A patient safety program led to two thirds more patients receiving necessary changes in care since its rollout to all acute hospitals in England last August.
Data from NHS England shows 1,703 calls received by the Martha’s Rule hotline as of November resulted in adjustments to care to combat acute deterioration in patients – a rise of 61% from the 1058 calls with the same outcome in July.
Proportionate to calls received, however, there was a marginal increase in changes following urgent reviews of care, from 47% of the 2,277 calls by the end of the pilot stage to just over half of the 3,186 acute deterioration calls recorded to date.
The success of the pilot across 143 NHS sites that began in September 2024, before its extension to all 210 hospitals, came three years after Martha Mills, 13, died of sepsis at King’s College Hospital in London after her doctor failed to detect her worsening condition.
A later inquest found that Martha’s delayed transfer to intensive care amounted to “gross negligence” on behalf of Prof Richard Thompson, the gains in total care changes and those as a result of relevant calls a welcome sight for the NHS.
An NHS spokesperson said: “It’s really encouraging that Martha’s Rule is being increasingly used by patients, families and staff, to help us better identify and respond to acute deterioration in patients.
“This initiative is transforming the way hospitals listen to and work with families to address changes in their loved one’s condition.”
Martha’s mother, Merope, advocated with her husband for the NHS to introduce this system, designed to champion the concerns of patients’ families, as their worries over their daughter’s worsening condition were waived away by senior doctors.
Following her great success in campaigning for change, Merope is taking the next step in sharing Martha’s story to help parents with children in similar positions.
She said: “I’m delighted you’re writing about the success of Martha’s rule and the positive life-saving impact it’s had on so many people’s lives.
“Right now, I’m writing a book about Martha’s story and everything I’ve learned about healthcare since she died.”
Acute deterioration is defined by the NHS as the rapid decline of a patient’s physical health requiring prompt medical intervention, identified by physiological changes like respiratory rate or more subtle signs, such as a loss of appetite.
Changes made to patients’ care as a result of escalation calls include full transfers to critical, specialist, or enhanced units, changes in medication, and the admission of IV fluids or oxygen.
On closer inspection of acute deterioration calls recorded between July and November, changes in care surpassed cases in which no intervention was made – now representing under half of the outcomes from calls found to relate to acute deterioration.
Transfers of care remained consistent in proportion to the number of calls recorded monthly as the program was extended, giving rise to 147 (or 55%) more patients being transferred in total.
Since the program’s introduction, patients are asked how they are feeling on a daily basis and staff have been able to ask for a different team to review their condition at any time, with the same escalation route available to patients and their families.
Ronny Cheung, deputy chief medical officer of Guy’s & St. Thomas’ NHS Trust, credited the “huge effort” from clinical teams, stressing the importance of the Patient Wellness Question (PWQ) and Early Warning Score (EWS) in aiming to avoid an escalation call altogether.
He said: “It has been a huge effort from clinical teams in all hospitals, with support by the national team, and the rising number of calls is testament to their efforts.
“The ability for patients to invoke Martha’s Rule when they are concerned their deterioration is being missed is really important. However, it is really a safety net, to be used as a last resort.
“The PWQ and EWS help and prompt doctors and nurses to assess this much more proactively and reliably – in the long run we should reduce the need for patients to ever invoke Martha’s Rule.”
Although the program was designed to prevent further cases of acute deterioration not being managed adequately, those whose health wasn’t found not to relate to acute deterioration have also benefitted.
During the first four months of the national rollout, the number of non-acute deterioration calls that raised clinical concern almost doubled from 1,015 to 2,013 as of last November, accounting for a fifth of all 9,135 calls so far.
The number of cases signposted to another relevant team as a result of non-acute deterioration calls rose from 407 to 647 as of November, matching the performance of the program’s pilot stage.
What’s more, analysis of who called to request urgent reviews of care appears to suggest NHS staff are more alert to their patients’ conditions worsening in hospital.
As of the latest NHS report, not only are escalation calls originating from staff members at an all-time high of 1,261, but 783 of those calls (or 62%) identified cases where treatment should have been changed.
With almost two-thirds of the 733 calls made by staff during the pilot also relating to rapid deterioration, doctors and nurses across the country are now using the system to good effect on a national scale.
Cheung said: “The rise in NHS staff calls represents good news, that staff are increasingly aware of Martha’s Rule as a means to escalate their concerns about a patient they may be looking after.
“However, just like with patients, we should be aiming for a situation where our staff feel that they’re able and confident to speak to the right professional colleagues and feel confident their professional concerns are acted upon.
“In the long run, lower number of staff Martha’s rule calls might be the bigger good news story, if it represents a system where staff can safely escalate concerns without having to invoke the safety net.”
On the back of the program’s national rollout matching its pilot, the health service has hinted at plans to extend the review system beyond maternity, neonatal, and emergency departments.
Community hospitals and mental health settings are the next service areas lined up to implement Martha’s Rule in the future.
It is evident that the “transformative impact” that NHS National Medical Director Meghana Pandit noted in reaction to the success of the pilot last September is now visible across the country.
She said: “There is no shadow of a doubt that Martha’s Rule is having a transformative impact on the way hospitals are able to work with patients and families to address deterioration or concerns about care.
“Merope and Paul have campaigned tirelessly on this issue and continue to work with us to ensure Martha’s Rule is at the centre of our efforts to boost patient safety and quality of care.
“I also want to thank clinical staff up and down the country who have swiftly implemented this potentially lifesaving intervention and ensured its success”.
Feature image: Kolforn via Wikimedia Commons under Creative Commons BY-SA 4.0
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