Date of Award

Spring 5-22-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Eligio Soliman, DNP

Abstract

Sepsis is the leading cause of in-hospital death and the most expensive inpatient condition in the United States, yet federal quality policy still relies on outdated Systemic Inflammatory Response Syndrome (SIRS) criteria in the Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1), creating fragmented, inequitable recognition of hospital-onset sepsis across U.S. acute-care hospitals. This health policy analysis evaluates the National Early Warning Score 2 (NEWS2) as an evidence-aligned replacement for SIRS-based SEP-1 trigger criteria within a hybrid governmental-organizational policy strategy for adult acute care inpatients. Guided by Kingdon's Multiple Streams Framework and an Evidence-Informed Health Policy model, the analysis synthesizes a PRISMA-structured review of 46 evidence sources, compares the diagnostic and prognostic performance of SIRS, qSOFA, MEWS, NEWS, and NEWS2, and incorporates a cost–benefit model for a representative 300-bed hospital plus feasibility and stakeholder analyses. NEWS2 demonstrated superior diagnostic balance, with high sensitivity for Sepsis-3-defined sepsis and 28-day mortality prediction, outperforming SIRS while reducing false-positive alerts. The cost-benefit model estimated a one-time implementation cost of 1.03 million dollars per 300-bed hospital, yielding 12.6 million in year-one net savings, a 13.8 five-year benefit-to-cost ratio, and a 1.26 billion dollar year-one federal return on a 20-million-dollar appropriation when scaled to 100 hospitals. The analysis recommends revising SEP-1 to embed NEWS2 as the mandatory upstream sepsis screening threshold, establishing NEWS2 as a certified electronic health record function, and funding an AHRQ-led implementation collaborative with DNP-prepared advanced practice nurses leading design, implementation, and policy advocacy.

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