The role of the microbiology laboratory in the processing of positive patient blood cultures has become more complicated with the increasing demand for rapid information to assist in the management of sepsis. Many laboratories have turned to using molecular systems that report identification and resistant marker results that supply actionable information but no susceptibility data. These systems have proven over time to be useful with the management of Gram positive bloodstream infections but vary in the ability to properly guide therapy choices for Gram negative bacteremia. In our institution, phenotypic antimicrobial susceptibility results are often necessary for optimization of therapy. This is particularly true due to emerging resistance mechanisms in Gram negative bacilli, such as AmpC and porin alterations. The Accelerate Pheno™ system is a truly unique and divergent technology that has the potential to produce final susceptibility results directly from a positive blood culture within 7 hours. This is a reduction in time to results from conventional susceptibility methods of 2-3 days. The Accelerate Diagnostics system was FDA cleared in February of 2017. Clinical trial and scientific presentations have shown the identification and MIC susceptibility results to be reliable and can be used to improve patient care. Rapid final MIC results provide invaluable information to a stewardship program to rapidly optimize the therapy of sepsis.