Managing suspected sepsis outside acute hospital settings

Management of suspected sepsis in primary care, community settings, and pre-hospital care focuses on rapid risk identification, emergency transfer decisions, and structured safety netting (1):

Immediate Emergency Referral (999 Ambulance) refer all people with suspected sepsis outside acute hospital settings for immediate emergency medical care via 999 ambulance if they meet any of the following (1):

• any high-risk clinical criterion (for example objective new altered mental state, respiratory rate >= 25 breaths/min, systolic blood pressure <= 90 mmHg, non-blanching rash, or cyanosis)
• NEWS2 score >= 7, or NEWS2 score 5–6 with a single parameter red flag (score of 3 in any single parameter)
• aged under 17 years with impaired immunity (due to disease or immunosuppressive treatment) presenting with any moderate-to-high risk criteria

Pre-Hospital Antimicrobial Protocol

• for patients meeting high-risk criteria, if emergency transport or handover time to secondary care is anticipated to exceed 1 hour (for example rural settings), primary care clinicians should administer an initial dose of broad-spectrum parenteral antibiotics prior to transfer where local protocols allow (1)

Community Assessment for Moderate Risk assess all people with suspected sepsis outside acute hospital settings who present with moderate-risk criteria or NEWS2 5–6 / NEWS2 3–4 with a single parameter red flag to (1):

• attempt a definitive diagnosis of the infection source
• evaluate vulnerability factors (age >= 75 years, multimorbidity, moderate-to-severe frailty, immunosuppression, indwelling devices, or social inequalities) which lower the threshold for emergency referral
• decide whether the patient can be managed safely in the community with close clinical review
• if a definitive diagnosis cannot be reached, vulnerability factors elevate concern, or the patient cannot be managed safely outside secondary care, refer urgently for emergency hospital evaluation (1)

Low Risk and Safety Netting for people with suspected sepsis who present with low or very low risk criteria (NEWS2 0–4 and no red flags) (1):

• manage the underlying infection according to standard primary care pathways
• provide verbal and written safety-netting information detailing specific deterioration red flags (for example worsening breathlessness, confusion, reduced urine output, or mottled skin)
• give clear instructions on how and when to access urgent medical advice or emergency services if clinical condition worsens

References

1. National Institute for Health and Care Excellence (NICE). Suspected sepsis in people aged 16 or over: recognition, assessment and early management (NG253). Published Nov 2025, updated Sep 2026 (supersedes NICE NG51).