Table 6 Themes which arouse from the open-ended questions with examples of related comments from participants

Variation in practice within the same unit

“Some answers may differ in individuals in the unit eg intercostal nerve sparing.”

“We have 2 surgeons with completely different pathways for pain control”

“Cut off value for pleural fluid drainage accepted for removal of chest drain in the first 24 h differs per consultant”

Barriers to ERAS implementation

“We have a quick turn around for surgery and do not currently have time to implement pre-hab.”

“The biggest barrier to implementing the physiotherapy part of our ERAS is physiotherapy staffing and provision.”

“We have struggled to convince our physiotherapists of the benefits of an aggressive post-operative mobilization plan or to attend pre-admission clinic.”

“The greatest issues are teamwork, consistency, reinforcing the same information & having the active support of consultants & decision-making managers - rather than in word only.”

Enablers to ERAS implementation

“We phone follow up patients 24 h and 72 h post op. Really good support to pts. and rels ensures point of hospital contact and prevents readmissions.”

“Patient education and pre-habilitation has significant role in better outcome and ERAS.”

Suggestions for improvement

“Moving forward, we need more resources at weekends- physio and occupational therapy especially but also pharmacy discharge team etc- we still see a weekend effect on length of stay. Also disappointing to see declining access to smoking cessation nationally- lung cancer surgery definitely a “teachable moment”.’