Day of surgery

Morning of surgery

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 waiting areas and free Wi-Fi for friends and family.

Lankenau Medical Center
100 East Lancaster Avenue, Wynnewood, PA 19096
Come to the main hospital entrance where valet parking is available. The registration desk will guide you to your destination. Family can wait in the Sun Room, located on the fourth floor between the Pew and Rosengarten buildings, next to the elevator lobby.

Bryn Mawr Hospital
130 South Bryn Mawr Avenue, Bryn Mawr, PA 19010
Come to the Warden Lobby entrance on Old Lancaster Road or enter the hospital from the Old Lancaster Garage walkway. The surgical registration desk is located in the Buck Atrium, adjacent to the Warden Lobby. This is our surgical waiting area and where you sign in. Follow signage.

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 and it is also the waiting area for your family and friends.

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. Family will be directed to one of two waiting rooms: Rothman surgeons prefer the 4th floor waiting room; Premier surgeons prefer the second floor.

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 change into a gown and remove your undergarments
  • Cleanse you with antibacterial wipes and swab your nose to prevent infection
  • 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, knee/hip replacement) and surgical site (for example, knee/hip), before marking the site and confirming your consent. You will meet with the anesthesiologist regarding your anesthesia options (spinal vs. general).

In the operating room

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

  • Apply leads for monitoring
  • Administer anesthesia (spinal or general)

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 feet and wiggle your toes
  • Monitor your pain level (on a 0–10 scale)
  • Medicate you as needed

When you are recovered from anesthesia, you will be taken to your new room. Your coach/designated family member will be given that location and can meet you there.

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.

In your room

When you arrive in your room you will:

  • Receive a nursing assessment
  • Have your vital signs taken often for the first 24 hours and less frequently 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 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 one to two hours 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 medicaiton and monitors

After surgery, you may be connected to monitors to ensure you’re breathing and other vital signs are recovering fully. Pain medications, both scheduled and at your request, are used to help you walk with assistance as soon as possible and to keep you comfortable. Unless recently given, you will receive medication when your pain increases as well as 30 to 45 minutes before working with a physical therapist. Our goal is to minimize your pain so you can focus on healing. Keep in mind that:

  • Pain after surgery will be different than the pain you may be feeling now.
  • Pain comes from multiple factors, including muscle healing, incision, bone pain and swelling of the joint.
  • You will be given different types of pain medication on a schedule. Your nurses will tell you what they are giving you.

Notify your nurse if you feel that your pain is not well controlled.

For pain, your doctor may prescribe multimodal pain medications—a combination of medications that work together on a schedule to reduce your pain after surgery.

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. Blood work may be needed for as long as you are taking the medication, to make certain the medicine is working properly. Medications come in oral and injection forms. The type you need will be determined by your surgeon. Be sure to follow your discharge instructions.
  • Your surgeon may or may not order the use of sequential compression devices (SCD) or compression stockings to reduce blood clot formation.
  • Your SCDs need to be worn as prescribed by your surgeon.

If your surgeon wants your SCDs on at all times except when you are actively walking, please partner with the nursing staff to alert them when you return from physical therapy, the bathroom or walking so that the SCDs can be reapplied.

What you might need after surgery

Based on your physician’s protocol, you may also have any of the following not yet mentioned:

  • Oxygen therapy via nasal cannula or mask
  • Incision covered with a dressing
  • An ACE bandage covering your dressing from your heel to thigh (total knee)
  • Blood pressure monitor
  • Pulse oxygen monitor

Hand washing and hygiene

Cleanliness is key. Ask for help if needed!

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.
  • Ask family and visitors to clean their hands when entering and leaving the room.
  • Ensure visitors don’t put personal belongings on your bed or in your room.
  • Wash your hands before and after physical therapy.
  • Remind staff as necessary that during transport, legs should be covered with a clean sheet.

Staying well in the hospital

Hospitalization can present challenges at any age. Recovering from surgery presents unique challenges for both patients and providers when it comes to maintaining mental and physical functioning during a hospital stay.

Please be sure to carefully read and follow the instructions you receive from your physicians, the hospital and this guide.

Focus on function
Restoring and maintaining your ability to function well in everyday life should be a priority for both you and your health care providers. During your hospital stay, the nursing staff and therapists will help you do as much as you safely can for yourself.

Keep active
Not using your muscles for even a few days can cause them to become weak. This is one of the main reasons that we encourage patients to be out of bed as soon as possible with a hospital staff member always present.

See and hear
If you use glasses or hearing aids, remember to bring them with you. Not being able to see or hear well makes it harder to understand what is happening and may slow your recovery.

Visitors
Having a friend or family member stay with you as much as possible for a day or two can help you stay connected and on track.

Keep your mind active
Bring with you things to keep your mind active: books, crossword puzzles, word searches, newspapers, magazines, playing cards, favorite games. Consider bringing a CD or MP3 player with your favorite music.

Avoid confusion
Anesthesia can sometimes cause people to be confused or sleepy for up to several days. This happens more often in people who have emergency surgery, have a lot of medical problems, or have dementia or confusion before coming to the hospital. If you experience some confusion after surgery, having family or friends talk with you about your past experiences or shared memories may help you stay anchored and recover more quickly. Visitors can also help you reorient by reminding you of things like the current date, recent or upcoming holidays, and other topical subjects. Having a nightlight on in your room may help if waking up in the dark in a strange place makes you feel disoriented. Ask the staff to turn this light on for you if you need it.

Don’t fall: call!
Please, get help before you get out of bed. Falling can cause serious injuries and delay your progress. We have found that the most common reason people try to get out of bed by themselves is the need to use the bathroom and the wish to do so in private. We recognize the importance of privacy—we also know how devastating a fall can be. Please ask for and accept help from the staff.

Good night’s sleep
If possible, try to avoid using sleeping pills while in the hospital, especially if you have not used them at home. These medicines can sometimes cause confusion, poor balance and an increased risk of falling. Instead, try keeping the room bright during the day, staying out of bed as much as possible, and keeping the room quiet and the light low at bedtime. Ask for ear plugs or a warm, caffeine-free drink before bed.

Put your coach to work
Your coach should play an active role while you are in the hospital, taking part in your rehab sessions, meeting with you and your case manager to discuss your discharge plan, and learning how best to help you once you are home.

Physical and occupational therapy

Physical and occupational therapy typically begins the day of surgery. The role of therapy after a total joint replacement is to help you get back to doing things on your own. Unlike other therapies, therapy in the hospital focuses on function and skills to be safely discharged. Physical therapists will assist you in achieving mobility, strength and range of motion during your rehabilitative phase, such as:

  • Standing up from bed, chair or toilet
  • Stair climbing
  • Using walkers and assistive equipment
  • Car transfer

Physical therapy plan of care
Your start date depends on doctor’s order and time of arrival to the surgical unit. Therapy usually involves:

  • Daily therapy
  • Walking 50–200 feet
  • Climbing stairs
  • Learning to use a walker, crutches and/or cane for support
  • Stretching of operative knee (if knee replacement)

Occupational therapy plan of care
Occupational therapy team members will assist you in being able to perform activities of daily living, such as:

  • Sitting down and standing properly
  • Getting dressed
  • Bathing
  • Grooming
  • Toileting
  • Transferring in and out of practice car

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 care manager works in your best interest with your health insurance company to obtain authorization and arrange inpatient and/or outpatient 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 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 is typically after one or two nights in the hospital. You should expect to go home upon discharge to continue your recovery. Follow your surgeon’s discharge instructions, which may include:

  • Home Activity and Exercise Program
  • Outpatient physical therapy
  • Home care health agency (physical therapy) when necessary
  • Skilled facility only if medically necessary (living alone, having stairs, or prior surgeries are not

Your physician’s group may also provide additional, computer-based support.

When you go home

Make a follow-up appointment. You’ll need a follow-up appointment with your surgeon so please call to arrange if an appointment is not already listed on your discharge instructions.

Follow discharge instructions. Be sure to follow directions for any needed post-op primary care appointments.

Have someone pick up any medications and new prescriptions. Plan to have a friend or family member stay with you as much as possible for a day or two can help you stay connected and on track. Use Appendix 5 in the PDF guide to track important information when you get home.