Emergency department nurse-led systematic nursing model for septic shock: impact on 1-hour bundle adherence and mortality

Objective To evaluate the impact of a systematic septic shock nursing model led by emergency department (ED) nurses on adherence with resuscitation protocols and clinical outcomes in patients with septic shock. Methods Our team employed the Delphi method to develop a systematic nursing model, and it was implemented in August 2023. To verify its application effect, a retrospective controlled study was conducted in the emergency resuscitation room of the First Affiliated Hospital of Wenzhou Medical University. Patients who met the Sepsis-3 criteria for septic shock were consecutively enrolled from January 2022 to February 2025. According to the nursing model received during different periods, they were divided into two groups: the control group (enrolled from January 2022 to July 2023, n = 331) received conventional nursing, and the observation group (enrolled from August 2023 to February 2025, n = 343) received the systematic nursing model led by emergency nurses. Propensity score matching (1:1, caliper value 0.2) was used to balance differences. Primary outcomes included the 1-hour bundle adherence rate, 28-day and 90-day mortality, and 24-hour resuscitation success rate. Secondary outcomes included SOFA score, duration of vasoactive agent use, mechanical ventilation duration, ICU length of stay, and incidence of adverse events. Results After propensity score matching, 524 patients were successfully matched, with 262 patients in each group. The 1-hour bundle adherence rate was significantly higher in the observation group than in the control group (23.66% vs. 14.12%, p = 0.005), although the absolute adherence rate remained low in both groups. Compared with the control group, the observation group showed a significant decreases in 28-day and 90-day mortality, and a significant increase in the 24-hour resuscitation success rate ( p < 0.05). Moreover, SOFA scores were significantly reduced, and both the duration of vasoactive agent use and ICU length of stay were shortened ( p < 0.05). The incidence of adverse events was also significantly lower in the observation group ( p < 0.05). Conclusion The systematic nursing model led by ED nurses significantly improves adherence in patients with septic shock, reduces short and medium-term mortality, enhances organ function recovery, and shortens ICU length of stay, demonstrating good potential for clinical implementation.