Barriers to implementing protocol-based sepsis resuscitation in the emergency department—Results of a national survey*

作者：David Carlbom, Gordon David Rubenfeld · 发表于：Critical Care Medicine · 年份：2007 · DOI：10.1097/01.ccm.0000298122.49245.d7 · 被引用次数：215 · 研究领域：Sepsis Diagnosis and Treatment、Simulation-Based Education in Healthcare、Hemodynamic Monitoring and Therapy

OBJECTIVE: To identify barriers to implementation of a written protocol for early goal-directed therapy for severe sepsis in the busiest emergency departments in the United States. DESIGN: Telephone survey with both quantitative and qualitative analysis. SETTING: Two busiest teaching and two busiest nonteaching emergency departments in each of the 25 most densely populated combined statistical areas in the United States. SUBJECTS: Twenty-four physician directors and 40 nursing managers representing 53% of the 100 emergency departments surveyed. INTERVENTIONS: Survey questionnaire. MEASUREMENTS AND MAIN RESULTS: Respondents identified lack of available nursing staff to perform the procedure, the inability to monitor central venous pressure in the emergency department, and challenges in identifying septic patients as the most frequent barriers. Although nurse managers and physicians identified similar barriers, nurses were more likely than physicians to list central venous catheter insertion as an important barrier (38% vs. 5%; p = .01), and physicians were more likely to endorse lack of agreement with the early goal-directed therapy resuscitation protocol (16% vs. 0%; p = .03). There were no statistically significant differences in the rankings assigned by clinicians from teaching and nonteaching hospitals. Qualitative analysis of open-ended questions identified barriers in a number of areas, including barriers to initiating the protocol process and factors that distinguish se...