Managing deterioration

Martha’s Rule

The Health Innovation Network has led on the implementation, guidance and support for the adoption of Martha’s Rule by NHS trusts. Our work involves helping teams in different settings identify and solve challenges, as well as sharing learnings nationally.

Martha’s Rule, which gives patients and their families round-the-clock access to a rapid review from an independent critical care team if they are worried about their own or a loved one’s condition, is named in memory of thirteen-year-old Martha Mills.

Martha died after developing sepsis in hospital, due to a failure to escalate her to intensive care and after her family’s concerns about her deteriorating condition were not responded to promptly.

The three components of Martha’s Rule 

1. Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse, and this information will be acted on in a structured way.
2. All staff will be able, at any time, to ask for a review from a different team if they are concerned that a patient is deteriorating, and they are not being responded to.
3. This escalation route will also always be available to patients themselves, their families and carers and advertised across the hospital.