Admission avoidance clinics Patients known to the respiratory consultants /CNS will contact the team when they are unwell. These patients may have complex respiratory infections, airways disease, or interstitial lung diseases. They will be booked to attend the respiratory SDEC where a clinician will assess them and discuss with the respiratory physician of the day. Pleural clinic Patients presenting to A&E/GP with a new unilateral pleural effusion will be seen directly by a member of the respiratory team. After a thorough history and examination, a thoracic ultrasound will be performed. When there are no contra-indications, a diagnostic pleural aspiration will be performed the same day. Patient will then be appointed to the correct follow-up pathway. Ambulatory primary spontaneous pneumothorax management Patients presenting to A&E with a spontaneous primary pneumothorax will be directed to the respiratory SDEC for their management. We plan to implement an ambulatory chest drain pathway for patients requiring intercostal drainage but well enough to be managed in an ambulatory setting. The clinical fellow will have the opportunity to participate in setting up this pathway and evaluating its implementation. Pathway for faster diagnosis of lung cancer Patients presenting to the radiology/A&E department with chest x-ray findings suggestive of a lung malignancy will be directed to the respiratory SDEC. They will be seen directly by a member of the respiratory team, the correct investigations (CT chest, diagnostic aspiration, bronchoscopy, PET, EBUS) organised and prompt follow-up in the lung cancer clinic will be arranged. Earlier intervention with the correct test means patients are diagnosed earlier and are therefore fitter for treatment. This is increasingly important with newer anti-cancer treatments such as immunotherapy and targeted therapy. We expect to develop further ambulatory respiratory care pathways as the service develops.