A lifetime of specialist care

Fitness for surgeryclinic

Harefield Hospital

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What is the fitness for surgery clinic? 3

When will my first appointment be? 3

Do I need to visit my dentist before I come to the clinic? 4

What happens at the clinic? 5

What happens after the clinic? 6

What may happen next? 7

What if I am having mitral valve surgery? 8

What happens if I am a “high-risk” patient? 8

What happens after my operation? 8

Useful contact details 9

Contents

This leaflet gives you general information about the fitness forsurgery clinic. It does not replace the need for personal advicefrom a qualified healthcare professional. Please ask us if youhave any questions.

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Fitness for surgery clinic

Welcome to the fitness forsurgery clinic at HarefieldHospital. The aim of the clinic isto carry out a number of teststo make sure you are fitenough to have cardiac surgery,and to reduce the possibility ofyour operation being cancelledwhen you are admitted tohospital for surgery.

The fewer operations we haveto cancel, the more efficientlyour operating theatrescheduling will be. That meanswe can treat more patientslike you.

All patients – except thosewho have emergency surgery –need to attend the clinic.

It is important you read thisleaflet before you visit theclinic to understand the testsand how the clinic works.

We cannot give you a date foryour operation at your clinicappointment. This will bedecided once we have theresults from all of your tests(as described on pages 5-6).

You will be sent a date foryour first clinic appointmentwithin six weeks of beingreferred to us by your cardiacsurgeon.

If the surgeon says you needan urgent appointment (thisinformation will be in your

consultation letter), we willcall you, and offer you ournext available appointment.

If you are unable to attend theclinic appointment you areoffered for any reason, pleasecontact us to re-arrange thedate.

When will my first appointment be?

What is the fitness for surgery clinic?

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Do I need to visit my dentist before I come to clinic?

It is very important that youhave visited the dentist in the12 weeks before yourappointment at the clinic. Ifyou have not visited yourdentist in that time, pleasebook an appointment to seehim / her now to check youhave no loose, broken orinfected teeth, and your gumsare healthy.

Problems with the teeth orgums can be a major source ofinfection, and bacteria (germs)can enter the bloodstreamand get into the heart. This iscalled endocarditis and canseriously damage the heartvalves and cause other seriouscomplications.

Ideally, any dental treatmentshould be completed beforeyour clinic appointment.However, it is important thatyou attend your clinicappointment even if yourtreatment is not complete.

We have enclosed a letter foryou to give to your dentist.The form at the bottom of theletter needs to be returned tous confirming you have noloose, broken or infectedteeth, and your gums arehealthy. This can be returnedeither by post or in person atyour clinic appointment.

We will only add your nameto the waiting list for anoperation after we havereceived the completed formfrom your dentist and wedecide you are fit for surgery.

Please note: when you cometo the hospital for surgery,our anaesthetist will alsoinspect your mouth. If he /she is not satisfied with thecondition of your teeth andgums, your surgery may haveto be cancelled.

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Fitness for surgery clinic

What happens at the clinic?

You will meet a specialistnurse who will go throughyour medical history andexamine you. The clinicpharmacist will also discussyour medication with you.

You will have a series of tests.

The tests

We will carry out these tests tocheck your general health andfitness for surgery:

• Blood tests – to checkdifferent areas of yourgeneral health.

• Chest X-ray – to look atyour heart and lungs.

• Electrocardiogram (ECG) –to look at your heartrhythm.

You may also need:

• Lung function tests – simplebreathing tests using amouthpiece.

• Carotid doppler – anultrasound that uses soundwaves to measure the flowof blood through the largecarotid arteries in your

neck that supply blood tothe brain.

• An echocardiogram (echo) –uses sound waves to buildup a moving picture of theheart. It is similar to theultrasound scan used inpregnancy.

However, if you have hadthese tests done at yourreferring hospital, we will tryto obtain the results beforeyour clinic appointment sothey do not have to berepeated.

Your consultant’s team willthen look at your test resultsand he / she may refer you forfurther tests on another day,which may include:

• CT scan (computerisedtomography) – a special X-ray that allows us to take aseries of detailed images ofthe body.

• MRI scan (magneticresonance imaging) – ascan that uses strongmagnetic fields and radiowaves to produce detailedimages of the inside of the body.

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• Angiogram – this shows theexact location andseriousness of anynarrowed areas in yourcoronary arteries. Duringthe test, a thin plastic tubecalled a catheter is insertedinto a blood vessel througha small cut in your groin orwrist. Using X-ray, thecatheter is directed throughyour blood vessels to yourheart. A special dye is theninjected through thecatheter so the arteries

show up clearly on thescreen.

• Transoesophageal echo(TOE) – uses sound waves(ultrasound) from a probeto check the structure ofyour heart and how well itis functioning. The probe isabout as wide as an indexfinger and goes in themouth, down the throatand into the oesophagus sowe can see the back of yourheart.

What happens after the clinic?

Fit for surgery

If no more tests are needed,we will call to inform you thatyou are fit for surgery. We willsend your medical notes to ourtheatre schedulingdepartment, which arrangesthe times and dates foroperations at Harefield.

You will receive a letter in thepost from the departmentconfirming that you are on thewaiting list for your operation.

When your name reaches thetop of the waiting list, amember of staff will call you

to offer you a date for yoursurgery. Once a date is agreed, you will be sent aconfirmation letter.

Where possible, the theatrescheduling department aim togive you two weeks’ notice ofyour operation date. This is togive you time to make anyarrangements, such asorganising transport toHarefield, contacting relativesand so on.

Sometimes, we have topostpone another patient’soperation, and we may offeryou that operation date and

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time at short notice. If thishappens, a member of stafffrom the theatre schedulingdepartment will contact youby telephone.

More information needed

The clinic nurse may inform youthat we need to arrange moretests or seek specialist advice.

If you require any furtherinvestigations or referrals, youwill not be told you are fit forsurgery until these issues havebeen resolved.

This may all seem a longprocess, but it is important thatyou are fit to undergo theoperation, and that the benefitsof surgery outweigh the risks.

What may happen next?

More tests

If more tests or scans areneeded, we will contact youand arrange an appointment.We prefer to do these tests atHarefield. We can organisethem more quickly than yourlocal hospital and get theresults within a couple ofdays.

Ask your GP to monitoror investigate a problem

If we need your GP to monitoror investigate a problem, wewill write to him / her. We willpost you a copy of the letterwe send. Please make anappointment to see your GP if

he / she has not contacted youby the time you receive yourcopy of our letter. This willspeed things up. When you dovisit your GP, please take yourcopy of the letter with you.

Referral to otherspecialist consultants

If you need to have specialisttreatment before you canhave surgery, we will referyou to specialist consultantseither at Harefield or yourlocal hospital.

We also do this if we needadvice on how best tomanage your condition whileyou are in hospital.

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If you are having mitral valvesurgery, a number of doctorswill need to discuss your caseto decide whether your heartvalve can be repaired orreplaced. We call this amultidisciplinary team meeting(MDT). It is attended by cardiac

surgeons, cardiologists andechocardiologists. Occasionally,further tests and / or referralsto specialist consultants may berequired after the MDTmeeting. If that happens, wewill tell you and organise thetests and referrals.

What if I’m having mitral valve surgery?

If you are a “high-risk”patient, cardiac surgeons andcardiologists meet to discusswhether surgery is the bestoption for you. This is called ajoint cardiology and cardiacsurgery (JCC) meeting.

Your referring hospital mayhave already had a JCC meetingabout your case. However, iftest results from our fitness forsurgery clinic show your risk ishigher than we expected, we

will also hold a JCC meeting atHarefield. This may result infurther tests and / or specialistreferrals. You may also need tosee a consultant anaesthetist,your cardiologist or cardiacsurgeon again to discuss therisk involved in having anoperation.

Your consultant will tell you ifyou are a “high risk” patient,but if you are unsure, pleaseask us.

What happens if I am a “high-risk” patient?

If your hospital stay is longerthan expected following youroperation, your consultantmay ask for you to betransferred to your localhospital for furtherrehabilitation and

recuperation. We will try totransfer you to a hospital ofyour choice. However, this isnot always possible becausewe have to make sure thehospital can deal with yourclinical / rehabilitation needs.

What happens after my operation?

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Fitness for surgery clinic

Fitness for surgery clinic 01895 828 542 (direct line)(Monday to Friday, 8am-4pm)

Theatre scheduling department 01895 828 913 (direct line)(Monday to Friday, 9am-5pm)

You can leave a message if no-one is available to answer yourcall at the clinic or the theatre scheduling department. Pleaseleave your name, and CRN number (you will find this on yourappointment letter), together with a short message. We willreturn your call as soon as possible. This may be the nextworking day.

Please note that the theatre scheduling department willcontact you once your name has reached the top of thewaiting list.

However, should there be a change in your condition (that isnot an emergency), or you have been admitted to hospital,please notify the fitness for surgery clinic team or the theatrescheduling department and we will notify your consultant. If your medical condition has changed, your consultant mayrequest an earlier operation date.

These contact details are not emergency numbers. In an emergency, please contact your GP or

dial 999 for an ambulance.

Useful contact details

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If you have concerns about any aspect of the service you havereceived in hospital and feel unable to talk to those peopleresponsible for your care, call PALS on:

• Royal Brompton Hospital – 020 7349 7715

• Harefield Hospital – 01895 826 572

You can also email pals@rbht.nhs.uk. This is a confidential service.

Your notes

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Royal Brompton HospitalSydney StreetLondonSW3 6NPtel: 020 7352 8121textphone: (18001) 020 7352 8121

Harefield HospitalHill End RoadHarefieldMiddlesexUB9 6JHtel: 01895 823 737textphone: (18001) 01895 823 737

Website: www.rbht.nhs.uk

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© Royal Brompton & Harefield NHS Foundation Trust November 2015

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