Excellence. Acutely ill patients in hospital: recognition

of and response to acute illness in adults in hospital. London: NICE, 2007. Early goal-directed therapy: can the emergency department deliver We read with interest the original article Early goal-directed therapy: can the emergency department deliver by Lyon et al.1 The authors identify elements of the ‘Early Goal Directed Therapy ’ (EGDT) component of the Surviving Sepsis Campaign’s ‘Resuscitation Bundle’, which emergency medicine (EM) registrars may fail to deliver due to lack of appropriate skills and the 4-h wait. A previous UK survey of EM and acute medicine consultants2 (n234) yielded similar results: lactate measurement, central venous pressure (CVP) monitoring and inotrope administration present major barriers to implementation. Recognising poor compliance, we developed an operational solution reflective of National Health Service (NHS) practice to facilitate early interven-tions. The ‘Sepsis Six ’ comprises three diag-nostic (lactate, blood cultures, urine output monitoring) and three therapeutic (oxygen, intravenous antibiotics, intravenous fluid) steps to be delivered within 1 h.3 The accompanying education programme, Survive Sepsis, reinforces that persistent evidence of hypoperfusion following delivery of the Sepsis Six mandates immediate referral to Critical Care to complete the remainder of the Resuscitation Bundle. EGDT is currently being re-evaluated in two multicentre studies: Australasia