Quality statement 5: Escalation of care
Quality statement
People aged 16 or over at high risk of severe illness or death from sepsis in acute hospital settings are seen by a senior clinical decision maker if their condition does not respond within 1 hour of any initial intervention.
Rationale
Septic shock is associated with a high risk of death, so specialist input is important for people who have not had significant improvement after any initial intervention. It is important for the senior clinical decision maker to attend in person. Being looked after by specialist healthcare staff can improve clinical outcomes for these people.
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
Proportion of people aged 16 or over at high risk of severe illness or death from sepsis in an acute hospital setting (who are not and have not recently been pregnant) who are seen by a senior clinical decision maker if their condition does not respond within 1 hour of any initial intervention.
Numerator – the number in the denominator who are seen by a senior clinical decision maker.
Denominator – the number of people aged 16 or over at high risk of severe illness or death from sepsis in an acute hospital setting (who are not and have not recently been pregnant) whose condition does not respond within 1 hour of any initial intervention.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, patient records. Senior clinical decision maker review should take place as soon as possible. For measurement purposes, services may wish to define a locally agreed timeframe.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that a senior clinical decision maker is available to see people aged 16 or over who are at high risk of severe illness or death from sepsis (who are not and have not recently been pregnant) if their condition does not respond within 1 hour of any initial intervention.
Healthcare professionals (such as healthcare professionals working in emergency departments) ask a senior clinical decision maker to see people aged 16 or over who are at high risk of severe illness or death from sepsis (who are not and have not recently been pregnant) if their condition does not respond within 1 hour of any initial intervention. Senior clinical decision makers attend promptly when asked to see people in these circumstances.
Commissioners ensure that they commission services in acute hospital settings in which senior clinical decision makers are available to see people aged 16 or over who are at high risk of severe illness or death from sepsis (who are not and have not recently been pregnant) if their condition does not respond within 1 hour of any initial intervention.
People aged 16 or over with symptoms that suggest life-threatening illness from sepsis (who are not and have not recently been pregnant) that do not improve within 1 hour of initial treatment, see a senior doctor. The senior doctor will be able to arrange specialist treatment to prevent septic shock.
Source guidance
Suspected sepsis in people aged 16 or over: recognition, assessment and early management. NICE guideline NG253 (2025) recommendation 1.8.15
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]
Senior clinical decision maker
A 'senior clinical decision maker' for people under 18 is a paediatric or emergency care qualified doctor of grade ST4 or above or equivalent.
A 'senior clinical decision maker' for people aged 18 years or over is a clinician of grade ST3 or above or equivalent. [NICE's guideline on suspected sepsis in people aged 16 or over, terms used in this guideline]
Does not respond
Signs that the person is not responding to resuscitation include lack of improvement or worsening:
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tachycardia
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level of consciousness
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blood pressure
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respiratory rate
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blood lactate
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urine output
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peripheral perfusion
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blood gases.
[NICE's guideline on suspected sepsis in people aged 16 or over, terms used in this guideline]
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]