Cook Children's Medical Center surgery guide

Many families find it difficult to talk with their child about his/her upcoming surgery.

Pre-Op Tour Video - English Pre-Op Tour Video - Spanish

This guide includes the following information:

• Before Surgery
• Pre-Op Tour
• Pre-op Physical Assessment
• Pre-op Physical Telephone Interview
• Talking to Your Child About Surgery
• The Night Before Surgery
• On the Day of Surgery
• What to Bring
• During Surgery
• After Surgery
• Your Child's Behavior After Surgery
• Going Home
• When You Receive the Bill
• Important Telephone Numbers

Before Surgery
Please be certain that your insurance company has been notified. This is known as pre-certification. Pre-certification is often required before the insurance company will pay. Doctors' office staff usually contact insurers, but it your responsibility to be certain that proper procedures have been followed.

Partial payment may be required upon admission. You are responsible for contacting your insurance company before your child's surgery to determine the amount due. Cook Children's accepts Master Card, Visa, American Express and Discover cards.

In summary, it is your responsibility to:

• Contact your insurance plan to learn how much you must pay for your child's care.
• Contact your insurance company to learn if your bill is being processed.
• Pay Cook Children's for all charges not paid by your insurance company.
• If you have questions or need information about payment, call 682-885-4432, or, outside area code 817 or 682, call 1-888-852-6635.

Please be prepared to bring the following on the day of your child's surgery:

• The child who will have surgery.
• Your current driver's license and one other form of identification.
• Legal documents concerning guardianship, if you are not the child's natural parent.
• A list of your child's current medication, if any.
• All medical information about your child.
• Any special information, instructions or paperwork from your doctor, such as doctor's orders or envelopes from the office.
• Insurance cards.

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Pre-op tour
Free pre-op tours are offered at Cook Children's Medical Center. The tour, for children 4 years and older, introduces you and your child to hospital staff and explains what to expect on the day of surgery. Please reserve a place for your child and family the week before the scheduled surgery. Reservations are necessary. Call 682-885-4053, 9 am -5 p.m. If you are unable to attend, take the six-minute video tour by clicking one of the links under the picture above.  If you have trouble viewing the video online, please call 682-885-1636 to request a video (VHS or DVD).

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Pre-op physical assessment
Some physicians require a visit to Cook Children's Medical Center before surgery. If you have a pre-op visit scheduled, you should:

• Come with your child one or two days before surgery.
• Allow one to two hours for your child's pre-op physical assessment.
• Arrive at Patient Registration on the first floor of the medical center at your appointed time ·
• Register your child and talk with the anesthesiology staff and a nurse. If necessary, medical tests will be performed.

You should also bring the following:

• The child who will have surgery.
• Your current driver's license and one other form of identification.
• Legal documents concerning guardianship, if you are not the child's natural parent.
• A list of your child's current medication your child's, if any.
• All medical information about your child.
• Any special information, instructions or paperwork from your doctor, such as doctor's orders or envelopes from the office.
• Insurance cards.

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Pre-op telephone interview
Your doctor may have scheduled a pre-op telephone interview instead of a pre-op visit. You will receive a phone call from anesthesia staff and a phone call from a nurse a day or a few days before surgery. You should be prepared to discuss important medical information about your child. A nurse will tell you when to be at the medical center for surgery.

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Talking with your child about surgery
Many families find it difficult to talk with their child about his/her upcoming surgery. We suggest that you give your child honest, age-appropriate information, rather than leave him/her to worry or be surprised. Involve your child in preparations, such as shopping for Popsicles™ or packing a favorite toy to take to the hospital. Using a toy doctor's kit or drawing pictures of the hospital also can help your child express thoughts. Reading a book about hospitals (check your local library) can be a good starting point for discussion. If you would like additional assistance, contact the outpatient surgery child life specialist at 682-885-1636. Suggested books include:

"Why Am I Going to the Hospital?"
Claire Ciliotta and Carole Livingston

"A Big Operation"
Richard Scarry

"Going to the Hospital"
Fred Rogers

"Franklin Goes to the Hospital"
Paulette Bourgeois and Brenda Clark

"KoKo Bear's Big Earache-Preparing Your Child for Ear Tube Surgery"
Vicki Lansky

"Chris Gets Ear Tubes"
Betty Pace

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The night before surgery
It is important that your child get plenty of rest before surgery. Be sure your child bathes and washes his/her hair. This helps us, and helps your child feel better while recovering.

Be sure your child has a well-balanced dinner the night before surgery. Give him/her plenty to eat and drink just before the food and drink cut-off time specified by your doctor. After the cut-off time, be sure that your child has absolutely nothing to eat or drink, not even hard candy, gum, water or ice. It is even best not to brush his/her teeth, as some of the water or toothpaste may accidentally be swallowed.

For your child's safety, it is important that his/her stomach is completely empty prior to the induction of anesthesia. Serious complications could arise with even small amounts of food or water in the stomach. Since children forget and may help themselves to food, they will need to be closely watched. If your child accidentally eats or drinks anything after the cut-off time, you must notify the nursing staff so that proper precautions can be taken.

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On the day of surgery
Sometimes parents are reluctant to eat when a child cannot, but in order to handle the day's activities and attend to your child's needs, you will need energy. We suggest you eat a nutritious meal before waking your child.

Check-in
If you had a pre-op visit, you may go directly to the Outpatient Surgery Department on the second floor at your appointed time. If you received a pre-op telephone interview, arrive in Patient Registration on the first floor at your appointed time. After your child is registered, you will be directed to the Outpatient Surgery Department. Since your child will require all your attention, please do not bring other children. You will be directed to the waiting area and you may stay with your child until it is time to go to surgery.

Your child may or may not be given medication before surgery, depending on his/her individual needs and the procedure involved. After your child is anesthetized and asleep, an IV will be started in most cases, and will remain in place until discharge.

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What to bring on the day of surgery

• A blanket or toy.
• Extra underwear or diapers.
• Comfortable clothes.
• An empty bottle or child cup.
• A pacifier.
• A blanket, towel and a car safety seat (if appropriate) for the car.
• Driver's license or other identification for parent or guardian.

What NOT to bring on the day of surgery

• Children, other than the patient.
• Visitors, other than parents or guardians. Visitors may wait in the Atrium on the first floor or in the restaurant, rather than the surgery waiting room.
• Food or drink, including gum, which the child could eat before surgery.

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During surgery
A parent or adult caretaker must stay at the medical center while surgery is being performed. In addition, parents or guardians must remain in the waiting room at all times during and after surgery. If you must leave this area, even for a minute, please tell the volunteer or nurse on duty where you will be. Because of limited space, family and visitors other than parents and appointed caretakers may be asked to wait in the Atrium or restaurant.

Children who receive general anesthesia, with or without pre-operative medication, will sleep 60 to 90 minutes after their surgery. However, it is still very important that one parent or guardian remain in the waiting room at all times during and after surgery.

Dining and snacks
Vending machines are located in the hallway outside the surgery waiting area. The hospital restaurant, Sir Eatsalot, is located on the first floor of the medical center. Grab-and-Go items (soft drinks, fruit, ice cream, pre-packaged sandwiches, etc.) are available Monday through Friday, 6:30 a.m. to 11 p.m., and on weekends from 7 a.m. until 11 p.m. Signs at Sir Eatsalot list times when hot meals are served.

Smoking
Cook Children's Medical Center is a non-smoking facility. Smoking areas are provided outside the both front entrances. Smokers are asked to stay within those areas and away from the front doors of the building. But remember-if you leave the waiting area for any reason, please tell the volunteer or nurse on duty where you are going and for how long.

Parking
Parking is available for a nominal charge in the garage at the corner of Seventh Avenue and West Terrell Street.

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After surgery
You will see the doctor after surgery. During this time your child will be sleeping in the Post Anesthesia Care Unit (PACU) or Phase I. Children wake up after surgery at various times, so the volunteer or nurse will keep you posted on your child's status. Your child will be transferred to the Phase II stepdown recovery room, as soon as he/she is awake. You will be allowed to join your child in Phase II.

If your child is spending the night at the medical center, he/she will remain in Phase I PACU until stable. Then, you will rejoin your child and be escorted to your hospital room. Please be sure to read your Guide to Patient Services (available from your nurse). This booklet offers detailed information about your child's stay at the medical center.

If your child is an outpatient, he/she will be transferred to the Phase II stepdown recovery room when awake. You will be allowed to join your child in Phase II.

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Your child's behavior after surgery
After surgery, your child may seem sleepy, confused, restless or irritable. Your child will be medicated, as ordered by your anesthesiologist, and he/she may be offered something to drink. Please remember that, in most cases, your child will have an IV, which must remain in place until discharge.

Your child's skin may appear puffy and flushed and could be warm to the touch. This normal reaction may continue for several hours and may not disappear until after discharge.

It is important to be calm and to soothe your child as much as possible during his/her stay in recovery. Encourage your child to take fluids and spend time rocking, singing and reading or talking to him/her.

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Before your child goes home
Arrangements for transportation home should be made before discharge. Your child will be released only to the person specified on the consent forms. For your child's comfort on the ride home, please have a blanket, a towel and a car seat/booster seat in the car before dismissal.

When you get home
Not all children respond to surgery and medication in the same way. However, you may expect:

• Vomiting
• Discomfort
• Sleepiness / limited activity
• Warm skin
• Dizziness

To help your child feel more comfortable, we suggest you have at home:

• Tylenol^TM
• Popsicles^TM
• Apple juice, Sprite^TM or 7-Up^TM
• Soups
• Jello^TM, pudding or ice cream.

If you have questions about your child's post-surgery diet, please ask. We understand that guidelines such as "clear liquids" and "soft, bland" may not be helpful. There are many foods, even on a restricted diet, that will probably taste good to your child.

About two to three days after your child's surgery, a surgery representative will contact you. Feel free to ask about your child's recovery. If you have questions at other times, consult your doctor or you may call us at 682-885-4117.

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When You Receive the Bill
Cook Children’s will bill your insurance company, if applicable, for your child’s surgery. When payment is received from your insurance company, you will be billed for the outstanding balance. Accounts left unpaid may be referred to a collection agency.

You will also be billed separately by one or more physicians who care for your child. This might include radiologists, pathologists, anesthesiologists or surgeons. For any questions relating to your account or to request an itemized statement, please call Patient Accounting at 682-885-4432. For families outside area code 817 or 682, the toll free number is 1-888-852-6635.

If you have questions about your insurance, please read your insurance card, policy or other material from the company to find a phone number to call for information. If your employer provides insurance, you may also call your employer’s benefits for assistance.

Methods of Payment
Self-pay patients: Self-pay means that you are responsible for paying 100 percent of the bill. You will receive a statement every 30 days until the balance is paid in full. You may also receive letters more frequently. A deposit will be required at the time of service or you can call Patient Accounting to arrange a payment plan.

HMO/CHIP patients: We will bill your HMO (health maintenance organization) for approved services, so please be sure that all information about your policy is accurate and up-to-date and present your current insurance card at registration. You will not receive a bill from the medical center unless your co-payment is not paid in full. Contact your insurance company directly for information regarding your payment. Co-payments are due at the time of registration. If you have CHIP (also known as TexCare Partnership), you may owe a co-payment to Cook Children’s.

Commercial insurance: We will bill your insurance company, so please be sure that all information about your insurance is accurate and up-to-date and present your current registration card at registration. When your insurance company pays the medical center, you will receive an explanation of payment from the company. The portion you owe the medical center will be billed to you after payment is received from the insurance company. This may take up to three months.

Medicaid/CSHCN: Please present your Medicaid/CSHCN card at the time of registration so that we may bill on your behalf for approved services. If accurate Medicaid/CSCHN information is provided, you will not receive any bills from the Medical Center.

Medicare: We will bill Medicare on your behalf and you will receive a bill for any remaining charges.

Financial assistance
We strive to assist all families in working with their specific financial needs. Insurance verification is not a guarantee for payment. If your insurance provider denies payment, please work with us to find other possible programs to assist you.

Charity medical treatment is also available to qualified families. Qualification is determined by family size and income, as outlined in the Federal Poverty Guidelines posted in Patient Registration and other areas of the medical center. For more information, contact Patient Accounting.

As required by state law, Cook Children’s Medical Center files an annual report of its community benefits plan with the Bureau of State Health Data and Policy Analysis of the Texas Department of Health. The report is public information and is available upon request from the Texas Department of Health, 100 West 49th Street, Austin, Texas 78756.

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