Integrated Nursing-led Sepsis Screening and Laboratory Rapid Diagnostics in Hospitalized Patients: Effects on Time-to-antibiotics, Antibiotic Use, and Mortality; a Systematic Review
Year: 2025
Type: article
Abstract: Background: Delays in diagnosing and treating sepsis increase mortality. Hospitals increasingly combine nursing-led screening with laboratory rapid diagnostics to accelerate recognition and antimicrobial therapy. We aimed to systematically review the effects of integrated nursing-led sepsis screening and laboratory rapid diagnostics on time-to-antibiotics, antibiotic utilization, and mortality among hospitalized adults. Method: Data sources include MEDLINE, Embase, CINAHL, and CENTRAL were searched from inception to 19 October 2025. We include original studies evaluating nursing-led screening or protocols and/or laboratory rapid diagnostics (rapid blood-culture ID or rapid phenotypic AST), reporting at least one outcome of interest. Two reviewers screened, extracted data, and assessed risk of bias (quasi-experimental studies by ROBINS-I; RCTs by RoB 2). Heterogeneity precluded meta-analysis; results were narratively synthesized. Results: Eleven studies (4 emergency department nurse-driven protocols; 3 hospital-wide/ward performance-improvement programs with substantial nursing components; 4 rapid-diagnostics studies including 2 randomized trials) met inclusion. Nursing-led protocols consistently reduced time-to-antibiotics by 29–60 minutes and were associated with lower in-hospital mortality in several cohorts. Rapid diagnostics reliably shortened time to organism identification and optimal therapy and reduced broad-spectrum exposure; mortality effects were mixed. Conclusions: Integrated approaches pairing nursing-led screening and activation with rapid diagnostics reduce treatment delays and can improve antibiotic stewardship; mortality benefits are most evident where programs include empowered nurse activation, streamlined order sets, and stewardship feedback. Hospitals should invest in nurse capacity and workflow integration alongside diagnostics.
Authors: NOUF FAYAD ALANIZI, AMJAD SAUD ALQAHTANY, ALI MOHAMMED ALGUBLAN, FREH ABDULAZIZ ALFREH, KHOLOOD MUTLAK ALSAHLI, AMJAD ABDULLAH ALANAZI, RAYYAN DHAIFALLAH ALOTAIBI
Institution: National Guard Health Affairs
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7093360284
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