1. Enhanced Recovery in Thoracic Surgery Referral Managing pre- existing medical conditions Informed decision making Pre-operative Health & risk assessment Good quality patient information Shared decision making Managed expectations Discharge planning Pre-operative assessment clinic Maximising hydration Admission Admit on day of surgery Optimise fluid hydration Reduced starvation Avoidance of sedative medication Intra-operative Minimally invasive surgery Pain minimising surgical approach Avoidance of fluid overload Use of regional anaesthetic Hypothermia prevention VTE prophylaxis Post-operative Active, planned mobilisation Early oral hydration & nourishment Drain management protocol IV fluids stopped early Routine catheters avoided or removed early Regular & breakthrough multi-modal oral analgesia Minimise use of systemic opiate- based analgesia Follow up Discharge when criteria met Telephone follow up (pilot) Whole team involvement Active patient involvement Getting the patient in best possible condition for surgery...best possible management during surgery...best possible management during surgery... experiences the best possible post-operative rehabilitation Birmingham Heartlands Hospital

2. Enhanced Recovery in Thoracic Surgery Referral Managing pre- existing medical conditions Informed decision making Pre-operative Health & risk assessment Good quality patient information Shared decision making Managed expectations Discharge planning Pre-operative assessment clinic Maximising hydration Admission Admit on day of surgery Optimise fluid hydration Reduced starvation Avoidance of sedative medication Intra-operative Minimally invasive surgery Pain minimising surgical approach Avoidance of fluid overload Use of regional anaesthetic Hypothermia prevention VTE prophylaxis Post-operative Active, planned mobilisation Early oral hydration & nourishment Drain management protocol IV fluids stopped early Routine catheters avoided or removed early Regular & breakthrough multi-modal oral analgesia Minimise use of systemic opiate- based analgesia Follow up Discharge when criteria met Telephone follow up (pilot) Whole team involvement Active patient involvement Getting the patient in best possible condition for surgery...best possible management during surgery...best possible management during surgery... experiences the best possible post-operative rehabilitation Birmingham Heartlands Hospital

3. Enhanced Recovery in Thoracic Surgery Referral Managing pre- existing medical conditions Informed decision making Pre-operative Health & risk assessment Good quality patient information Shared decision making Managed expectations Discharge planning Pre-operative assessment clinic Maximising hydration Admission Admit on day of surgery Optimise fluid hydration Reduced starvation Avoidance of sedative medication Intra-operative Minimally invasive surgery Pain minimising surgical approach Avoidance of fluid overload Use of regional anaesthetic Hypothermia prevention VTE prophylaxis Post-operative Active, planned mobilisation Early oral hydration & nourishment Drain management protocol IV fluids stopped early Routine catheters avoided or removed early Regular & breakthrough multi-modal oral analgesia Minimise use of systemic opiate- based analgesia Follow up Discharge when criteria met Telephone follow up (pilot) Whole team involvement Active patient involvement Getting the patient in best possible condition for surgery...best possible management during surgery...best possible management during surgery... experiences the best possible post-operative rehabilitation Birmingham Heartlands Hospital

4. Enhanced Recovery in Thoracic Surgery Referral Managing pre- existing medical conditions Informed decision making Pre-operative Health & risk assessment Good quality patient information Shared decision making Managed expectations Discharge planning Pre-operative assessment clinic Maximising hydration Admission Admit on day of surgery Optimise fluid hydration Reduced starvation Avoidance of sedative medication Intra-operative Minimally invasive surgery Pain minimising surgical approach Avoidance of fluid overload Use of regional anaesthetic Hypothermia prevention VTE prophylaxis Post-operative Active, planned mobilisation Early oral hydration & nourishment Drain management protocol IV fluids stopped early Routine catheters avoided or removed early Regular & breakthrough multi-modal oral analgesia Minimise use of systemic opiate- based analgesia Follow up Discharge when criteria met Telephone follow up (pilot) Whole team involvement Active patient involvement Getting the patient in best possible condition for surgery...best possible management during surgery...best possible management during surgery... experiences the best possible post-operative rehabilitation Birmingham Heartlands Hospital