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Surviving sepsis in Scotland: is the emergency department ready?


The Surviving Sepsis Campaign (SSC) guidelines were established to improve outcomes for patients with severe sepsis. Early goal-directed therapy (EGDT) forms a key part of the SSC guidelines and has been shown to reduce mortality rates in septic shock. However, implementation of EGDT requires specific knowledge and skills. Provision of optimal emergency care for patients with severe sepsis necessitates provision of these skills in the emergency department (ED). In the United Kingdom, all patients must be treated in the ED and discharged or admitted within a 4-hour time target.


We sought to establish the availability of these skills in Emergency Specialist Registrars working in Scottish emergency departments. An Internet-based questionnaire was sent to all 49 emergency registrars.


Forty-two responses were obtained (86%). The majority of respondents (95%) were aware of EGDT and the SSC. While 98% felt able to insert arterial and central venous lines, only 43% had inserted more than five central venous lines in the 12 months before the study. Only 45% of ED registrars possessed the full complement of skills and knowledge to implement EGDT. The fact that two-thirds of registrars stated that their preference was for EGDT to be started in the ED with referral to critical care for completion may be a reflection of this deficiency. In addition, the 4-hour time-to-admission target was seen by 78% of registrars to be a barrier to the implementation of EGDT in the ED.


This study has shown that less than one-half of ED registrars have the skills and knowledge to deliver EGDT. If EGDT is to be implemented within the ED, appropriately skilled personnel and equipment must be available. Early referral to critical care is essential if the SSC aim of reducing mortality from sepsis is to be achieved.


  1. Rivers E, Nguyen B, Havstad S, et al.: Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307

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Lyon, R., Hawkins, M., Mackinnon, M. et al. Surviving sepsis in Scotland: is the emergency department ready?. Crit Care 12 (Suppl 2), P416 (2008).

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