Before and During My Surgery

My Pre-Admission Clinic Visit

Your visit to the Pre-Admission Clinic is a very important part of preparing you for surgery.

Come with a friend or family member. They can help you remember information or ask questions during your Pre-Admission Clinic visit.

Please call the Pre-Admission Clinic office if you have any questions or if you have to cancel your appointment:
TGH: 416 340 3529
TWH: 416 603 5379

What can I expect during my Pre-Admission Clinic visit?

1. Your Pre-Admission Clinic visit will be completed over the phone with the Toronto General Hospital or Toronto Western Hospital. Your visit may last up to 3 hours or longer if you have several medical conditions, or need other tests.
2. As a first step, a registered nurse will do a complete check of your health over the phone. Depending on your health history, other health care professionals may also see you or call you.
3. After your initial assessment, you may have to come to the hospital for tests such as:
   • Blood work
   • ECG (Electrocardiogram or a recording of your heartbeat)
   • Chest x-ray
   • Swab for COVID-19 Screening

These tests may also be done in the community at a local blood lab if your doctors request this.

We will screen you for:

COVID-19

COVID-19 is a new coronavirus that can cause severe respiratory illness. You need to self-isolate at home until your surgery day. We will screen you for any symptoms or risk factors and test you for COVID-19 before your surgery, even if you don't have any symptoms. If you test positive for COVID-19, your surgery may be postponed until you have recovered or can safely be around others without spreading the virus.

MRSA

MRSA stands for Methicillin-resistant Staphylococcus Aureus. It is a bacterium (germ) normally found on the skin and in the nose of healthy people. The bacteria have become resistant to some antibiotics used to treat infections.

To find out if you have MRSA, we will take swabs (wipe with a cotton-tipped applicator) from the following areas:

• Nose
• Axilla (armpits)
• Groin
• Perineum (genital area)
• Open wound, if needed

We will let you know if you have a positive MRSA result. This may not happen until you return for your surgery, but this will not affect the date of your surgery. Once you are admitted to hospital, we will take steps to treat and manage your MRSA.

  Download printable information on MRSA:

What is MRSA  

Please ask your doctor or nurse for more information about MRSA.

CPO

CPO stands for Carbapenaemase-producing organisms. CPO are bacteria that live in the gut and are resistant to the antibiotics we use to treat infections. Because the bacteria have become resistant to antibiotics, CPO can cause infections that are very difficult to treat. This is why we must take extra care to prevent the spread of CPO within the hospital.

We may need to take a rectal swab from you in the Pre-Admission Clinic if:

• you have travelled and received any health care outside of Canada in the past 5 years (CPO is found to be more common in particular areas)
• you were hospitalized in the Greater Toronto Area in the past 12 months
• you travelled to the Indian subcontinent (India, Sri Lanka, Bangladesh, Pakistan) in the past 12 months
• you previously tested positive for CPO, or had contact with someone known to have CPO

Sleep Apnea

Sleep apnea can be a serious sleep problem. Sleep apnea means you stop breathing many times during your sleep. It happens because your throat muscles relax, you stop breathing, and then you wake up from your sleep to start breathing again. This waking and sleeping cycle happens many times when you are trying to sleep. People with sleep apnea may feel very tired and sleepy during the day because they cannot fully rest.

Please tell your doctor if you have sleep apnea or make sure you use your breathing machine (PAP machine), if you have one. It is very important for the doctors and nurses to know that you have sleep apnea so they can watch you closely and plan the best and safest care for you.

What else happens in the Pre-Admission Clinic?

We speak with you about:

• Preparing for your hospital stay and coming to the hospital (we may ask you to join a Pre-Admission class or watch a video).
• Review your medications and tell you what medications to take or not to take before your surgery.
• What happens during your surgery.
• What kind of help you may need as you recover from surgery.
• How to manage your pain and other symptoms.
• Exercises and activities you must do after your surgery and after you leave the hospital.
• How to plan for your recovery after surgery.

Patient Blood Management Program

You may or may not need a blood transfusion during or after your surgery. Your surgical team will discuss this with you. The Patient Blood Management Program aims to reduce or avoid the need for a blood transfusion during or after your surgery.

Your surgeon may order a blood test called a complete blood count (CBC). This test will determine the level of red blood cells and hemoglobin in your blood. If your blood test shows that your hemoglobin levels are low, this is called anemia. People with anemia before surgery may have a higher chance of receiving a blood transfusion during their hospital stay.

Your doctor and Patient Blood Management Team will assess your anemia and decide if you need more testing and treatment.

If you have any questions about the UHN Patient Blood Management Program, please call the Patient Blood Management Coordinator:

• For patients at TGH or PM, call 416 340 4800 ext. 6102
• For patients at TWH, call 416 603-5164

You can also talk with a member of your health care team.

Your Medications and Your Advance Care Plan

Your health care team needs to know about any medications you have been taking. A doctor, nurse or pharmacist will review your medications with you during your Pre-Admission Clinic visit and during your hospital stay.

Medications include:

• Prescription medications such as antibiotics, water pills (Lasix™) and others
• Non-prescription medications such as acetaminophen (Tylenol™), Aspirin™ and other over-the-counter medications
• Vitamins and minerals, such as Vitamin D and calcium
• Herbal medicines
• Homeopathic and home remedies
• Supplements such as Glucosamine, Coenzyme Q10
• Medications that we do not have in the hospital

Remember to bring these items if you use them:

• Eye or ear drops
• Inhalers or nasal sprays
• Medicated patches or creams
• Injectable medications (like Insulin)
• Medication samples from your doctor
• Any medications you have stopped taking recently (such as blood thinners or anticoagulants and antibiotics)
• Also, bring your pharmacy and family doctor's contact information.

Tell your health care team about any allergies or reactions you have had, including any reactions to:

• anesthetic medications
• injectable contrast dye
• latex
• food
• antibiotics

While at your Pre-Admission Clinic visit, you may get special instructions about stopping certain medications before your surgery. This will be written down for you so you will not forget. You may also get special instructions about which medication(s) you should bring with you to the hospital on the day of surgery.

Advance Care Plan

If you were unable to speak for yourself, an "Advance Care Plan" can help us know your health care wishes and who you trust to act on them.

Power of Attorney for Personal Care

This document tells us who you trust to make decisions on your behalf if you are incapable of doing so. If you have a Power of Attorney for Personal Care, please bring a copy and give it to the Pre-Admission nurse for our records.

If you don't have a Power of Attorney, more information is available from the Ontario Ministry of the Attorney General.

Advance Directive or Living Wills

You can use these documents to tell us about values and preferences that you would want to be known if you were not able to make treatment decisions yourself. If you have one of these documents, please bring a copy of this the morning of your surgery and give it to the Pre-Operative Care Unit (POCU) nurse for our records.

You can get more information from Advance Care Planning or ask your Pre-Admission nurse for an "Advance Care Planning Workbook" to help you in this process.

Preparing for Your Pre-Admission Clinic Visit

What should I have ready for my Pre-Admission Clinic appointment?

• This guide – you can use it to remember the details of your surgery or keep new information you get during your visit.
• Your health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID (such as a driver's license, passport, or other provincial health card).
• Information on coverage from your extended health insurance plan such as policy numbers. Please tell us if you have private or semi-private coverage.
• Name and contact information for an emergency contact.
• Copy of Power of Attorney for Personal Care (POA), Advance Directives or both, if you have them.
• A complete medication list. This includes prescription medications and over-the-counter medications, herbal remedies and vitamins. You may want to label these and put them in a plastic bag.
• Name and contact number for your pharmacy.
• A history and physical form from your family doctor about your general health. Make sure that you have enough time to make an appointment with your family doctor and get any tests done before your family doctor signs the form for your surgeon. Your surgeon may also fill this out instead of your family doctor.
• All recent reports (past 6 months) and consult notes from your specialists.
• All test results from your family doctor or specialist such as cardiology reports, cardiac stress test, Echocardiogram, ECG, CT scan, MRI scan, pulmonary function test or sleep study results.
• Name and contact information for your family doctor.
• Something to do while you wait (such as read a book or magazine or knit).

What should I do before my Pre-Admission Clinic appointment?

• If you have MRSA, CPO or C. difficile, please call the Pre-Admission Clinic before your appointment. This will help us to plan for your care during your surgery and hospital stay.
• If you have any symptoms of a respiratory illness, please call the Pre-Admission Clinic before your appointment.
• Eat as you normally would before you come to the Clinic.
• Take all your medications as you normally would before you come to the Clinic.
• Think about advance care planning before your surgery and bring copies of any Power of Attorney or Advance Directive documents to your Pre-Admission visit.

Please tell us if there are changes to the information on your health card (OHIP card) at your Pre-Admission Clinic visit (for example, a change of name).

If you have questions or have to cancel your Pre-Admission Clinic appointment, call the Pre-Admission office at TGH: 416 340 3529 or TWH: 416 603 5379.

What Instructions Do I Follow Before My Surgery?

Other important instructions

• Do not smoke or drink alcohol for 24 hours before your surgery day.
• Do not use any recreational drugs (such as marijuana or cocaine) for 3 days before your surgery.
• If you have been told by the anesthetist, nurse or pharmacist to take a medication on the morning of surgery, take it at home with a sip of water.
• Remove all nail polish, acrylic and shellac nails, jewelry, contact lenses and body piercings at home before your surgery.
• Brush your teeth or rinse out your mouth, but do not swallow any water.
• Shower and shampoo your hair on the night before your surgery.
• Wash your skin the night before surgery and the morning of your surgery. If your surgeon asked you to use a specific cleaning solution or protocol when bathing (such as soap and water or chlorohexidine) make sure to follow the instructions.
• Do not use lotions, moisturizers or make-up on the day of your surgery.
• UHN is a scent-free hospital. Do not wear perfumes, colognes or other scented products. Other patients and staff may have severe allergic reactions.
• Follow all special instructions and preparations explained to you during your Pre-Admission Clinic visit. Your surgery could be cancelled if you do not follow the instructions. Please call your surgeon if you have questions.

Is it possible that the date of my surgery will change?

Yes. The operating rooms may be needed for life-threatening emergencies. We will tell you as soon as possible if your surgery is going to be postponed. You may already be at the hospital when this happens. Your surgery date or time might be changed for other reasons too.

If your surgery is postponed to another day, your surgeon's office will call you with a new date. We will do everything we can to not change the date of your surgery. We thank you for your understanding and cooperation.

What if I feel sick?

Call your surgeon's office as soon as possible if there is a change in your health before your surgery.

Need more information?

Automated Surgery Helpline Toronto Western Hospital: Phone 416 603 5211

For Toronto General Hospital or Princess Margaret patients: Phone your surgeon's office.

The Day of My Surgery

When is my surgery?

Your surgeon's office will confirm the date and time of your surgery.

Where and when do I go to check in on the day of my surgery?

You must arrive 2 to 3 hours before your surgery or at the time your surgeon gives you. Please go to the Pre-Operative Care Unit (POCU).

Toronto General Hospital POCU – Take the Munk Elevators to the 2nd Floor
Toronto Western Hospital POCU – Take the Fell Elevators to the 2nd Floor
Princess Margaret – please go to 18B Surgical Admission Unit

We ask that you and your Essential Care Partner follow the visitor guidelines at the time of your surgery. Ask the health care team for more information about the UHN visitor policy during COVID-19.

What happens when I arrive in the Pre-Operative Care Unit (POCU)?

1. The ward clerk checks you in.
2. Your nurse double-checks your name, date of birth and chart information.
3. You change into a hospital gown and remove your underwear and socks. A nurse will give you a warm blanket or an electric heating blanket will be placed on you to keep you warm before surgery. Being warm before and during surgery helps to reduce the risk of infection. You may also be given a disposable hair cap. You will need to place all your hair inside this cap.
4. If needed, some of your body hair is removed in the hospital just before your procedure. Do not shave or clip your body hair in the area of your surgery at home before your surgery. This can increase your chance of getting an infection.
5. In the POCU, members of your surgical team review your health.
6. An intravenous (IV) may be started in your arm and, you may be given medication to help you relax.
7. If you are admitted as an inpatient after surgery, you will have your blood sugar tested in POCU and PACU so we can monitor your blood sugar levels.
8. We may also give you an antibiotic before surgery, depending on the surgeon and type of surgery you are having.
9. Your surgeon marks the area of your body where you will have your surgery with a special marker.
10. You will be placed in either a recliner or on a stretcher (depending on your surgery). The nurse will place a warming blanket on you to help keep you warm before and during your surgery. This helps lower the chance of infection.
11. You are taken to the operating room.

What Should I Bring to the Hospital on the Day of My Surgery?

On the day of your surgery bring these items in one small bag with your name on it:

• This guide – you can use it to remember the details of your surgery or keep new information you get during your hospital stay.
• Toiletries (such as tissues, toothbrush, toothpaste, comb, brush, soap, shampoo and shaving kit).
• Socks and comfortable shoes with rubber, non-skid soles (such as running shoes).
• Hearing aids, dentures and eyeglasses in their protective cases (all labelled with your name and phone number).
• Any walking aids such as canes or walkers (all labelled with your name and phone number).
• Your Ontario Health Card (OHIP), and your health benefits card and drug plan card, if you have one. If you do not have an OHIP card, please bring another form of government-issued photo ID (such as a driver's license, passport, or other provincial health card).
• Medications you were asked to bring during your visit to the Pre-Admission Clinic. Please bring only these medications with you in their original bottles.
• Any new medications you started since your Pre-Admission Clinic visit. If there have been any changes in how you take any of your medications, please let the pharmacist, nurse or doctor know when you are admitted to the hospital.
• If your Pre-Admission assessment was done by phone and not in the Clinic, please bring all of your medications in their original bottles.
• Personal cell phone, tablet or laptop for use during your stay.
• 2 reusable bags to hold your belongings during surgery.
  • 1 small bag for your shoes
  • 1 larger bag to hold all of your other belongings
  This may include shopping totes, duffel bags or any other bag you'd like. Bags with a zipper are preferred to keep your belongings safe.

Any items you may need, like a bathrobe, clothes or other belongings can be brought to you by your family or friends after your surgery.

My money and valuables

The hospital is not responsible for your money or valuables.

We know that you will have your personal items with you such as clothing, medications and personal support aids (for example, eyeglasses, contact lenses, dentures, hearing aids, mobility aids such as a cane, walker, prostheses or wheelchair). The hospital cannot be responsible for these items if they are damaged or go missing. When you are admitted, we will give you a copy of our valuables form.

Caring for You in the Operating Room

Having surgery may make you feel afraid or uncomfortable. It can be hard because during surgery, you can't take part in your care.

At UHN, we want to give you and your family the best possible care before, during and after your surgery. The operating room always has a team of people with you to make sure you are safe.

Who is part of my operating room team?

While you are in our care, a team works together with you to make sure your surgery is a success. Your team may include:

• surgeons, surgical fellows and residents
• nurses
• anesthetists (doctors who give you medication to put you to sleep so you feel no discomfort or pain during surgery)
• anesthesia assistants
• respiratory therapists (monitor your breathing)
• respiratory technologists (help the respiratory therapists)
• evoked potential technologist (professional trained to measure electrical responses in your brain)
• perfusionist (professionally trained to use heart-lung machines)
• support staff

What happens in the operating room?

1. A member of the health care team helps you onto the operating room table and gives you a blanket to keep warm.
2. We place monitors on your body for your safety and clean the area of skin around where the surgery will take place.
   
3. We give you oxygen to help with your breathing.
4. On the morning of your surgery, both you and your anesthetist talk about the anesthetic option that is right for you. There are different types of anesthesia available. The type that is best for you will depend on your surgery.
5. We give you medication through an intravenous (IV) line. This makes you go to sleep. If you are getting general anesthesia, we put a breathing tube into your mouth once you are asleep.
6. If you are having regional anesthesia, we freeze the area of your body where you will have surgery. We give you oxygen and intravenous medications to make you sleepy and comfortable.

UHN Patient Education and Engagement provides more information about regional anesthesia and general anesthetic.

What Does UHN Do to Keep Me Safe?

There are very important steps we follow before and after your surgery to make sure it is safe and successful.

1. We make sure that we have the right patient and the right site (area on your body).

Before your surgery, your surgeon confirms with you the area on your body where the surgery will happen. They use a marker to mark the area. We won't take you to the operating room until the site is marked. Please don't mark your body yourself before your surgery.

We also make sure that you have a wristband that has your name. If you have allergies or you are at risk of falling while in the hospital, we will give you separate allergy or fall-risk armbands. We check your armbands before you go for your surgery.

If you have a regional block:

If you are having a regional block or medication that freezes an area of your body before your surgery, the anesthetist marks the site where they give you the block. We take you to a different room to do the regional block. We give you some medication to make you relax while the anesthesia team gives you the block.

After you get the regional block, your surgeon comes to the room, confirms with you the site where your surgery will happen and marks the site. When the operating room team is ready for you, we take you to the operating room.

2. We review all of your information.

Before your surgery begins, we review all of the important information about you out loud. This is called a briefing session. This makes sure that the operating room team understands and agrees with what they will do.

Before the surgeon starts your surgery, we talk about:

• the important steps in your surgery
• your medications
• your allergies
• any special needs you may have during your surgery

3. We review one more time before surgery.

Before we make any incisions (cuts) the team reviews one more time that you are the right patient. This is called a time-out. The side of your body and the site of your surgery are talked about out loud and everyone agrees on what they will do.

4. We review when your surgery is over.

Before you leave the operating room, we talk about what happened during your surgery. We also make sure we agree on where you will go after surgery (for example, the recovery room). This is called the debriefing.

How does the operating room team keep me safe during my surgery?

The operating room may be cold and bright. You may hear some alarms and bells. These safety alarms help us with our work and keep you safe. We also watch you closely in the operating room. There are some important safety checks we use to keep you safe during your surgery. For example:

• We make sure all the instruments have been sterilized.
  We follow special instructions to wash and sterilize all the tools we use during your surgery before we begin. This makes sure they are clean and germ-free. We won't use any instruments until we are sure they are sterile.
• We position your body properly.
  When you enter the operating room, we help you onto a narrow bed. Then we place a safety strap around your body to make sure you don't fall off.
  While you are lying on the operating room bed, we put pads and cushions under your bony areas (elbows, ankles). This prevents any pain and discomfort during your surgery.
  We support all parts of your body when you are on the table and keep you warm. We also check your skin before and after your surgery.
• We keep track of all the instruments we use.
  We use many different items when we do your surgery. To keep track of them, we carefully count any sponges, tools and instruments we use before and after your surgery.
  If the count doesn't match, we will x-ray the area on your body where you had surgery. A surgeon will read your X-ray to make sure we have all the items we used.

Who can I call if I have questions?

If you have any questions about your surgery, please call your surgeon's office.

Where Can My Essential Care Partner Wait While I Am in Surgery?

Please review UHN's COVID-19 page for the most up-to-date and important information about UHN's visitor policy and what to expect when coming to the hospital.

How do my family and friends get information about me after my surgery?

Choose 1 person to call the hospital to find out how you are doing. This person can share the information with your family and friends. Please give us the name of this person, their phone number and what type of information you would be comfortable with them knowing. We will write this information down in your chart.