Getting Ready For Your Surgery

Making life decisions about your health care or the health care of a loved one can be stressful and frightening, but you are not alone. While your physician is your primary source of information on these sensitive decisions, all members of the Gritman Medical Center team are here to answer your questions or discuss concerns with you.

Planning ahead can be beneficial to you, your family and your friends. Discussing your preferences for medical treatment now with family, friends and your physician ensures if there comes a time when you are not able to communicate in an emergency situation or other medical crisis, your loved ones can communicate for you.

Having a medical advanced directive on file is the best way to make sure your health care wishes are followed. It allows you to provide instructions on who can make medical decisions for you in the event you are unable to make them yourself. An advanced directive also allows you to determine the type and amount of care you wish to receive.

Download the Idaho Health Care Directive Registry form or the Living Will and Durable Power of Attorney for Health Care form to make sure your document is recorded. Fivewishes.org is a good resource to use as you consider documenting your wishes and health care preferences.

What is an advance directive?

If you become terminally ill, what type or how much medical treatment would you want to prolong your life? If you become unable to speak for yourself, who would you want to make decisions on your behalf?

An advance directive is a document that communicates your wishes about health care treatments at a time when you cannot speak for yourself. You do not need a lawyer to create an advance directive.

There are two components of an advance directive:

• Living will – Allows you to state your wishes about medical care in the event you are terminally ill or in a persistent vegetative state and can no longer make your own medical decisions.
• Durable power of attorney – Allows you to name someone, usually a family member or close friend, to make decisions about your medical care if at any time you are unable to speak for yourself. You are also able to name two other people to act as alternate agents in this regard.

Things to consider

You have an opportunity to make choices related to the health care we provide for you in cases of serious injury or terminal illness. You have the right as a patient to have or not to have life-sustaining measures if you are suffering from a terminal condition. You can be assured your decision to forego life-sustaining measures does not mean medical and nursing care will be withdrawn.

If your heart or breathing stops, would you want to be resuscitated? Emergency measures to restore heartbeat and/or breathing may be taken unless a previous decision by you has been communicated to your physician and your family. Emergency measures may include:

• Cardiopulmonary resuscitation (CPR)
• Electrical cardioversion/defibrillation (electric shock)
• Cardiac (heart) medications
• Intubation (placement on a breathing machine)

Changing your advance directive

Despite the best predictions, conditions do change. Your decisions may be changed at any time either verbally or in writing. Should you wish to change a previous decision, be sure to let your physician know.

Organ and tissue donation

If you choose to be an organ and tissue donor, it is important to inform your family of your wishes. Your family’s consent is required for organ and tissue donation, even if you have noted your intention to donate on your driver’s license or have signed a donor card. Carrying out your wishes to provide a better quality of life to others can provide your family with great comfort in a time of grief.

Making decisions for loved ones

If you have already discussed life-support issue with a family member, encourage them to share their views with their physician. If you have not had such a discussion, it is necessary to think seriously about the values important to them. Your own physician, nurse, social worker or pastor can help you reflect on those values. Your decision should express what your loved one would have wanted if he or she could have made the decision themselves.

Gritman is your health care partner

Gritman Medical Center respects the rights and wishes of every patient while delivering the highest quality medical care. We honor all advance directive documents, and we do not discriminate against anyone without an advance directive.

Discuss your goals for medical treatments with your physician. Provide a copy of your advance directive to your doctor, your family and your friends.

For more information or assistance in completing an advance directive, contact Gritman Social Services at 208-883-6360.

Complete a POST (Physician Orders for Scope of Treatment) form

If you or someone you help care for has been diagnosed with advanced illness or frailty, you should also consider completing a POST (Physician Orders for Scope of Treatment) form in addition to an advance directive. Your doctor can help guide you through the process of completing an Idaho POST (an Idaho POST must be signed by a physician to be valid).

At Gritman Medical Center, we care about you as a patient, and we believe you have the right to quality, compassionate care. Gritman prohibits discrimination based on age, race, ethnicity, religion, culture, language, the presence of any sensory, physical or mental disability, socioeconomic status, marital status, sex, sexual orientation and gender identity or expression.

Learn More

We recognize hospital bills are often confusing and occasionally need interpretation. Understanding the relationship between Gritman, physicians and payers is helpful in understanding your bill. Your bill from Gritman covers services provided by the hospital, such as your room and nursing care. It may also include services ordered by your physician, such as X-rays, laboratory tests, medical supplies, medication and oxygen. Your bill does not include charges by your personal physician, surgeon, pathologist, radiologist and other specialists. These providers will send you a separate bill for their services.

Billing Process

A claim will be sent to your insurance company approximately seven days after discharge. We allow six weeks for your insurance company to provide payment for services. If we do not receive payment from your insurance company within this period, we will bill you for the remaining balance.

Should you have a discrepancy with your insurance provider over covered services, please contact them directly.

After receiving payment from your insurance carrier, you will be billed for the balance of the account. If you do not have insurance, we will bill you directly.

Insurance Payment Information

Insurance policies vary widely with different benefits, coverages and exclusions. We do our best to ensure you receive all the benefits to which you are entitled.

Your insurance policy is a contract between you and the insurance company. The hospital has no control over the provisions, exclusions, coverages or benefits. We will cooperate to the fullest in expediting your claim, but please remember you are ultimately responsible.

Prior authorization for treatment is required more and more frequently by insurance companies. If your insurance company requires such authorization, please obtain written approval before admission.

Patient Payment Options

Gritman Medical Center accepts cash, check and all major credit cards. You can also pay online at gritman.org.

Payment Plans

Payment plans can be arranged through our patient financial counselor. If you need to set up a patient payment plan, contact our patient financial counselor at 208-883-2223.

Financial assistance program

We provide counseling for patients who do not qualify for Idaho Medicaid or Latah County Social Services. Contact our patient financial counselor for further details at 208-883-2223.

Contact Patient Billing

If you would like to talk to someone about your bill or need help in filling out your insurance forms, our patient representatives will be happy to assist you. The patient billing office hours are 8 a.m.-5 p.m. Monday through Friday.

• Patient Billing Office
  208-883-2224
• Patient Financial Counselor
  208-883-2223

Billing Information

Infection prevention is key to your safety. If you are ill, injured or have an opening in your skin, such as a wound or tube placed in the body, you are more at risk of developing an infection.

By being involved in your care, you can work with us to prevent infections.

What is an infection?

An infection occurs when germs, bacteria or viruses get into your body and cause disease. Germs can be spread through touch, through the air or through your eyes, nose and mouth.

Bacteria are found everywhere, including in patient care settings, our hands, our skin, in our noses and on surfaces. In small numbers, bacteria rarely cause problems. In fact, your body always carries bacteria and some types, such as those in your digestive tract, are helpful. However, when bacteria grow and multiply or are overtaken by harmful bacteria, infections develop.

What is infection prevention?

It is preventing the spread of infections or illnesses like:

• Urinary tract infections (UTI)
• Catheter-associated UTIs
• Surgical site infections
• Respiratory infections, such as pneumonia and ventilator-acquired pneumonia
• Hepatitis B and C
• Human Immunodeficiency Virus (HIV)
• Multi-drug resistant organisms (MDROs)

Why is infection prevention important?

Infections can spread to others, including patients, family and staff, and they can lengthen a patient’s hospital stay and increase health care costs.

Who can get an infection?

Anyone can get an infection, but some people are at increased risk, especially:

• Surgical patients
• Elderly
• Newborns
• Seriously ill (ICU) patients
• Long-term patients
• Patients on certain types of medications (like steroids, chemotherapy)
• People with diabetes

Why do people sometimes get infections in hospitals?

Many sick people are together in one building, which leads to numerous microorganisms being present and spreading from one person to another (especially patients who are at increased risk for infection). Procedures that save lives – like surgeries and catheterizations – may also increase the risk of infection.

Why can’t all infections be avoided?

However hard we work, not all infections can be avoided – you may:

• already have an infection when you come into the hospital
• be having surgery or treatment that increases the risk of infection
• have a low immune system (the body’s defense system), making you more vulnerable to infections

Chain of infection

All elements must be present to develop an infection:

• Microorganisms
• A carrier — patient or health care worker
• A way out of the carrier — sneezing, coughing, open wound
• Method of transmission — air, direct contact, linens, towels, contaminated hands, instruments
• A way into another person — breathing, break in the skin
• A susceptible person

What steps can be taken to limit infections?

• Avoid touching your eyes, nose and mouth
• Wash your hands with warm soapy water for at least 20 seconds. Wash the front and back of your hands and wrists, between fingers and under nails. Then rinse well and turn off the faucet with a paper towel.

How do staff limit infections?

Staff wash their hands:

• before putting on and after removing gloves
• between patients
• after touching body fluids, blood, broken skin, mucous membranes
• after using the restroom
• after coughing or sneezing into their hands
• after blowing their nose
• before and after eating or preparing food
• before invasive procedures

Staff also wear personal protective equipment (PPE) like gloves, gowns, masks and face and eye protection.

We also are committed to thoroughly cleaning your room, bedside equipment and surfaces with approved disinfectants.

Standard precautions

We use standard precautions for all patient care regardless of suspected or confirmed infection status of the patient. Standard precautions protect health care providers from infection and prevent the spread of infections.

Isolation precautions

Transmission-based precautions are used in addition to standard precautions when standard precautions alone do not fully prevent communicable disease transmission. There are three types transmission:

• Contact: Prevent the spread of infectious diseases by skin to skin or contact with contaminated objects
• Droplet: Prevent the spread of large particle droplets that can be spread by coughing or sneezing
• Airborne: Prevent the spread of small particles that remain suspended in the air. Also requires special air handling and ventilation

What are MDROs?

A multi-drug resistant organism (MDRO) is bacteria that is resistant to many antibiotics. When bacteria are resistant to an antibiotic it means certain drug treatments will not work.

Examples of MDROs

• Methicillian Resistant Staphlycoccus Aureaus (MRSA)
• Vancomycin Resistant Enterococcus (VRE)

It is important to prevent the spread of MDROs. Infections caused by MDROs can be more difficult to treat since there are fewer antibiotics that work against them.

They spread primarily by direct person-to-person contact, and you don’t have to be infected to be a carrier.

Colonization vs. infection:

Colonization indicates the presence of the organism without symptoms of illness. People can carry it in their nose or on their skin.

Infection is tissue invasion of the organism with clinical symptoms.

In the hospital, we also use contact precautions to prevent becoming infected or transmitting infection to other patients who are at risk.

Together we can prevent the spread of germs

Hand washing is the single most important measure to prevent the spread of infections. Other measures we practice to keep you safe include:

• Safe injection practices: one needle, one syringe and only one time
• Remove invasive devices (such as urinary catheters) as quickly as possible
• Environmental cleaning
• Pre-surgery shower/bathing
• Antimicrobial stewardship (proper antibiotic usage)
• Vaccinations
• Cover your cough – sneeze and cough into your elbow, not your hand
• Evidence-based care bundles – set of practices that have been proven to
  improve patient outcomes (examples are surgical site infections, sepsis)