A safety initiative being trialled in 143 NHS hospitals, where patients and families can seek urgent reviews if someone’s condition deteriorates, has led to ‘potentially life-saving changes in care’
In May this year, the NHS announced that 100 hospitals would take part in a trial of ‘Martha’s Rule’, a scheme named in memory of Martha Mills, who died from sepsis in 2021 when she was 13. It was later acknowledged by NHS authorities that there had been a failure to escalate Martha to intensive care and that her family’s concerns about her deteriorating condition had not been responded to appropriately.
Photo by Stephen Andrews
In response to their tragic loss, Martha’s parents Merope Mills and Paul Laity backed a campaign to ensure that concerns about the deterioration of a patient are responded to swiftly. The new Martha’s Rule comprises three elements.
First, the escalation process is available 24/7 and advertised via posters and leaflets in hospitals so that patients and families know to contact the critical care outreach team when they are concerned that a case should be swiftly reassessed and, if need be, escalated.
Secondly, the same process is available to NHS staff.
Thirdly, clinicians formally record daily insights and information about a patient’s health directly from their families, to ensure any changes noticed by the people who know the patient best are given due consideration.
Martha’s Rule is just one of a number of measures introduced recently to improve the identification of deterioration in patients. For example, November 2023 saw the rollout of a new early warning system for staff treating children.
These initiatives seem to be welcomed by staff. Indeed, there was such significant interest in the Martha’s Rule processes that the 100 hospitals initially taking part in the trial study will have expanded to 143 by March 2025.
What’s more, Martha’s Rule is already showing positive impacts. In just September and October 2024, across the participating hospitals in England there were a minimum of 573 calls to escalate concerns about a patient’s deteriorating condition. These includes calls from patients themselves, family members, carers and NHS staff.
Approximately half of these calls (286 of 573) led to a clinical review for acute deterioration, of which about one-fifth (57 of 286) led to a change in the patient’s care. This included the administration of potentially life-saving antibiotics, oxygen or other treatment.
In just the first two months that the trial was in operation, 14 calls made through Marth’s Rule led to a patient getting an urgent transfer to an intensive care unit. Other patients have been moved to high-dependency units or coronary care units, or returned to operating theatres or radiology.
Evaluation of the trial programme will inform proposals for rolling out Martha’s Rule more widely to all acute hospitals, subject to future government funding.
Merope Mills and Paul Laity, Martha’s parents, say: ‘We’re really pleased to see the immediate positive impact Martha’s Rule has made in the hospitals that have introduced it so far. It is our view that listening to the voices of patients and their families makes for the best and safest medicine. The early data suggests that Martha’s Rule isn’t being triggered inappropriately or overused. Were it to be implemented nationally, it would greatly improve care, help change the culture and save lives.’
Professor Sir Stephen Powis, National Medical Director of the NHS, adds: ‘The introduction of Martha’s Rule represents one of the most important changes to patient care in recent years, and we are really encouraged to see the impact it is already having for patients in this first phase. This early data highlights just how essential the Martha’s Rule escalation process will be for patients, families and staff, to help ensure those experiencing acute deterioration can be identified and treated at the earliest possible opportunity.
‘With one-in-five clinical reviews triggered by Martha’s Rule so far leading to potentially life-saving changes in care, this early insight suggests the initiative is starting to have a transformative effect in improving patient safety further – we are so grateful to Martha’s parents, Merope and Paul, for their campaigning and continued collaboration to help the NHS save more lives.’
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