For patients with severe sepsis and septic shock in the ED, studies have shown that goal-directed therapy is effective. However, many EDs throughout the country have not implemented such protocols. In a recent study, a survey was conducted by investigators in New York. The purposes were to identify and address specific barriers to optimal sepsis treatment and to maximize benefits of implementing a planned sepsis treatment initiative. According to findings, several barriers to a quantitative resuscitation protocol for sepsis were identified, including:

The inability to perform central venous pressure monitoring.
The inability to perform central venous oxygen saturation monitoring.
Limited physical space in the ED.
Lack of sufficient nursing staff.

Among nurses, the greatest perceived contributor to delays in treatment was a delay in diagnosis by physicians. For physicians, a delay in availability of ICU beds and nursing delays were the greatest barriers. The majority of respondents reported that written protocols would be helpful, even with these perceptions. The authors concluded that the knowledge gaps and procedural hurdles identified by their survey can help inform educational and process components for initiatives to improve sepsis care in the ED.

Abstract: Journal of Emergency Nursing, November 2012.