in a stretcher or wheelchair. If no
sedative is given, you will be able to walk to the OR with a nursing assistant
escort.
In the Operating
Room
Your surgeon leads the
OR team. Other team members usually include nurses, an anesthesiologist or
nurse anesthetist, and a surgical assistant. As a team, they provide a sterile
and safe surgical environment. If the OR feels cold, you can ask for a
blanket.
In preparation for the
procedure, an intravenous (IV) line will be started in an arm or hand vein.
This will be used to deliver medications and fluids during surgery. Vital
signs are monitored through a cuff placed on your arm to measure blood
pressure; pads placed on your chest will track your heart's function; and a
clip placed on your finger will measure the oxygen level in your blood. During
the operation, the blood pressure cuff will inflate automatically at intervals
and you will feel pressure on your arm.
Recovery / PACU
After your surgery, you
will be taken to the recovery room, also called the PACU (Peri Anesthesia Care
Unit), or to the Ambulatory Surgery Center, where you will be closely
monitored until the anesthesia wears off and you wake up. Your blood pressure,
pulse, temperature and breathing, as well as the area of your body where you
had surgery, will be checked.
You may feel drowsy and
cold, and you may have some pain, which is normal after surgery. The PACU or
Ambulatory Surgery Center nurses will take care of your needs and make you
comfortable. Once you are sufficiently awake, you either will be discharged
home if you are an ambulatory surgery patient, or you will be transferred to
your room in the hospital until you are well enough to go home.
You will be given simple
exercises to help in recovery. Taking deep breaths and coughing will help to
clear your lungs and prevent pneumonia. Walking and moving your legs will help
your circulation. Be sure to have someone with you the first time you get up
and until you feel steady.
Pain Management
The New York Eye and
Ear Infirmary is committed to recognizing and treating your pain using
medicines and treatments that will provide the best level of relief. As the
patient, you have valuable information to give the staff regarding your
pain. Remember that you know your pain best.
Always tell your
doctor, nurse or other staff member when you are having pain. Don't be
afraid to ask for pain medicine. Many people are so worried about
"getting hooked" or addicted that they don't talk about their pain
or take the medicines that are prescribed. In most cases, addiction is not a
concern and medicines can, and should, be taken to relieve pain. If you have
concerns about addiction, you should speak openly about them to your doctors
and nurses. Managing pain is an important aspect of getting well.
The nurses and doctors
will ask questions about the intensity (how strong), location, and the type
(throbbing, burning, aching) of pain you may be experiencing. We often ask
you to rate the intensity of pain using a pain scale. The pain scale is used
in evaluating the pain and also in evaluating the effectiveness of pain
medications or treatments. The pain scale uses numbers from 0 (no pain) to
10 (the worst pain possible) or pictures of faces that show various levels
of pain intensity.
It is helpful for you
to know that pain control is important in providing you with the comfort and
strength to heal and get well. We know that patients who have their pain
well-controlled generally tend to recover better and faster.
From Wong D. L.; Hockenberry-Eaton M.; Wilson, D.; Winkelstein, ML, Schwartz, P.; Wong's Essentials of Pediatric Nursing, ed. 6, St. Louis, 2001, Appendix H
Copyrighted by Mosby. Reprinted by permission.
You are being assessed
for pain when you can't speak for yourself -- such as in the OR and PACU --
with the FLACC Behavior Pain Scale. All children under for are also
monitored at all times with this scale.
At NYEE, we can
provide a variety of options in the prevention and management of pain. Some
of these options are:
- pain medication by
mouth (pills) or skin patch
- pain medicine given
by injection into a muscle
- pain medicine given
into a vein
- pain medicine given
through a Patient Controlled Analgesia (PCA) pump (The PCA pump is a
machine that contains pain medicine. It has a button that you can push
to give yourself a dose of pain medicine when you need it within the
limits ordered by your doctor.)
- regional
anesthesia: Local anesthetics and/or pain medicine is injected into an
area to relieve pain or numb a part of the body for a period of time.
There also are m
ethods
that can assist in the relief of pain that do not involve medicines, such as
relaxation techniques, hot or cold packs, rest, deep-breathing exercises,
proper positioning in the bed or chair, and distraction techniques such as
music, television and visitors. No matter which pain management therapy you
use, remember some important facts:
- Discuss pain
management therapy with your health care providers. Let them know your
allergies, previous experience with pain medicines, other medications
that you are taking and your health history.
- Tell the staff how
strong or severe your pain is. Let them know what makes it better and
what makes it worse.
- Ask for pain
medication when you need it or before doing an activity that may cause
pain - don't wait until the pain is too strong or out of control.
- Be sure your
identification band is checked before you are given the medication.
- Give the pain
medication time to work. Ask the staff when you can expect to feel some
relief from the pain.
- Use rest, deep
breathing and other non-drug treatments to help your pain.
- Tell the staff how
you are feeling. Let them know how effective the pain management therapy
is. Tell them if you are experiencing any unexpected or unacceptable
effects from your pain management therapy.
Your health care
provider knows how to assess and treat your pain. If you have any questions
or need further information, speak with your nurse or doctor.
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Going
Home
You will be discharged
from the Ambulatory Surgery Center according to your surgeon's orders and with
your escort accompanying you. If you live alone, you may want to arrange for
someone to stay with you on the first night after your surgery.
You will be given
written discharge instructions upon leaving The New York Eye and Ear Infirmary. Please follow these
instructions regarding the medication, rest, activity and diet and any other
after-care advice to help you recover faster, be more comfortable, and reduce
the risks of complications when you follow your doctor's orders.
Prescription
Medications
After surgery, your
physician will probably prescribe medications. These prescriptions may be
filled either at your neighborhood pharmacy or at The New York Eye and Ear Infirmary Pharmacy,
which is conveniently located in the outpatient area - first floor. It is open
from 9 am to 6 pm, Monday to Friday. You may pay for your prescriptions with
cash, personal check, MasterCard, VISA, American Express or Discover Card.
NYEE accepts most prescription plans. Please bring your prescription care with
you. Eye patients should note that many doctors prefer eye medications be
filled there because some pharmacies do not carry special medications.
Escorts
For your safety, a
spouse, friend or relative must accompany you when you leave the hospital. You
will not be admitted unless you have made proper arrangements for an escort
upon your departure. We cannot allow you to leave unescorted. If you need
assistance, please let us know in advance, and NYEE will be happy to refer you
to a private pay patient escort service.
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The
following information is designed to help you prepare for your stay at The New
York Eye and Ear Infirmary. If you have any questions regarding pre-operative
instructions, please call the Ambulatory Surgery Center at (212) 979-4360 or 4165, Monday - Friday from 7AM -
8PM. If you have questions regarding your insurance coverage, please call the
Financial Screening Office at (212) 979-4311 or 4309.