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Martha's Rule - Detecting DETERIORATION

Martha’s Rule is named after Martha Mills, a 13-year-old girl who became seriously ill in hospital. Her family’s concerns were not taken seriously, and she passed away soon after.

The rule was created so that worries about care are always listened to and acted upon. Don’t hesitate to ask about Martha’s Rule, all staff have received training about the process and will be able to help you.

Martha’s Rule is currently live in all of our adult wards at University Hospital Coventry and the Hospital of St. Cross Rugby, as well as our Paediatrics and Maternity departments.

You can use Martha’s Rule if:

  • You think you or someone else is getting worse while in hospital.
  • You feel your clinical concerns are not being listened to.

What to do:

  1. Talk to a member of the ward team looking after the patient.
  2. If you are still worried, call the Call for Concern number: 02476 964128 (available 24/7).
  3. Tell the team the patient’s name, what ward they are on, and your concerns.

After Martha’s Rule is activated, a member of our Critical Care Outreach Team will check the patient, ask patient wellness questions to better understand how the patient is feeling, and use these questions to help identify any early signs that the patient may be getting worse.

Sometimes these independent reviews will be carried out differently depending on which area you are in. You can see more information of how Martha’s Rule may change across our departments below.


  • Unusual tiredness or confusion
  • Breathing changes (noisy, fast, or slow)
  • Eating or drinking less
  • Not passing urine
  • Vomiting or diarrhoea
  • Feeling hot, cold, or shivery
  • Not walking as usual
  • Anything else that feels “not right”

The team will listen to your concerns and check how urgent the situation is. They’ll come quickly if needed.

In Paediatrics, Martha’s Rule calls will be handled a little differently. Once you pass on the patient’s information, you will receive a visit from the Senior Paediatric Nurse, who will advocate for your concerns and the patient.

Sometimes, the doctor who sees the child for the independent review may be someone who has already checked them before. If you would like them to be seen by someone else, another senior children's doctor will be available from 9am to 1pm.

In Maternity, the independent reviews for mothers will be done by a member of the Critical Care Outreach Team and an obstetrician. Babies will be reviewed by a Paediatrician.

At the Hospital of St. Cross, independent reviews of patients will be done by the Matron allocated to the area.

Martha’s Rule will roll out soon in our Neonatal Unit and Emergency Department.


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