Improving patient safety through Martha’s Rule – Managing Deterioration in the South West
With Health Innovation South West playing a key implementation role, Martha’s Rule is improving how acute hospital trusts across Devon, Somerset and Cornwall manage patient deterioration.
Impact
- Supported four acute trusts in the South West to test this major patient safety initiative.
- Improved patient safety and prevention. Harm is avoided through earlier escalation and intervention, with staff, patients, families and carers able to act promptly.
- Increased staff knowledge and response. Structured conversations have improved how staff respond to early warning signs.
- Expected reduction of pressure on secondary care. Spread of improved deterioration management to community and mental health settings in 2025/26 is expected to accelerate patient flow from secondary care to community.
Project summary
Martha’s Rule is a patient safety initiative to improve the management of deteriorating patients through structured conversations and 24-hour access to a second clinical review from the Critical Care Outreach Team. All staff, patients, families and carers can promptly raise concerns and trigger escalation, thereby improving safety and patient outcomes.
Martha’s Rule has been tested and implemented in all acute hospital trusts across Devon (except Royal Devon University Hospital), Somerset, and Cornwall participating in Phase 1 of the rollout.
Health Innovation South West’s Patient Safety Collaborative have worked very closely with the Trust teams to coordinate the implementation of Martha’s Rule. We have played an instrumental role in the provision of tailored QI support, facilitation of regional Community of Practice sessions, supporting and coaching teams around tests-of-change and supporting the sites to provide the necessary data to the national team to support the evaluation and wider learning around the initiative.
Rationale
Managing clinical deterioration in patients is a long-standing challenge for patient safety and prevention, placing additional pressure on secondary care. Martha’s Rule encompasses the importance of timely escalation and listening to all staff, families and carers to prevent harm and reduce pressure on acute services.
This project supports the NHS’s key shifts of Hospital to Community by enhancing safety across care settings and Sickness to Prevention, as early escalation prevents harm.
Key stakeholders
- Somerset Foundation NHS Trust, Royal Cornwall Hospitals NHS Trust, University Hospitals Plymouth NHS Trust, Torbay and South Devon NHS Foundation Trust are lead partners and participated in the roll out of Phase 1 of the project.
- NHS England provide support and commissioning.
- Health Innovation South West played a critical role with tailored QI coaching, regional learning sessions and support for data collection for national evaluation.
Next steps
In 2025/26, Martha’s Rule will be rolled out to community settings, mental health, maternity and neonatal units, emergency departments, and Royal Devon University Healthcare NHS Foundation Trust.
