Martha's Rule - Detecting Deterioration

Martha’s Rule is a patient safety initiative. It was developed following the death of Martha Mills, and other cases where patients became more unwell and concerns about their health were not acted on.

Martha’s Rule gives patients, families and staff a clear way to raise concerns if they feel that a patient’s condition is getting worse and their concerns are not being heard.

It means that patients and families can:

Speak to someone about their concerns if they are worried about a patient’s condition.
Ask for a review by another healthcare professional if they are still worried after speaking to the care team.
Get help from a separate team if they feel their concerns have not been listened to or acted on.

NHS trusts are working to put Martha’s Rule in place across hospitals. Martha’s Rule is currently available across all adult inpatient wards at University Hospital Coventry and the Hospital of St Cross, Rugby, as well as in our paediatric, maternity and neonatal inpatient areas. It is not currently available in the adult emergency department or children’s emergency department but is expected to be fully implemented by March 2028.

You can use Martha’s Rule if:

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

What to do:

Talk to a member of the ward team looking after you or the patient. You can ask to speak to a senior nurse, ward manager, matron or doctor.
If you are still worried, call the Call for Concern number: 02476 964128 (available 24/7).
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 discuss your concerns with you and advise on the most appropriate next steps. If necessary, they will arrange an independent review.

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

Martha's Rule in the Emergency Department

Martha’s Rule is not currently available in the Emergency Department or Children’s Emergency Department at UHCW. Our Critical Care Outreach Team cannot provide a Martha's Rule review for patients in these areas

If you are concerned about a patient in the Emergency Department, please speak directly to the nurse caring for them, the nurse in charge, or a doctor within the department. They will be able to review your concerns and arrange further assessment if necessary.

Martha’s Rule in Paediatrics

For children, your call will be answered by the Critical Care Outreach Team. They will pass on your information to the right team.

A senior children’s nurse will then call you or come to see you. They will listen to your concerns and speak up for you and your child.

If the nurse thinks your child needs to see a doctor, they will arrange this. The doctor may be someone who has already seen your child. If you would rather see a different doctor, we can arrange this if one is available.

Martha’s Rule in Maternity

In maternity, your call will be answered by the Critical Care Outreach Team. They will pass on your information to the right team.

A senior midwife will then call you or come to see you. They will listen to your concerns and speak up for you.

If the midwife thinks you or your baby need to be seen by a doctor or another member of the care team, they will arrange this.

Martha's Rule in Neonates

In neonates, your call will be answered by the Critical Care Outreach Team. They will pass on your information to the right team.

A senior neonatal nurse will then call you or come to see you. They will listen to your concerns and speak up for you and your baby.

If the nurse thinks your baby needs to be seen by a doctor, they will arrange for a senior neonatal doctor to assess your baby.

Martha’s Rule at the Hospital of St. Cross

Your call will be answered by the Critical Care Outreach Team. They will pass on your information to the matron in charge of the area where you, or the person you are calling about, is being cared for.

Outside normal working hours, your information will be passed to the Senior Site Coordinator. They will advise on what should happen next.

If needed, they will arrange for another senior member of staff to carry out an independent review.