Aims and objectives: To explore the longitudinal impact of the New South Wales Sepsis guideline on time to antibiotics, triage assessment and emergency management before and four years after guideline implementation. Background: Globally, sepsis continues to be a significant cause of mortality and morbidity within hospitals. To reduce avoidable adverse patient outcomes the corner stone has been to improve the early recognition and management of sepsis. The New South Wales government in Australia introduced sepsis guidelines into Emergency Departments. However, the longitudinal impact of the sepsis guideline, has never been conducted. Methods: A 12-month retrospective randomised health care record audit of adult patients with a sepsis diagnosis was conducted 12-months before and four years after implementation of the sepsis guideline. Results: This study demonstrated sustained improvement in allocation of urgent triage categories in the follow-up group (n = 43; 53.1%) and a reduction in the median time to antibiotics from 189 min to 102 min (p ≤ 0.001) after the implementation of the sepsis guideline. Conclusion: The study has demonstrated the sepsis guideline has improved a sustained change in early assessment, recognition and management of patients presenting with sepsis in one tertiary referral Emergency Department.