Impact of an Emergency Triage Nursing Strategy on Early Recognition and Clinical Outcomes in Patients with Sepsis: A...

To evaluate the effect of a nurse-led "Identify-Alert-Act" three-step triage strategy on early sepsis recognition and clinical outcomes in the emergency department (ED).

This single-center retrospective pre-post case-note review enrolled 178 adult ED patients with sepsis who met the Sepsis-3 criteria between January 2022 and December 2024. Patients managed during the routine triage period were defined as the comparator group (86 patients), whereas patients managed after full implementation of the structured nurse-led triage strategy were defined as the intervention-period group (92 patients). The strategy incorporated dual-track screening with the Modified Early Warning Score (MEWS) and quick Sequential Organ Failure Assessment (qSOFA), nurse-led zero-level interventions, and expedited fast-track pathway activation. The primary outcome was 28-day all-cause mortality. Secondary outcomes included ICU admission within 28 days, ED length of stay, key triage-to-treatment time intervals, vasoactive agent use, and requirement for invasive mechanical ventilation. Separate multivariable logistic regression models were constructed for ICU admission within 28 days and 28-day all-cause mortality. The ICU admission model included study period, age, baseline full SOFA score, initial lactate level, and Charlson Comorbidity Index, whereas the mortality model included study period, baseline full SOFA score, and initial lactate level.

The intervention-period group had shorter median times to early warning trigger (15.00 [12.25, 18.00] vs 29.50 [18.00, 43.00] min; Z, -7.28; P<0.001), point-of-care lactate measurement (32.00 [23.00, 44.75] vs 42.00 [25.75, 59.25] min; Z, -2.23; P, 0.026), blood culture collection (33.00 [23.00, 45.75] vs 41.50 [28.75, 57.25] min; Z, -2.52; P, 0.012), and first empirical antibacterial administration (54.00 [33.00, 78.75] vs 90.00 [62.75, 116.00] min; Z, -6.02; P<0.001). ED length of stay was also reduced in the intervention-period group (4.55 [3.53, 6.78] vs 6.45 [4.30, 9.20] hours; Z, -3.55; P<0.001). ICU admission within 28 days was lower in the intervention-period group than in the comparator group (28/92 [30.43%] vs 41/86 [47.67%]; χ²[1], 5.57; P, 0.02). No significant difference was observed in 28-day all-cause mortality (15/92 [16.30%] vs 20/86 [23.26%]; χ²[1], 1.36; P, 0.24). In multivariable analysis, management during the intervention period was independently associated with lower odds of ICU admission within 28 days (aOR, 0.49; 95% CI, 0.25-0.99; Wald χ²[1], 3.98; P, 0.04), but not with 28-day all-cause mortality (aOR, 0.78; 95% CI, 0.35-1.75; Wald χ²[1], 0.37; P, 0.55).

In this single-center retrospective pre-post study, the structured nurse-led triage strategy was associated with earlier sepsis recognition, shorter treatment delays, reduced ED length of stay, and lower ICU admission within 28 days. No statistically significant reduction in 28-day all-cause mortality was observed. These findings should be interpreted cautiously and require further validation in prospective multicenter studies.