Emerg Med J 29:219-221 doi:10.1136/emj.2010.106179
  • Original article

The 4-h target: an example of destructive goal pursuit?

  1. Richard David Hardern
  1. Correspondence to Dr Richard David Hardern, Emergency Department, University Hospital of North Durham, North Road, Durham DH1 5TW, UK; richard.hardern{at}
  • Accepted 14 February 2011
  • Published Online First 21 March 2011


Destructive goal pursuit (DGP) is the situation in which goal setting becomes dysfunctional, leading to impaired performance. This paper considers the 4-h target against the model of DGP and finds many similarities. It does not attempt to provide a critique of the model, nor does it seek to review all the effects of the 4-h target. The need for multiple goals, for all domains of quality to be addressed in these, and for a focus on effective team working and team learning are emphasised. Targets, in a way analogous to drugs or other ‘therapeutic’ interventions, have the potential to cause adverse effects as well as positive ones. A greater understanding will help ensure their overall impact is as beneficial as positive.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
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Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

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