When should I consider referring a patient with NMS to secondary care for further management?

Consider referring a patient with neuroleptic malignant syndrome (NMS) to secondary care urgently if they present with severe symptoms or complications that require specialist management. This includes features such as high fever, marked muscle rigidity, autonomic instability, altered consciousness, or evidence of organ dysfunction (e.g., renal failure, respiratory compromise). Immediate referral is also warranted if the diagnosis is uncertain or if the patient’s condition is rapidly deteriorating despite initial management in primary care.

Secondary care referral ensures access to multidisciplinary teams for comprehensive assessment, monitoring, and treatment, including intensive care support if needed. Early specialist involvement improves outcomes in NMS due to the potential for rapid progression and life-threatening complications.