Table 1.

Cardiac enhanced recovery pathway (reproduced from NHS Improvement for use in South Tees Hospital). PPI, proton pump inhibitor

<-------Active patient involvement-------->
Referral from primary care	Preoperative	Admission	Intraoperative	Postoperative	Follow-up
•Optimising haemoglobin concentrations •Managing pre-existing comorbidities (e.g. diabetes, hypertension)	•Health and risk assessment •Good quality patient information •Informed decision-making •Patient surgery school •Optimised health/medical conditions •Therapy advice •Nutritional advice •Discharge planning	•Admit on night before or day of surgery •Optimise fluid hydration •Minimise fasting period (i.e. solids 6 h liquids 2 h) •Avoid routine use of sedative premedication •Carbohydrate preloading •Gabapentin and PPI	•Surgical site infection reduction •Temperature management •Tranexamic acid •Opioid-sparing analgesics •Use of local anaesthetic to wound and drain sites •Antiemetic prophylaxis	•Sedation hold and extubation •Active, planned mobilisation within 4 h of extubation •Systematic delirium screening •Early oral hydration •Early oral nutrition •Early drains and catheter removal •Glycaemic control •Thromboprophylaxis •Avoidance of systemic opioid-based analgesia when possible	•Discharge on planned day or when criteria met •Therapy support (physiotherapy, dietician, community nurse) •24 h telephone follow-up if appropriate
<-------Whole team involvement-------->