Early goal-directed therapy: can the emergency department deliver?

Abstract

Background: Early goal-directed therapy (EGDT) has been shown to improve outcome in patients presenting to the emergency department (ED). Uptake of EGDT in EDs in the UK has been slow.

Objective: To establish the level of awareness and skills necessary for EGDT to be implemented by emergency medicine (EM) specialist registrars (SpR) working in Scottish EDs.

Method: A cross-sectional web-based survey of all 49 Scottish EM SpRs was performed.

Results: 42 responses were obtained (86%). Only 19 (45%) EM SpRs possessed the full complement of skills and knowledge necessary to fully implement EGDT independently within the ED. The 4 h target for time to admission was seen by 78% of SpRs as a barrier to the implementation of EGDT in the ED. The preference of most respondents was for initiation of EGDT delivery in the ED and referral to critical care for full implementation.

Conclusion: Full delivery of EGDT by ED staff would require significant consultant support, improved training of juniors and flexibility in the 4 h target. This study suggests that it may be practical for EGDT to be initiated in the ED and that early referral to critical care will remain essential if patients are to receive the full benefit of this intervention.