We are just as accountable for cost management as the next hospital. We just happen to see a lot of very sick, very high risk sepsis patients and have become well practiced in their management.
The number one reason why we have good outcome though isn't resources. It's that our nurses own their care. They own rapidly assessing and identifying sepsis, they own initiating the sepsis protocol and sepsis alert (or fever in neutropenia alert) with the attending, they own getting their cultures and labs (including lactate on the istat), giving early antibiotics, starting fluids early, and completing the one hour, three hour, and six hour bundles on time and before the patient leaves the ED (our average level 3 ESI patient stays under two ours before admission, ESI 2 under three hours). Our nurses work hard to give that rapid care, and I wouldn't have it any other way.
We also discuss our sepsis concerns in committee, and have ran quite a few QI/QA projects as a result. We have played with the nicom, flotrack, clearsight, and other modalities including ultrasound assessment. We ran our own data on NS vs LR vs Plasmalyte after the vandy study came out. We discuss our choices in pressors, antibiotics, and other interventions regularly when new literature comes out or we start to see a new trend.
I would ask what you are using as your perfusion indicators that you feel works better and quicker than a lactate on an istat. ESR, CRP, Procal, LDH, WBCs, et cetera don't change quickly enough to judge the effectiveness of rapid fluid intervention. Sending a tube to lab to run a lactate will take most good labs 20-30 minutes, average labs much longer. Flotrack requires the placement of an A-Line, clear sight is very limited by patients that don't hold still. We found the NICOM to not be robust enough to stay in place during ED care, and the accuracy we just didn't find as good as the flotrack or clearsight. On that note a CG4 cartridge is a couple bucks, non-invasive cardiac output monitors are hundreds. Ultrasound is great, but typically only preformed by our docs and are heavily reliant on good technique. Capillary refill may indicate poor capillary perfusion but doesn't really show the level of anaerobic metabolism in the body. CVP requires central line placement.
Certainly POC labs are not the only way to assess sepsis, but are a critical tool in patient management.
Our nurses are not responsible for everything. They are not responsible for the medical decision making. They are not responsible for mixing non-vial dose antibiotics. Our bedside nurses are not responsible for the decisions that are made in committee. They are responsible to make sure that the bedside care is performed, but we work as a team to ensure good care.
Who do you think should be running the lactate? If the lab runs it you will have delayed care. If you have an additional lab tech or ED tech in the ED you will still have a delay, albeit much shorter. However also consider that if you are up-staffing a lab or ED tech that the FTE has to come from somewhere, and will probably result in fewer nurses for the workload. Would you rather have one more lab tech and ED tech but as a result have one fewer nurse (and therefore take on another patient in your load)? Do you want that tech to be calling you while you are seeing that additional patient to let you know of the result, or do you want to delay care to only see it when you get back in the patient's chart?
If your system doesn't provide adequate supplies or staffing then that is a different problem, but that doesn't make nurses performing POC tests less valid.
As far as burnout. I doubt the reason many nurses leave the bedside is due to running POC tests. Most employees leave because of poor management, not because their work is hard.
Back in the day docs were doing all the blood pressures, nurses were just feeding the patients, perhaps changing a dressing, and putting oil in the lamps; is that the nursing you would prefer? Or is there a different list of skills you want to keep or get rid of?