Thank you for choosing the Brigham and Women’s Hospital and entrusting our surgeons and staff to care for your orthopedic needs. This pamphlet is intended to provide you with more information about your elective surgical experience in the operating room and your surgical team members. Specifics about your individual surgery and the risks and benefits of surgical intervention should be directed to your individual surgeon.
At the Brigham and Women’s Hospital we know surgery is an important and life-changing experience. For each surgery, a team of surgeons, anesthesiologists, nurses, technicians, and other staff work together to provide the safest and most effective care possible. As you may know, Brigham and Women’s Hospital is an academic teaching hospital and some of those involved in your care are in training and are supervised by attending staff.
For many patients, the operating room is an unknown place, and surgery can provoke at lot of anxiety. To help explain what your experience will be like, we have provided a general outline of your transition through your operating room. Your specific experience may be slightly different than what is stated below, but this is to provide a general walk-through of your day. You may feel that certain aspects of your day are repetitive and unnecessary, but these repetitions are to ensure your safety.
While it takes an entire team to provide the safe care you expect and deserve, you have a special relationship with the surgeon whom you trust to perform your surgery safely and skillfully. Here at Brigham and Women’s we take that relationship, and the trust it implies, extremely seriously. While fellows and residents will participate in your operation, they do so only at the discretion of your surgeon. During your surgery, you are the sole focus of your surgeon and your surgical team.
However, as you may have gathered from previous paragraphs, your actual time in surgery may occupy a relatively smaller portion of your overall time spent in the Brigham and Women’s operating suite. There is a significant amount of time built into the schedule for the cleaning, setting-up and turnover of each operating room between surgical cases. In order to provide surgical services as optimally as possible (to maximize the amount of time that our surgeons are actually performing the surgery as well as minimizing the delays that patients often experience), we may at times utilize a second operating room and team in order to allow the surgeons to move quickly from one operation to another. This does NOT mean that your surgeon is performing two surgeries at once.
Hospital policy allows for a surgeon’s schedule to overlap in two rooms as long as he/she is present for all critical parts of the surgery. Your surgeon will determine the critical parts of your case, taking into account the particular clinical circumstances. More routine portions of the case, such as positioning and preparing the surgical field for surgery, or closing the wound at the conclusion of the case, may be delegated to other members of the team who are highly qualified to perform those duties.
If your surgeon or the operative team is aware that overlap between operating rooms may occur or is planned, they will disclose that to you in the pre-operative area or even during your clinic visit respectively. In such instances, a designated second surgeon will also be assigned to your surgery. This second surgeon’s name will also be disclosed to you on your surgical consent form.
If at any time during the process you have questions or feel uncomfortable with what you are being told then you have the right to stop and ask those questions, and they should be answered to your satisfaction prior to proceeding.
Q: Do I get to choose my type of anesthesia?
A: The type of anesthetic an individual patient receives is based on many factors. Each of these factors, including your own preference as the patient are taken into account when you meet with your anesthesia team the before surgery and together, you and your anesthesia team will determine the safest and best anesthetic for you based on the procedure you are about to have.
Q: Do Residents perform portions of my surgical procedure?
A: Brigham and Women’s Hospital is an academic teaching hospital tasked with training residents to perform orthopaedic surgery. The attending surgeon allows the participation of residents in your care as they see fit and according to their experience and ability. The amount of participation may vary depending on the type of procedure and complexity and should be discussed with your surgeon individually if you have concerns. However, your safety is our greatest concern, so your best surgical outcome will be prioritized over any educational mission we may have.
Q: What roles do the Fellows have in my surgery?
A: Fellows are not involved in every operation, but many of the attendings do indeed work with fellows. The fellows are fully licensed to practice orthopaedic surgery and can legally perform many orthopaedic procedures independently. However, at the Brigham and Women’s Hospital, during elective surgery, they are still under the supervision of your attending surgeon so if they are involved in your case, they will assist in your surgical procedure. (Your primary surgeon will be present during all of the critical portions of the operation.) The fellow may also be listed as a second surgeon on your consent form when the possibility of overlapping operating rooms exist (in order to add an extra layer of safety during the non-critical part of the operation.)
Q: I have pain tolerance issues and am concerned about my pain management for surgery. How do I ensure this is adequately addressed?
A: Each individual patient decides on surgery for a number of reasons and has varying amounts of pain preoperatively. These pain concerns should be mentioned not only to your Surgeon and surgical team, but also to your anesthesia team on the day of surgery so that your pain management can be addressed in the safest and most effective way possible.
Q: Will my attending surgeon always be available for my care during surgery especially when there are overlapping operating rooms?
A: The attending surgeon will always be present and overseeing all the critical parts of your surgery. In the instance when the attending has overlapping operating rooms during the non-critical parts (see above policy), there will always be a designated second surgeon available as well to ensure your absolute safety. This second surgeon will be disclosed to you prior to your surgery.
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