Implementation of Early Goal-directed Therapy for Septic Patients in the Emergency Department: A Review of the Literature

IntroductionThe Surviving Sepsis Campaign outlines the elements of early goal-directed therapy when treating patients with sepsis in the emergency department. The success of these guidelines relies on their implementation in order to attain optimal patient outcomes. The purpose of this article is to review the literature regarding the implementation of the sepsis guidelines in emergency departments.MethodsUsing the search terms systemic inflammatory response syndrome, emergency service, and sepsis, the Cumulative Index of Nursing and Allied Health, MEDLINE, and Cochrane database were searched for information pertaining to implementing early goal-directed therapy for sepsis in the emergency department.ResultsStudies that discussed collaboration, preplanning, and education were able to implement monitoring of central venous pressure, mean arterial pressure, and central venous oxygen saturation. However, nursing interventions recommended by the Surviving Sepsis Campaign such as measuring urine output and obtaining blood cultures were less often considered.DiscussionThis review provides some factors important for the successful implementation of the Surviving Sepsis Campaign guidelines. Operational and system issues significantly influenced the success of implementing sepsis protocols or bundles. More research is needed to overcome barriers to implementing early goal-directed therapy and to uncover which elements of the guidelines are most important and feasible to achieve optimal patient outcomes.