Martha’s Rule

Detecting Deterioration in inpatients – what’s Martha’s Rule?

You know yourself or your loved one better than anyone and you may notice small changes in deterioration before anyone else. If you spot any unexpected signs of deterioration, Martha’s Rule – Call 4 Concern is a dedicated line to call to request a rapid review.

Need translation? See the headphone image on the top right of this page and at the bottom of the page.

Why call?

While someone is staying 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.

In addition, we 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.

Some changes that you may notice before anyone else

• You are worried about their condition.
• 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

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. The Critical Care Outreach Team will speak to you about your concerns and work with current medical team to instigate treatment or further review if necessary.

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

When should I not make a call?

Only call about unwell inpatients who require an urgent clinical response.

Please note that this is not a route to request a second opinion or to make a complaint. You will need to speak to the Patient Advice and Liaison Service (PALS) for either of these, who support patients, carers and relatives who wish to raise concerns or share compliments.

What about deteriorating children’s health?

You can read more about the LIONS service, Leeds Inpatient Outreach Nursing Service that leads on deteriorating children’s health 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.

Martha’s Rule supportive translated information leaflets

Use the following links provided to download the required information leaflet for your preferred language.