The Heart Surgery Program at the Cleveland Clinic Foundation

Patients who choose to come to The Cleveland Clinic Heart Center for heart surgery can expect to be operated on by the best surgeons and cared for by the finest nurses and medical staff in the world.

The Heart Surgery Program at The Cleveland Clinic has been fine tuned from years of experience with patients and their families. We are proud to provide a program that meets the patient's and family's needs from our first meeting to discharge home.

This is a general description of the heart surgery program. More specific instructions are included in the information you will receive during your visit, hospital stay and before you go home. Please feel free to ask questions to our health care team at any time during your stay.

TCI

About 2,000 thoracic and cardiovascular patients are scheduled through our TCI (To Come In) program each hear. This means patients come to the Cleveland Clinic a few days before surgery as an outpatient to complete the pre-surgery evaluation and receive information to prepare for surgery. The TCI program allows patients to spend more time with their families instead of being admitted to the hospital several days before surgery.

The TCI Center is located at Desk P-29.

Patients come into the TCI Center for a one or two-day evaluation process that includes meeting with:

TCI staff

TCI surgical nurse clinicians stand by their teaching tools

TCI patient with cardiothoracic anesthesiologist

The TCI Surgical Nurse Clinician
The TCI surgical nurse clinician works with your surgeon. He or she will perform a limited exam, review your records and provide you with instructions for your surgery. Instructions include:

• You will watch a video outlining what to expect on the day of surgery. You also will receive information about how to prepare for surgery and what to expect during your hospital stay and recovery at home
• You will receive a binder that explains the surgical process and important steps for recovery. Your family will bring this binder to the hospital after your surgery, as you will refer to it often during your stay. Also plan to bring it to al of your outpatient doctor's appointments.
• You will receive a free guided imagery tape or CD to listen to before, during and after your surgery. Guided imagery uses the power of imagination to induce peace, calm, strength and control. The calming music on guided imagery programs can be very helpful in quieting the mind. Many people find the program's soothing words create a greater sense of calm, well-being, safety and control. Plan to bring a tape or CD player with you on the day of surgery to listen to the tapes.
• You will also learn about theStatus.com, a website where you can create a private, secure and confidential Web page to communicate how the patient is doing to family and friends. To begin your theStatus.com webpage before your visit - create or log on to your personal folder and click on theStatus.com to learn how to use theStatus.com and obtain a sponsor code.
• You will have time for questions and answers.

The Cardiothoracic Anesthesiologist
You will meet one of our Cardiothoracic Anesthesiologists who is specially trained to administer anesthesia for cardiac surgery patients.

Your Cardiologist
You will meet with a cardiologist who will perform a preoperative cardiac exam, answer your questions and review your medications.

The cardiologist will review your medical records and test results. He or she may order additional tests, if necessary. These tests may include a cardiac catheterization, echocardiogram, electrocardiogram, chest x-ray, blood-work or urinalysis.

Your Surgeon
Every attempt is made for you to meet your surgeon on the day of your preoperative visit. If this is not possible, we will schedule a more convenient time for you to meet the surgeon and discuss your surgery.

The night before surgery you will be told what time and where to report for surgery. Please limit the number of family members as the pre-surgery waiting area is very small. After checking in, you and your family will go to Desk H21, where you will prepare for surgery.

Surgery takes place on the third floor of the G building in state-of-the-art operating rooms that are specially designed for heart surgery. The operating room nurses and cardiothoracic anesthesia team work with your surgeon to ensure your safety and comfort during surgery.

Waiting During Surgery
While you are in surgery, your family waits in the P building Surgical Waiting Area.

Your family is asked to check in with the receptionist in the P20 area. For the first few hours, your family may wait in this waiting lounge, or go to the cafeteria or gift shop. If you are staying in a local hotel, your family may return to your hotel room for the first few hours. It is important for your family to let the receptionist know if they leave the area. They are the link to the operating room for updates. Pagers are available to maintain contact with the surgical receptionist at all times.

Note - make sure you bring your parking ticket for validation - you will receive free parking on the day of surgery.

The Surgical Waiting Area area has many amenities such as a pharmacy, ATM, café, Information kiosk, televisions, pay phones, vending machines, and comfortable seating.

Family Spokesperson
One individual needs to be the family spokesperson to provide an efficient flow of consistent information and to ensure patient confidentiality.

Receiving Updates about the Patient's Surgery

Receptionists updating patients' families at the P20 Surgery Lounge

The length of surgery depends on the type of surgery being performed. Your family members are updated on your condition at certain times:

1. When you are placed on the heart-lung bypass machine or when off-pump bypass surgery has begun. Please be aware that this may be several hours after you were taken to surgery. The preparatory time in the operating room and anesthesia induction may take three to six hours, so your family should not be alarmed if they do not hear any updates for a few hours. If problems occur during surgery, your family will be notified immediately.
2. When the surgery is complete - the surgeon will contact your family spokesperson by phone or meet with him or her in person. Sometimes the surgeon may prefer to talk to the family in his office to discuss the patient's surgery. Do not be alarmed; this does not indicate there is a problem. Have a list of questions ready to ask the surgeon.

Please note the amount of time it takes to perform the surgery can vary greatly. Emergency situations and unexpected findings may result in long wait times. We also hope your family will understand that delays result from our commitment to providing each patient with the best care. Please be prepared for unexpected delays by bringing reading or writing materials, small games or audio tapes and a cassette player to occupy yourself while waiting. We will do our best to make sure that you and your family are as comfortable as possible during your stay.

Cardiothoracic Intensive Care Unit (CTICU)

There are five units, a total of 55 beds, that are located on the fifth floor of the G building. They are specially designed to care for patients after heart and lung surgery.

Two hours after speaking with the surgeon, family members can report to the G5 Family Lounge and check in with the receptionist. The G5 Family Lounge is located outside the ICUs. There is a receptionist present in the Lounge form 9AM-9:30 PM Monday-Friday, and 9AM-7:30PM Saturday, 9AM-5:30PM Sunday.

G5 Family Lounge receptionist

If a receptionist is not available, you should use the phone to call the CTICU Nurse Liaison or the CTICU (phone numbers are located by the telephone).

Visiting hours in the ICU are 10 to 11:30 am, 4 to 6 pm, and 8 to 9 pm. Only two people may visit at a time. For patient safety and comfort, family members should limit their visit to 15 minutes.

G5 nursing staff

While in the ICU, there will be a registered nurse assigned to provide nursing care for you. A team of well-trained specialists cares for our patients in the CTICUs. The team includes the following:

• Cardiothoracic Surgeon
• Anesthesiologists
• Cardiac Intensivists (physicians from within the Department of Cardiothoracic Anesthesia with advanced training in Critical Care Medicine, who specializes in the care of patients in the ICU)
• Clinical Nurse Specialists
• Nurse Practitioners
• Nurse Clinicians
• Registered Nurses
• Transplant Coordinators (when applicable)
• Clinical Technicians

The Team follows an individualized plan of care for each patient and monitors his or her progress closely. The goal of the entire team is to help you recover as quickly and safely as possible.

The units are equipped with state of the art cardiac monitoring equipment and all essentials to provide the best possible patient experience.

Tips for visitors:

• To prevent infection and insure patient safety, please wash your hands with soap and warm water or apply the antibacterial foam located at the patient's bedside to cleanse your hands.
• The following are not permitted in the ICU: children under age 12, food and drinks, flowers, cameras/video recorders, cellular phones (must be turned off).
• Additional information is found in the patient binder.

G5 Nurse helping patient use incentive spirometer	G5 Nurse and Cardiac Intensivist examining patient
Patient with Family	G5 Nurse comforting patient

The surgeon determines when you are ready to leave the ICU.

Most patients stay in the ICU overnight. You will be notified when you are able to be transferred to a regular hospital room.

Call the CTICU Coordinators if you have questions.

G100 Nursing Staff with Nurse Manager, Terri Murray		G101 Nursing Staff with Nurse Manager, Kelly Hancock and Cardiothoracic Surgeon, Dr. Smedira
G80 Nursing Staff with Nurse Manager, Kelly Hancock

Patients recover on a post-cardiothoracic surgery nursing floor (also called a telemetry unit or step-down unit). Most rooms on the surgical recovery units are semi-private (2 patients in 1 room). The availability of private rooms is based on individual medical needs. If you would like a private room, let the CTICI Nurse Liaison or the ICU nurse know. We will try to accommodate your requests.

Cardiologist, Dr. Mills with cardiovascular nurse clinician surgical nurse clinician discussing patient care

Surgeon, Dr. Smedira, with Nurse Manager, Kelly Hancock, reviewing patient records

During this time, you will begin your recovery phase. You will be encouraged to do as much as you can for yourself to assist in regaining strength and independence.

The balance of pain control and increasing activity will help you recover at a faster pace. Click here for information on pain control after heart surgery.

You will be in contact with many caregivers helping with your recovery:

Cardiologist - once you are transferred to your hospital room, the cardiologist becomes the primary physician responsible for your care in the hospital and discharge instructions. These cardiologists are specialists in post-operative care of heart surgery patients and work closely with the surgical team.

Cardiothoracic Surgeon - performs your heart surgery and manages your care in the intensive care unit. On the surgical recovery unit, the surgeon works with the nurse clinician to oversee your surgical needs.

Cardiac Intensivist - (physician from within the Department of Cardiothoracic Anesthesia with advanced training in Critical Care Medicine, who specializes in the care of patients in the ICU) will continue to follow complicated patients who transfer to the nursing floor.

Surgical nurse clinician - works with the surgeon and visits you on the nursing unit to coordinate your surgical recovery needs.

Nurse manager - The nurse responsible for managing the nursing care and other personnel on the nursing unit, along with the assistant nurse managers. The nurse managers visit patients frequently. The nurse managers will ask you if the Nursing Unit Team is meeting and exceeding your expectations. Please let them know at any time if we can improve services or if they could help in any way to make your stay more comfortable.

Registered Nurses (RN) - specially trained nurses who provide care around the clock. The RN coordinates your care while on the nursing unit, assessing your condition,offering medications, and providing education. They are specially trained in Advanced Cardiac Life Support. The RN staff will be monitoring your vital signs, lab values, and test and procedure results, managing your pain, and helping to make you comfortable during your hospital stay.

Clinical Nurse Specialists (CNS) - Masters prepared nurses with advanced cardiac knowledge are available for nursing staff as clinical resources and are available to answer your questions after surgery. They also help coordinate patient teaching and family resource classes on the nursing unit.

Patient Service Associate - a patient advocate, visits patients to make sure they are comfortable, questions are answered and works to resolve any complaints.

Patient Care Nurse Assistants (PCNA) - specially trained individuals who work under the direct supervision of the nurse. They assist with activities of daily living (such as bathing or going to the bathroom) as needed.

CHIRP Phase I in-patient coordinator, Charles Walters, with patient

Unit secretary greets a new family

Cardiac Health Improvement and Rehabilitation Program (CHIRP) - Exercise specialists see the patient to assess activity needs and begin Phase I cardiac rehabilitation, early activity progression. Patients return home with a Home Activity Guide to continue Phase I rehabilitation.

Cardiothoracic Anesthesia Respiratory Therapists -therapists who specialize in respiratory needs and oxygenation post surgery.

Case Managers - available to assist with skilled needs beyond the hospital.

Social Workers - available to assist with psychosocial adjustment needs and community support.

Nutrition Services- Although your cardiologist will prescribe your diet after surgery, your nurse will consult nutrition services for individual needs. Many specialized diets are available and focused on recovery needs.

Unit Secretary - provides clerical support to the nursing units and greets families upon arrival to unit. The Secretary is located behind the nurses' desk. The Secretary assists the nursing staff by scheduling and coordinating tests and maintains communication on the unit.

Environmental Services - maintains a clean comfortable environment.

Visiting Hours

Visiting hours on the nursing unit are unrestricted. However, it is important to take into consideration the patient's need for rest. Also, we ask that your guests be considerate of your roommate during their recovery phase by limiting to 2 to 3 visitors at a time.

Advanced Practice Nurses Debbie Hanes and Ross Swanson teaching Family Resource Group
Patient with guided imagery CD
Nurse reviewing Heart Center binder with patient
Family member using G10 computer to log onto theStatus.com
Massage & Relaxation Suite

Educational and Support Resources on the Nursing Unit

Patients and family members are provided many resources for support and education on the nursing unit:

Family Resource Group - This class is designed to provide an opportunity for families and friends to gather information, express concerns and share experiences. Discussions take place from 9 to 9:45 am Mondays through Fridays and are led by a multidisciplinary team. Subjects include exercise, incision care, discharge planning, medications, and nutrition.

Guided Imagery - Patients continue to use their guided imagery tapes or CDs obtained pre-surgery to help with relaxation and pain control.

Heart Center Channel 33 - Closed circuit educational television channel provides a variety of programs for all cardiac patients.

Cardiac Rehabilitation Discharge Class - Exercise staff discuss your activity guidelines after you are discharged. This class takes place at 3 pm, Mondays through Fridays in the Activity Center on the 10th floor.

Heart Surgery video - All patients receive a dvd/video to take home. This video reviews discharge instructions and lifestyle issues after heart surgery. You and your family may review this video at home and reinforce education received during your hospital stay.

Heart Center binder - You and your family members will continue to review the information in the binder that was given to you before surgery. You will review discharge instructions, medication information, and a diagram of your surgery with your cardiologist and nurse before you go home. You will continue to use this binder at home to answer your questions and guide your recovery.

Computer stations - there is a computer station located on G10 to use theStatus.com or view the Heart Center web site. The Heart Center website will continue to be a valuable resource for you after you go home.

The Relaxation and Massage Suite - located across from the nurses’ station at G100, opened in August. It is open 24 hours a day, 7 days a week, and features soothing music, soft lighting, and a relaxing atmosphere. All patients and family members are encouraged to use this room to take a quiet break from their daily hospital routine. Patients from other units (not G100) must notify their nurse prior to leaving the floor. Massage therapists are available on Tuesdays and Thursdays for patients and families. Click here to learn more.

Tips for visitors:

• To prevent infection and insure patient safety, please wash your hands with soap and warm water in the public restroom before and after visiting the patient.
• Please be respectful of all patients' need for rest, recovery and nursing care.
• Encourage the patient to walk as much as tolerated, use the incentive spirometer and any other recommended breathing aids, and request pain medication when needed.
• Additional information is found in the patient binder.

Discharge to home

Your cardiologist will determine when you are ready to go home. The average length of stay after heart surgery is 4 to 8 days.

On the day of discharge, please have your family member arrive at 10:00 am to take the patient home. If you are planning a long trip home, you may want to stay overnight in a hotel and begin your trip home the following day.

When you travel home after surgery:

• You are not permitted to drive a car
• You can be a passenger in a car
• You may fly in an airplane.

Your health care team is available to answer your questions. Keep a paper and pencil nearby and write your questions down. Phone numbers are provided in your binder to assist you with further questions when you return home.

Cardiac Rehabilitation

For many people after surgery, a cardiac rehabilitation program provides an excellent opportunity to continue the recovery you began in the hospital:

Phase I - Cardiac Health Rehabilitation Program - Exercise specialists see the patient in the hospital to assess activity needs and begin activity progression. Home activity instructions are given to encourage progressive activity. Discharge classes are also available to help answer questions by the patient and family.

Phase II - Preventive Cardiology and Rehabilitation Program - Builds on what you learned during Phase I: continue a regular exercise program, learn about heart disease, and learn strategies to change your lifestyle to prevent further progression of your disease. It also provides support and guidance as you recover from your surgery. Phase II cardiac rehabilitation is covered by most insurance companies. To learn about programs in your local area:

• Call the Cleveland Clinic Foundation Preventive Cardiology and Rehabilitation Program at 216/444-9353.
• Ask your family doctor.
• Go to the American Association of Cardiovascular and Pulmonary Rehabilitation website and click on Program Directory (a new browser window will open).

• Recovery after Heart Surgery
• The Department of Cardiovascular Surgery
• Our Surgical Outcomes
• Support Groups, such as Mended Hearts
• Cardiovascular Nursing Opportunities at the Cleveland Clinic
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• If you do not find what you are looking for about heart surgery, click here to contact us or call the Heart and Vascular Institute Resource & Information Nurse at 216/445-9288 or toll-free at 866/289-6911,. We would be happy to help you.