Bloodstream infection (BSI) is a severe systemic infectious disease with rapid disease progression and high in-hospital mortality. The widespread and irrational use of antibiotics in recent decades has continuously driven the emergence of drug-resistant strains, resulting in a year-by-year increase in the detection rate of multidrug-resistant pathogens in BSI patients. In this context, early and accurate diagnosis is particularly critical for guiding rational antimicrobial therapy, preventing disease deterioration and optimizing patient long-term prognosis. As the recognized gold standard for clinical BSI diagnosis, conventional blood culture remains the most reliable testing method, yet it has prominent inherent technical limitations, including long incubation cycles and slow turnaround times. Generally, the positive detection time of routine blood culture exceeds 12 h after venous blood collection. Each hour of delayed antimicrobial intervention significantly increases the risk of adverse clinical outcomes and patient mortality. Moreover, the lag of laboratory test results easily leads to blind empirical antibiotic abuse, which further promotes the spread of drug-resistant bacteria and substantially increases the difficulty of nosocomial infection prevention and control in clinical institutions. The primary report of blood culture, covering Gram staining results and positive alert time, can effectively distinguish Gram-positive cocci, Gram-negative bacilli and yeast-like fungi, enabling timely and targeted early empirical anti-infection treatment before the acquisition of definitive species identification and antimicrobial susceptibility data. This review systematically summarizes effective strategies to accelerate blood culture detection efficiency from two core dimensions: clinical process optimization and blood culture bottle product improvement. At the clinical process level, standardized blood collection procedures, strict specimen delivery within 2 h, satellite blood culture laboratory mode and hierarchical reporting system can significantly shorten specimen transportation and pre-processing time, thereby effectively advancing the release of primary detection reports. These optimized clinical strategies require almost no additional equipment investment and are highly feasible and promotable for grassroots and community hospitals with limited laboratory resources. In terms of product modification, the optimization of medium formula, the addition of high-efficiency antibiotic adsorption resins, and the improvement of CO₂ sensing membranes and gas-isolated bottle structures can effectively promote the resuscitation and proliferation of dormant or inhibited pathogenic microorganisms. Such consumable improvements can shorten the turnaround time of primary reports by 1–4 h and are fully compatible with mainstream automatic blood culture detection platforms widely used in current clinical practice. This review also comprehensively sorts out a variety of emerging BSI detection technologies, including FISH (fluorescence in situ hybridization), PCR (polymerase chain reaction), MALDI-TOF-MS(matrix-assisted laser desorption/ionization time-of-flight mass spectrometry), direct whole-blood pathogen detection, next-generation sequencing, T2MR(T2 magnetic resonance), biomarker detection and machine learning-assisted identification. The study deeply analyzes the unique technical advantages and practical clinical limitations of each detection technology, and clarifies that the large-scale clinical promotion and popularization of these novel detection methods are restricted by high operating costs, incomplete pathogen coverage, nucleic acid contamination risk, blood matrix interference and the lack of stable routine phenotypic drug susceptibility testing capacity. Although emerging detection techniques possess prominent rapid-detection advantages, traditional blood culture is still clinically irreplaceable because it isolates viable pathogens, which can then be subjected to Gram staining and phenotypic antimicrobial susceptibility testing to provide accurate results for precise antibiotic selection. Overall, blood cultures remain irreplaceable. So speeding up blood cultures is still an important way to address the pain points in BSI detection.