Martha’s Rule?

Martha’s Rule is built around three linked elements:

1. Asking patients daily how they’re feeling
   Patients will be asked, at least once a day, whether they feel better, worse, or about the same. Any noted change should be acted on in a structured way
   
   
2. Staff escalation
   Any staff (nurse, doctor, allied health) can, at any time, request a review from a different team if they believe a patient is deteriorating and isn’t being responded to appropriately.
   
   

Patient / family / carer escalation
If a patient, relative, or carer is worried after speaking to the ward team, they can trigger a Martha’s Rule review by calling a dedicated number or using a process advertised in the hospital.

• The review is conducted by an independent (i.e. different) clinical team, often the hospital’s critical care outreach or emergency review team.
  
  
• They may assess in person or by phone, consult existing ward teams, and make recommendations or arrange further care escalation

Yes — early results are encouraging:

• Between September 2024 and June 2025, nearly 4,906 calls were made under Martha’s Rule to escalate concerns.
• Of those, 241 calls led to potentially life‑saving interventions (for example, admission to intensive care, transfer to enhanced care, new treatments)
• Also, many other calls resulted in changes to care (e.g. new investigations, treatments, referrals) even without ICU transfer
• These data suggest Martha’s Rule is helping detect and respond to deterioration earlier, complementing existing clinical warning systems

Of course, ongoing evaluation continues to refine how best to make it work everywhere.

• Nottingham University Hospitals is listed as a Phase 2 site for Martha’s Rule, currently in the planning for launch phase.
• This means that NUH is preparing to pilot Martha’s Rule (for example, on a few wards or units) starting in 2026.
• Learning from that pilot—what works, what needs improvement, challenges and successes—will then guide how Martha’s Rule is rolled out across the rest of the trust (i.e. to all wards and units).
• Until that fully operational stage, the usual escalation routes remain in place, but the trust encourages staff, patients and families to prepare for the new expanded escalation option when it becomes active.

While the formal Martha’s Rule number may not yet be active in all areas of NUH, you should know:

• If you (or your relative) are concerned that an inpatient’s condition is worsening and feel your worry isn’t being taken seriously, speak immediately to the senior nurse on the ward (e.g. nurse in charge or ward manager).
• If you remain worried, you can ask to speak to senior medical staff (registrar or consultant) in that clinical area.
• Do not rely on calling the hospital switchboard for this type of acute escalation — they are not set up to manage urgent clinical deterioration concerns and may not be able to redirect calls appropriately.
• For non-urgent feedback, complaints, or concerns (for example about communication, facilities, bed management) you should contact the PALS team (Patient Advice and Liaison Service).

• Patients, family members and carers often notice subtle changes before they become obvious to clinical monitoring systems. Martha’s Rule recognises that those closest to a patient may raise early warning signs.
• It provides an extra “safety net” beyond normal escalation routes — a formal means to ask for review when there are concerns about acute deterioration.
• It encourages openness, responsiveness, and shared vigilance in patient safety culture.
• In practice, some lives may be saved or harm prevented by earlier intervention in deterioration.