Sepsis continues to pose a serious threat to patients and a significant challenge to hospital systems. Despite advances in awareness and clinical guidelines, delays in diagnosis and treatment remain common and costly. Sepsis is the leading cause of death in U.S. hospitals and costs the U.S. health care industry $62 billion annually.

The ripple effects of sepsis extend far beyond the bedside, impacting everything from reimbursement rates to emergency department (ED) boarding and overall bed utilization. The solution is both clinical and operational, and it lies in empowering nurses with standardized, nurse-initiated order sets designed to identify sepsis early—just as we have done for stroke with rapid CT protocols and ST-elevation myocardial infarction (STEMI) with EKG protocols.

The case for nurse-initiated standing orders

Nurse-initiated standing orders (NISOs), also known as nurse-driven protocols or triage protocols, are predefined care pathways initiated by registered nurses prior to physician assessment. Common in EDs, these protocols have been proven to streamline care, improve outcomes and enhance patient safety. In conditions like stroke and STEMI, NISOs have become a gold standard, enabling nurses to begin time-sensitive assessments, like EKG, rapid CT or lab work, to accelerate the time to detection of a medical emergency and provide the physician with actionable information.

It is time to treat sepsis as the “third S,” alongside stroke and STEMI, with standardized, nurse-initiated protocols that drive rapid recognition and response.

Empowering nurses to practice at the top of their license

While nurses cannot diagnose or write medical orders, it is well within their scope to initiate pre-approved protocols in collaboration with a physician. These protocols are designed not to replace clinical judgment but to extend it, thus enabling faster care based on objective clinical indicators, such as abnormal vital signs, signs of infection and systemic inflammatory response syndrome (SIRS) criteria.

One of the greatest barriers to timely sepsis treatment is its clinical ambiguity. Sepsis often mimics other conditions, including influenza, pancreatitis, pulmonary embolism and even heart failure. Early symptoms, such as fever, elevated heart rate and altered mental status, can be non-specific and overlap with a wide range of differential diagnoses.

Such varying symptoms make frontline sepsis detection extremely difficult, particularly in high-volume settings like the ED, and put an enormous burden on nurses. Nurse-initiated screening tools and protocols help reduce this uncertainty by anchoring early intervention to objective criteria—not simply subjective suspicion. This enables critical steps to begin even before a definitive diagnosis is made and empowers nurses to practice at the top of their license.

Taking the guesswork out of sepsis detection

For too long, nurses have been limited to documenting vital signs and waiting for a physician to advance the patient through triage. Yet acting without a clear understanding of a patient’s condition can lead to serious consequences. Delays or errors in starting fluids or antibiotics, whether too late or when not clinically appropriate, can negatively impact outcomes for sepsis patients. For instance, giving a fluid bolus to a patient in cardiogenic shock can be fatal. Similarly, inappropriate use of antibiotics undermines our ability to preserve these essential medications.

The National Institutes of Health recognizes the role of nurses in initiating certain orders, particularly in settings like EDs where rapid decision-making and action are crucial.

Hospitals that have embraced nurse-initiated sepsis protocols are already seeing benefits in both improved care outcomes, reduced length of hospital stay for the patient and improved nurse satisfaction. For example, Franciscan Missionaries of Our Lady Health System (FMOLHS) in Louisiana developed a standardized sepsis protocol leveraging IntelliSep, a U.S. Food and Drug Administration (FDA)-cleared cellular host response technology that provides insights into a patient’s immune response.

With the new sepsis protocol and technology, ED nurses can be enabled to act rapidly based on a standardized infection risk assessment, initiating sepsis testing and moving patients efficiently through the system. This approach is showing a dramatic impact, alleviating ED congestion and reducing delays in care.

The operational and financial stakes of sepsis

Sepsis is one of the leading contributors to hospital admissions and complications, yet it is also a frequent source of non-reimbursed care. Due to the complexity of diagnosis, hospitals often find themselves treating patients as septic based on non-specific signs, only to discover later that the condition did not meet sepsis criteria. Once coded and submitted, these cases are often denied reimbursement, which is a costly misstep under the diagnostic related group (DRG) system.

More than a coding issue, sepsis is a throughput issue. When patients remain in the ED due to delays in diagnosis or treatment, or delivery of non-beneficial care, ED boarding worsens. This causes bottlenecks throughout the hospital and contributes to patient safety risks. Nurse leaders and hospital executives are responsible for both high-quality care and efficiency of patient flow. Sepsis sits at the intersection of both.

By utilizing the early sepsis detection technology, FMOLHS reports that potentially septic patients are pulled from the ER waiting room 60 to 70 minutes faster and the average length of stay has been reduced by nearly a day. The hospital has also reduced health care costs by about $1,400 per patient and saved about 40 hours of nursing time per month on unnecessary blood cultures. A recent peer-reviewed study published in the journal Healthcare also showed that the hospital’s sepsis quality improvement initiative, leveraging IntelliSep, reduced the relative rate of sepsis mortality by 39 percent. Nursing staff report that the new sepsis protocols take the guesswork out of sepsis detection.

National sepsis standardization is long overdue.

What’s missing across the board, however, is consistency. Unlike STEMI and stroke protocols, sepsis protocols vary widely from hospital to hospital. National standardization is long overdue.

The Centers for Medicare and Medicaid Services (CMS) introduced the Severe Sepsis and Septic Shock Management Bundle (SEP-1) measure to encourage evidence-based care for sepsis. But recent studies find that compliance with the bundle does not lead to mortality improvements. Compliance is highly variable and many hospitals continue to struggle with timely identification and treatment.

As demonstrated by FMOLHS, nurse-driven sepsis identification protocols offer a clear solution. One that incorporates objective sepsis detection tools beyond vital signs, empowers nurses and drives measurable improvements in sepsis outcomes.

Outcomes, safety and stewardship

Sepsis presents a complex challenge from a clinical, operational and financial perspective. By implementing NISOs for sepsis and enabling frontline nurses to begin time-sensitive diagnostics, hospitals can accelerate care, improve outcomes, reduce boarding and protect reimbursement. It’s a model that has worked for stroke and STEMI. By initiating standardized protocols for sepsis based on well-defined criteria, nurses can help ensure that patients receive the right treatment at the right time, for the right reasons. Let’s make sepsis the third “S” and give nurses the tools and technologies they need to lead the charge.

Rhonda Collins is the chief nursing officer at Cytovale, where she leads efforts to integrate nursing innovation into diagnostic technologies. With more than 30 years of experience, Dr. Collins is a nationally recognized leader in healthcare communication and cognitive workload management. She is pioneering nurse-led implementation of IntelliSep, Cytovale’s rapid sepsis detection tool, to facilitate early diagnosis in emergency departments. Formerly the chief nursing officer at Vocera, she also held leadership roles at CareFusion, Masimo, and Fresenius Kabi, where she led FDA clearance and launch of a medical device. A Fellow of the American Academy of Nursing, she earned her degrees from Texas Tech University Health Sciences Center and the University of Texas. Dr. Collins has published on cognitive burden in nursing, including “Clinician Cognitive Overload and Its Implications for Nurse Leaders” and “Managing the Cognitive Overload of Nurses.” Connect with her on LinkedIn.