Martha’s Rule – Call 4 Concern

Detecting Deterioration – what is Martha’s Rule?

We have introduced Martha’s Rule – Call 4 Concern to help spot any unexpected signs of deterioration early and give you the right to request a rapid review if you’re worried that your or your loved one’s condition is getting worse. You will see Call 4 Concern posters and information around our hospital sites.

How we monitor patients

While someone is in hospital, we regularly check their vital signs and other important health measurements. The frequency of these checks will depend on the patient’s individual condition and needs. Sometimes we may need
to wake patients to do these checks.

In addition, we will also ask at least daily if patients are feeling better or worse. This is to monitor any unexpected changes in their condition. You may notice small changes before they show up in our routine measurements. These changes could be early warning signs of deterioration.

What to do if you’re worried

If, after speaking to the care team, you remain worried and feel your concerns are not being addressed, call for a rapid review.

Your call will go to a different team in our hospital, who specialise in the care of critically ill patients. They will work with your or your loved one’s care team to arrange any treatment needed or further review.

What things might make me Call 4 Concern?

Some changes that you may notice before anyone else

• The patient seems different to usual (not themselves)
• Breathing differently
• Sweating or unusual skin colour
• Reduced urine output or not passing urine
• More sleepy than usual or confused
• Hands feel cold or very hot
• In pain and looks uncomfortable
• You are worried about their condition.

After prioritising the urgency of the problem, the team will visit the ward to discuss your concerns. The Critical Care Outreach Team liaises with the patient’s medical team and instigates treatment or further review if necessary.

When should I not make a call?

Call 4 Concern is only for concerns about unwell inpatients who require an urgent clinical response. There is a difference between Martha’s Rule and second opinion

Martha’s Rule allows hospital inpatients and their families to seek a rapid review if their condition, or the condition of a loved one, is deteriorating.

A second opinion is when you would like to see another consultant to discuss any diagnosis or treatment.

Additional contact information

The Patient Advice and Liaison Service (PALS) supports patients, carers and relatives who wish to raise concerns or share compliments. PALS works closely with those who contact them, and CSUs, to ensure concerns are responded to as soon as possible.

What about deteriorating children’s health?

You can read more about the LIONS service, Leeds Inpatient Outreach Nursing Service that leads on the deteriorating child at Leeds Children’s Hospital Deteriorating Child and Martha’s Rule – Leeds Teaching Hospitals NHS Trust

More about Martha Mills

Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha, aged 13, would probably have survived had she been moved to intensive care earlier.

The initiative has three main components:

• 24/7 rapid review: All staff and patients, families, carers, and advocates can contact a critical care outreach team at any time.
• Daily health information: Clinicians will record daily information about a patient’s health directly from them or their families.
• Escalation process: Staff can use the 24/7 escalation process to raise concerns.