Information for patients having an operation / procedure as an inpatient

Information for patients from Day Surgery

Contents

Having an operation as an inpatient (under a general or local anaesthetic)

If you will be having a general anaesthetic or sedation

If under local anaesthetic without sedation you may take light refreshment up until coming into hospital.

Preassessment teams

What will happen at my preassessment appointment?

Before the date of your operation, you may be asked to attend for preassessment. It is important to attend as failure to do so may result in your operation being cancelled.

You may be booked for a telephone preassessment. Please check your letter which will advise you either to attend or be available for a call.

At preassessment you will be seen by a nurse who will discuss your medical history with you and assess your fitness in preparation for your operation. The nurse will need to know:

On the day of surgery, please bring the following with you:

Please do not bring

What should I do before the day of my operation?

Please ring the Waiting List Office or the unit where you are booked to attend (Surgical Admissions Lounge or Day Surgery Centre) as soon as possible if you will NOT be attending. This will allow us to offer the place to another patient.

If you develop a cough, cold, sore throat, other illness, or become pregnant, you must ring the unit where you are booked to attend (Surgical Admissions Lounge or Day Surgery Centre) to let them know.

If anything changes with your medical history please contact your preassessment team.

What happens when I arrive at hospital?

The photo’s in this booklet show the location of the Day Surgery Centres and Surgical Admissions Lounges.

If you are having a general anaesthetic, the anaesthetist will put a small plastic tube (called a cannula) into a vein in your hand or arm. For further information about your anaesthetic, please go to the You and your anaesthetic section of this booklet.

Use this time to ask hospital staff any further questions or raise concerns. Please note you have the right to withdraw your consent for treatment at any time.

Smoking - please try not to smoke for at least 48 hours before your operation.

What should I do before surgery?

This will depend on the type of surgery you are having. You will be given the necessary information at your preassessment appointment.

What should I do to prepare for my operation?

What happens after my operation?

If you have a general anaesthetic you will be taken to the recovery room, which is next to the operating theatres, where you will be looked after by a recovery nurse. Whilst in the recovery area your blood pressure will be taken several times.

How will I feel after my general anaesthetic?

Some people may feel wide awake straightaway, while others feel sleepy for several hours. Some people may feel sick. If sickness is severe you may be given an injection to treat this. You may have a sore throat.

How soon after my operation can I fly?

Please advise the preassessment team of these plans so that the correct advice can be given.

If you have a general anaesthetic

Channel Day Surgery Centre and the Surgical Admissions Lounge, William Harvey Hospital, Ashford

Photo of the entrance to the Channel Day Surgery Centre
Channel Day Surgery Centre entrance

Day Surgery, Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate

Photo of St Peter's Road entrance to QEQM hospital
St Peter's Road hospital entrance, QEQM
  1. Photo of the stairs, just inside the St Peter's Road entrance doors, that go up to Day Surgery at QEQM
    Stairs to Day Surgery
  2. Photo of the entrance doors to Day Surgery at QEQM
    Day Surgery entrance

Surgical Admissions Lounge, QEQM Hospital, Margate

Enter through the Ramsgate Road entrance and follow the signs for the Surgical Admissions Lounge. If in doubt, ask a member of the reception staff for help.

  1. Photo of the Ramsgate Road entrance to QEQM
    Ramsgate Road hospital entrance
  2. Photo of the entrance to the Surgical Admissions Lounge at QEQM
    Surgical Admissions Lounge QEQM entrance

Canterbury Day Surgery Centre, Kent and Canterbury Hospital, Canterbury

Photo of the entrance to Orthopaedic Centre and Day Surgery Centre at Kent and Canterbury Hospital
Orthopaedic Centre and Day Surgery Centre, Kent and Canterbury Hospital

Surgical Admissions Lounge, Kent and Canterbury Hospital, Canterbury

Enter the hospital through the Fracture Clinic entrance, which is next to the the Urgent Treatment Centre. Follow the corridor to the end, turn left and the entrance to the Surgical Admissions Lounge is on your left.

fracture-clinic-entrance-(1)-1692174181.JPG
Entrance to the Surgical Admissions Lounge through the Fracture Clinic entrance

About the consent form

Before a doctor or other health professional examines or treats you, they need your consent. Sometimes you can simply tell them whether you agree with their suggestions. However, sometimes a written record of your decision is helpful – for example if your treatment involves sedation or general anaesthesia. You will then be asked to sign a consent form. If you later change your mind, you are entitled to withdraw consent – even after signing.

What should I know before deciding?

Health professionals must make sure you know enough to enable you to decide about treatment. They will write information on the consent form and offer you a copy to keep as well as discussing the choices of treatment with you. Although they may well recommend a particular option, you are free to choose another. People’s attitudes vary on things like the amount of risk or pain they are prepared to accept. That goes for the amount of information too. If you would rather not know about certain aspects, discuss with whoever is treating you.

Should I ask questions?

Always ask anything you want. As a reminder, you can write your questions in the space at the back of this leaflet. The person you ask should do his or her best to answer, but if they do not know they should find someone else who is able to discuss your concerns.

To support you and prompt questions, you might like to bring a friend or relative. Ask if you would like someone independent to speak up for you.

Is there anything I should tell people?

If there is any procedure you do not want to have, you should tell the people treating you. It’s also important for them to know about any illnesses or allergies which you may have or have suffered from in the past.

Who is treating me?

Amongst the health professionals treating you may be a “doctor in training” – medically qualified, but now doing more specialist training. They range from recently qualified doctors to doctors almost ready to be consultants. They will only carry out procedures for which they have been appropriately trained. Someone senior will supervise – either in person with a less experienced doctor in training or available to advise someone more experienced.

What about anaesthesia?

If your treatment involves general or regional anaesthesia (where more than a small part of your body is being anaesthetised), you will be given general information about it in advance. You will also have an opportunity to talk with the anaesthetist when he or she assesses your state of health shortly before treatment. Hospitals sometimes have pre-assessment clinics which provide patients with the chance to discuss things a few weeks earlier.

Will samples be taken?

Some kinds of operation involve removing a part of the body (such as a gall bladder or a tooth). You would always be told about this in advance. Other operations may mean taking samples as part of your care. These samples may be of blood or small sections of tissue, for example of an unexplained lump. Such samples may be further checked by other health professionals to ensure the best possible standards. Again, you should be told in advance if samples are likely to be taken.

Sometimes samples taken during operations may also be used for teaching, research, or public health monitoring in the interests of all NHS patients. The NHS trust treating you will have a local system for checking whether you are willing for this to happen.

Photographs and videos

As part of your treatment some kind of photographic record may be made – for example x-rays, clinical photographs, or sometimes a video. You will always be told if this is going to happen. The photograph or recording will be kept with your notes and will be held in confidence as part of your medical record. This means that it will normally only be seen by those involved in providing you with care or those who need to check the quality of care you have received.

The use of photographs and recordings is also extremely important for other NHS work, such as teaching or medical research. However, we will not use yours in a way that might allow you to be identified or recognised without your express permission.

What if things do not go as expected?

Sometimes things do not go as they should. Although the doctor involved should inform you and your family, often the patient is the first to notice something amiss. If you are worried – for example about the after-effects of an operation continuing much longer than you were told to expect – tell a health professional right away. Speak to your GP, or contact your clinic - the phone number should be on your appointment card, letter, or your copy of your consent form.

What are the key things to remember?

It’s your decision! It is up to you to choose whether or not to consent to what is being proposed. Ask as many questions as you like, and remember to tell the team about anything that concerns you or about any medication, allergies, or past history which might affect your general health.

Possible questions to ask health professionals

As well as giving you information health professionals must listen and do their best to answer your questions. Before your next appointment, you can write some down in the space at the back of this leaflet.

Questions may be about the treatment itself, for example:

Questions may also be about how the treatment might affect your future state of health or style of life, for example:

You and your anaesthetic

This leaflet gives information to help you prepare for your anaesthetic. It has been written by anaesthetists working together with patients and patient representatives. It also shows you where to find other information that might be helpful.

What is anaesthesia?

Anaesthesia stops you feeling pain and unpleasant sensations. It can be given in various ways and does not always need to make you unconscious. There are different types of anaesthesia, depending on the way they are given:

Local anaesthesia involves injections that numb a small part of your body. You stay conscious but free from pain.

Regional anaesthesia, e.g. a spinal or epidural, involves injections that numb a larger or deeper part of the body. You stay conscious or receive some sedation, but are free from pain. For some surgery you may be aware of pressure sensations.

General anaesthesia gives a state of controlled unconsciousness. It is essential for some operations and procedures. You are unconscious and feel nothing.

Sedation gives a ‘sleep like’ state and is often used with a local or regional anaesthetic. Sedation may be light or deep and you may remember everything, something or nothing after sedation.

For more information about sedation, please see our Sedation explained leaflet.

Anaesthetists

Anaesthetists are doctors with specialist training who:

You may also meet Anaesthesia Associates who are highly trained healthcare professionals.

Before coming to hospital

There is much you can do to prepare yourself for surgery and the recovery period.

Our Fitter Better Sooner resources will provide you with the information you need to become fitter and better prepared for your operation.

Starting the anaesthetic

Your anaesthetic may start in the anaesthetic room or in the operating theatre. Your anaesthetist will be working with a trained assistant. The anaesthetist or the assistant will attach leads to machines to measure your heart rate, blood pressure and oxygen levels and any other equipment as required.

A cannula, a small plastic tube inserted in your vein with a needle, is used to start most anaesthetics in adults, including a local anaesthetic. All drugs can then be given into your veins using the cannula. If you have any concerns about this, please talk to your anaesthetist.

Local and regional anaesthetics

If you are having a local or regional anaesthetic:

General anaesthetics

There are two ways of starting a general anaesthetic:

The recovery room

After the operation, you will usually be taken to the recovery room. Recovery staff will make sure you are as comfortable as possible and give any extra medication you may need. When they are satisfied that you have recovered safely from your anaesthetic and there is a bed available, you will be taken back to the ward.

Pain relief after surgery and at home

For information on pain relief after surgery, please go to the How will my pain be managed? section of this leaflet.

Risk and anaesthesia

For more information on the common events and risks that healthy adult patients of normal weight face when having a general anaesthetic for routine surgery (specialist surgeries may carry different risks), please go to the Royal College of Anaesthetics website.

Modern anaesthetics are very safe. There are some common side effects from the anaesthetic drugs or the equipment used, which are usually not serious or long lasting. Risks will vary between individuals and will depend on the procedure and anaesthetic technique used.

Your anaesthetist will discuss with you the risks that they believe to be more significant for you. There are other less common risks that your anaesthetist will not normally discuss routinely unless they believe you are at higher risk. These have not been shown in this leaflet.

How will my pain be managed?

How much pain will I have?

The amount of pain you feel will depend on many things such as the kind of operation, injury, or illness you have. A certain amount of pain or discomfort may be expected and it is usually not possible to relieve all pain. As healing takes place the level of pain should reduce. Our aim is to provide enough pain relief to make you comfortable and prevent complications.

Is pain relief important?

Yes. As well as making you more comfortable good pain relief may help you to recover more quickly. If you are comfortable you will be able to take deep breaths, cough, and sleep better. Also if you are able to move around you are less likely to get blood clots in your legs. Please do not be tempted to cope by lying still, taking only shallow breaths, and not coughing as this may (in a short time) cause a chest infection.

So please, do let the ward nurses know if you are in pain so that it can be treated.

How will my pain be managed?

Your doctor and nurse will discuss a plan for managing your pain with you that is suited to your individual needs. You should let them know if you already take regular painkillers or have had problems with painkillers in the past, such as allergies or stomach upsets.

Painkillers will be prescribed to be given regularly or when you tell your nurse that you are in pain. The nursing staff will assess your pain regularly and will ask you if the pain you feel is mild, moderate, or severe. The Pain Assessment Score we use is shown below.

0 = No pain

1 = Mild pain

2 = Moderate pain

3 = Severe pain

What painkillers might I be offered?

Painkillers may be given by mouth (oral), injection, suppositories, Patient Controlled Analgesia (PCA) pump, epidural infusion, or nerve block. You may be prescribed a combination of painkillers as research shows this may give better pain relief.

Will I suffer any side effects?

All drugs including painkillers may cause side effects in some people. Painkillers may cause sickness, constipation, drowsiness, dizziness, itchiness, and confusion. If epidural or nerve block is used for pain control, sensations of weakness, numbness, or ‘pins and needles’ may be felt.

Please tell your nurse or doctor if you experience side effects. Your painkiller may need to be changed or medication given to treat any side effects.

Some people worry that they will become addicted if they take strong painkillers. When used appropriately for a short time this is very unlikely.

You may go home on morphine-type painkillers following your operation. It is important that you reduce and then stop these medications as soon as possible as their continued use can cause you significant harm.

When should I have painkillers?

Research shows that taking painkillers regularly provides better pain relief as the level of drug in your body remains more constant. We would advise you not to try and do without your painkillers unless you are comfortable and able to take deep breaths, cough, and move about.

Please do not wait until your pain is severe before asking for painkillers.

You do not have to wait until the drug round is due.

What can I do to help myself?

What else can I do to help myself?

Regular periods of relaxation are very beneficial as they reduce anxiety and ease muscle tension which can reduce your pain. Also, distracting your attention away from your pain can make pain more bearable.

Reading, listening to music, watching television, chatting to fellow patients, or doing crosswords are just a few distraction suggestions.

The following relaxation tips may help.

Avoid areas which have undergone recent surgery or injury.

How will my pain be managed when I go home?

You may be given some painkillers to take at home. Your nurse will explain how and when these should be taken. If you need more painkillers or your pain worsens you should contact your GP.

Where can I get more information?

Preventing a blood clot whilst you are in hospital

This section discusses the risks of having a blood clot whilst you are in hospital and outlines what you and your doctor can do to reduce this risk

What are deep vein thrombosis (DVT) and pulmonary embolism (PE)?

Deep vein thrombosis (DVT) is the name given to a blood clot which forms inside a vein, usually in the deep veins of the leg, and blocks the flow of blood. This can cause the leg to become painful and swollen.

Pulmonary embolism (PE) occurs when a fragment of blood clot in a leg breaks loose and becomes lodged in a blood vessel in the lungs. This is a potentially serious condition which can cause pain, breathlessness, and a lack of oxygen in the blood.

Collectively deep vein thrombosis and pulmonary embolism is known as venous thromboembolism or VTE.

Am I at risk of developing VTE whilst in hospital?

As part of your admission to hospital your healthcare professional will consider a series of questions. These questions are about factors that are particularly associated with the development of VTE.

Questions they may ask:

What can I do to reduce the risk of developing VTE?

If you can start before your planned admission to hospital.

What will be done when I come into hospital?

Your clinical team will assess your risk of VTE and will discuss with you what will be done to reduce your risk of developing a VTE.

The risk assessment will be done as soon as possible after you come into hospital or in the preassessment clinic, if you are having a planned procedure.

The nurse or doctor carrying out the assessment will ask you about all the risk factors already mentioned - your individual risk factors.

They will also look at:

In addition to your individual risk factors, the type of surgery you are having will also determine the treatment you receive to reduce your risk of VTE.

What treatment will I be given to reduce the risk of VTE?

The treatments recommended for you will depend on the result of your risk assessment and will be discussed with you by your doctors. These may include the following.

  1. Medication

    You may be given drug treatment to stop your blood from clotting too quickly; these medicines are called anticoagulants. You may be treated with heparin injections such as enoxaparin or with anticoagulants taken in tablet form called rivaroxaban or apixaban. If you already take an anticoagulant medication such as warfarin, your doctor will talk to you about what anticoagulation treatment is suitable for you while you are in hospital.

    Some heparins contain animal products, if you are concerned about having animal products, please let your doctor know. Anticoagulants can increase the risk of bleeding, so please discuss with your doctor what to look out for.

  2. Special stockings

    These are called anti-embolism stockings (AES). They have been shown to reduce the risk of DVT by reducing swelling and preventing blood from collecting in the veins.

    Anti-embolism stockings are not recommended for people who have:

    • poor circulation (Peripheral Vascular Disease)

    • loss of feeling in their lower legs (Neuropathy)

    • leg ulcers

    • had a recent skin graft

    • extreme deformity of their legs

    • very swollen legs; or

    • have had an acute stroke.

Let staff know if you have any skin allergies.

How are anti-embolism stockings fitted in hospital?

AES should be fitted, so before wearing stockings staff should take your measurement for below knee stockings and thigh measurement if measuring for thigh length stockings.

Measuring for correct stocking size

  1. Diagram showing the distance around an ankle being measured with a tape
    Around your ankle (below knee stockings)
  2. Diagram showing the distance around an ankle and the thigh being measured
    Upper thigh (thigh length stockings)

How do I put my stockings on?

  1. Diagram showing putting the stocking over your ankle and easing the fabric up your leg, avoiding dragging the stocking against your skin
    A
  2. Diagram showing a patient smoothing out any excess material causing creases at the foot, by pulling the open toe section of the stocking forward
    B
  3. Diagram showing a patient pulling the stocking up over their calf, making sure they smooth out any wrinkles that appear, and that the band at the top is smooth and not rolling over
    C

It is important not to roll the stocking down your leg or to fold the toe section back on itself. This can reduce the blood flow in your legs and put you at risk of developing a blood clot in your leg.

Special points to note about your stockings

How do I remove my stockings?

Pull down from the top of the stocking, down your leg and then over your heel and foot. This will leave the stocking inside out - turn the stocking back to its right side before refitting.

3. Foot or leg pumps

These are called intermittent pneumatic compression (IPC) and have also been shown to reduce the risk of DVT by gently compressing your leg. This increases blood flow and stops blood pooling in your leg to create clots.

leg-pump-1692341650.jpg
Photo of a leg pump being used

IPC sleeves are not recommended for people who have:

Your legs should be measured before fitting to make sure the correct size sleeves are used. The sleeve should fit snugly round your leg or foot but you should still be able to get two fingers under it.

Special points to note about foot or leg pumps

How can I help myself while in hospital?

What should I do when I return home?

How do I care for my stockings at home?

What symptoms of DVT and PE should I look out for and what should I do if I get them?

Symptoms of DVT

Symptoms of PE

Pre-admission screening for surgical patients regarding Methicillin Resistant Staphylococcus aureus (MRSA)

What is Staphylococcus aureus (SA)?

Staphylococcus aureus (SA) is a common bacteria (germ) which can often be found in healthy people. It is carried harmlessly on the skin or in the nose of about 20% to 30% of people without causing infection, a state known as colonisation or carriage. It may, however, cause infection and is the commonest cause of minor skin infections.

What is Methicillin Resistant Staphylococcus aureus (MRSA)?

There are many different strains of Staphylococcus aureus and as a result of the widespread use of antibiotics, strains resistant to the more commonly used antibiotics have emerged. These are known as Methicillin Resistant Staphylococcus aureus (MRSA). MRSA may be carried harmlessly on the skin or in the nose and people may carry MRSA for varying lengths of time without ill health and be unaware of it. Approximately 80% of people who acquire MRSA are carriers.

What will happen if you have MRSA?

Simple swabs from your nose and groin will identify if you are a carrier of MRSA. If you have MRSA you will be prescribed a course of treatment (nasal gel and body washes) before your surgery. This course of treatment reduces the number of MRSA bacteria on your body for the time of surgery and will therefore reduce the risk of wound infection due to MRSA. It is important to understand that MRSA is sometimes difficult to clear completely from the body and may return in the future.

The Infection Prevention and Control Team recommend that it is not necessary to obtain clear (negative) swab results before your surgery or indeed cancel the operation. However, the timing of your surgery may be delayed to make sure your course of treatment is completed.

When you are admitted to hospital for your operation, if you have MRSA you may be nursed in a single room which will help to prevent bacteria spreading to other vulnerable patients.

Further information for those found to be carrying MRSA will be provided by nursing and medical staff as appropriate.

Day Surgery Helplines

Only ring your own GP if you cannot contact us