Quality statement 3: Urgent assessment and antibiotic treatment for people at high risk
Quality statement
People aged 16 or over at high risk of severe illness or death from sepsis in acute hospital settings have an urgent assessment by a clinician with core competencies in the care of acutely ill people and antibiotics given within 1 hour of risk being identified if indicated.
Rationale
Sepsis is a medical emergency and needs urgent assessment, to identify the source of infection or any other potential cause of severe illness, and ensure that people receive appropriate treatment. People aged 16 or over, who are not and have not recently been pregnant, should be assessed by a clinician with core competencies in the care of acutely ill people. This will support rapid access to treatment without having to wait for a more senior doctor, alongside referral to a senior clinical decision maker to confirm diagnosis. The assessment should take place as soon as possible and within a timeframe that allows antibiotics to be given within an hour of risk being identified if indicated. For people at high risk of severe illness or death from sepsis, the clinical benefits of having the first dose of intravenous antibiotics within an hour of risk being identified outweigh any risks associated with possible antimicrobial resistance.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
a) Proportion of people aged 16 or over with a high risk of severe illness or death from sepsis in an acute hospital setting (who are not and have not recently been pregnant) who have an urgent assessment by a clinician with core competencies in the care of acutely ill people.
Numerator – the number in the denominator who have an urgent assessment by a clinician with core competencies in the care of acutely ill people.
Denominator – the number of people aged 16 or over with a high risk of severe illness or death from sepsis in an acute hospital setting (who are not and have not recently been pregnant).
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
b) Proportion of people aged 16 or over with a high risk of severe illness or death from sepsis in an acute hospital setting who receive the first dose of intravenous antibiotics within 1 hour of risk being identified.
Numerator – the number in the denominator who receive the first dose of intravenous antibiotics within 1 hour of risk being identified.
Denominator – the number of people aged 16 or over with a high risk of severe illness or death from sepsis in an acute hospital setting.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records and local prescribing data. The Emergency Care Data Set includes data on assessment tools, including NEWS2, and treatment with intravenous antibiotics.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that a clinician with core competencies in the care of acutely ill people is available for urgent assessment of people aged 16 or over with a high risk of severe illness or death from sepsis (who are not and have not recently been pregnant). Mechanisms should be in place to give the first dose of intravenous antibiotics within 1 hour of risk being identified if indicated.
Healthcare professionals (such as healthcare professionals working in emergency departments) request an urgent assessment from a clinician with core competencies in the care of acutely ill people, or carry out an urgent assessment if they have the relevant competencies, when they identify people aged 16 or over with a high risk of severe illness or death from sepsis (who are not and have not recently been pregnant) so that antibiotics can be given within 1 hour of risk being identified if indicated.
Commissioners ensure that acute hospital settings can demonstrate that a clinician with core competencies in the care of acutely ill people carries out urgent assessments for people aged 16 or over identified as being at high risk of severe illness or death from sepsis (who are not and have not recently been pregnant) and that intravenous antibiotics are given within 1 hour of risk being identified if indicated.
People aged 16 or over with symptoms that suggest life-threatening illness from sepsis (who are not and have not recently been pregnant) have an urgent assessment by a healthcare professional with expertise in caring for people who are acutely ill and start antibiotics within 1 hour if needed to make sure that they have the best treatment as soon as possible. If it will take more than an hour to get to hospital, the antibiotics may be given by healthcare professionals in primary care or by ambulance staff.
Source guidance
Suspected sepsis in people aged 16 or over: recognition, assessment and early management. NICE guideline NG253 (2025), recommendations 1.8.2 and 1.8.3 and expert consensus
Definitions of terms used in this quality statement
High risk of severe illness or death from sepsis
In acute hospital settings, people aged 16 or over (who are not and have not recently been pregnant) are at high risk of severe illness or death from sepsis if:
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they have suspected or confirmed infection and a NEWS2 score of 7 or above
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they have suspected or confirmed infection, a NEWS2 score below 7, and:
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a single parameter contributes 3 points to their NEWS2 score and a medical review has confirmed that they are at high risk or
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there are any other clinical reasons for concern.
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Clinical judgement should be used to interpret the NEWS2 score. [NICE's guideline on suspected sepsis in people aged 16 or over, recommendation 1.8.1]
Urgent assessment
An urgent assessment should take place as soon as possible and within a timeframe that enables provision of antibiotics within 1 hour of risk being identified, if indicated. [Expert opinion]
Clinician with core competencies in the care of acutely ill people
A clinician at FY2 level or above. [NICE's guideline on suspected sepsis in people aged 16 or over, recommendation 1.8.2]
Within 1 hour of risk being identified
Within 1 hour of calculation of the person's NEWS2 score on initial assessment in the emergency department or on ward deterioration. [NICE's guideline on suspected sepsis in people aged 16 or over, recommendation 1.8.3]
Recently pregnant
Someone is considered to have recently been pregnant:
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in the 24 hours following a termination of pregnancy or miscarriage
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for 4 weeks after giving birth.
Clinical judgement is needed after miscarriage (particularly in the second trimester) or termination (particularly in the second or third trimester), because it is not clear how quickly people's physiology returns to pre-pregnancy levels in these situations. [NICE's guideline on suspected sepsis in people aged 16 or over, terms used in this guideline]