Martha’s Rule in action – a patient’s story

Martha’s Rule is a patient safety initiative empowering patients, families and carers to raise concerns if their loved one’s condition is getting worse and their concerns are not being responded to. It is also for staff to ask for a review if they are concerned a patient is deteriorating, and they are not being responded to. Now being rolled out across all acute hospitals in England, every acute site in the country is working to offer access to this important service.

As the implementation partner for Martha’s Rule, the Health Innovation Network supports its delivery through the regional Patient Safety Collaboratives. In the East of England, Health Innovation East has been working with NHS hospitals to test, implement and share learning to help shape national policy on Martha’s Rule.

Here, Elaine and Diane share their experience of calling Martha’s Rule into action.

Elaine’s story

An active and independent women, 81-year old Elaine enjoys walking and keeping herself busy, including walking the family’s dachshund, Monty. She had recently travelled to Italy to spend time with friends and family.

On return from her trip, Elaine slipped on some fallen fruit on the pavement. She was taken to hospital where doctors discovered she had broken her leg. The bone was surgically pinned and her initial recovery seemed to be going well. Elaine kept in touch with her daughter, Diane, for the next few days – exchanging regular messages that reassured Diane that her mother was recovering well.

After returning from her own trip to Italy, Diane planned to visit her mother in hospital with her husband.

Recognising something wasn’t right

The first sign that alerted Diane that something wasn’t quite right was when the regular messages between the pair stopped. Later that day Diane was able to visit her mother and noticed straight away that something was wrong with Elaine.

“Her mouth was squint, she was trying to eat yoghurt and it was running down her chin. Her glasses were also sitting wonky on her head and she was speaking in a really strange way. I turned to my husband and said ‘she’s had a stroke’.”

Diane alerted a nurse, who also noticed that Elaine seemed different from earlier that day. A healthcare assistant also shared the same concern and so the issue was escalated to a senior nurse on duty. An initial assessment was carried out however the assessment team did not believe there was a cause for concern at that stage.

Still concerned, Diane asked to see a doctor, who carried out a few quick tests and reassured Diane that Elaine appeared fine but said they would do further checks the following day if her condition didn’t improve.

Escalation via Martha’s Rule

Fortunately Diane spotted a Martha’s Rule poster displayed on the wall in the corridor and with the encouragement of a nurse called the number. Within minutes the hospital’s Martha’s Rule critical care outreach team answered the call and listened to Diane’s concerns.

Two nurses arrived on the ward within nine minutes and interviewed Diane and her husband to understand Elaine’s usual behaviour and personality, they also spoke to the staff members who had expressed concern. After reviewing the situation, they decided there was enough justification to carry out an urgent stroke assessment.

Swift diagnosis and treatment

Elaine was taken for a brain scan within an hour of the Martha’s Rule call being made. That evening, a consultant phoned Diane to confirm the scan had revealed a clot on the brain. The team sought consent to operate straight away, and the procedure was successful in removing the clot.

Thanks to the quick action and diagnosis, the next day Elaine was back to normal with no lasting damage from the stroke.

Elaine is now back home and continuing her recovery from the repair on her leg. She is now using just one crutch and is already catching the bus independently. Her active lifestyle and determination has helped her regain strength and confidence and she looks forward to being able to take Monty for walks again.

Diane credits the speed of Martha’s Rule progress for the recovery of her mum

“The critical care outreach team answered the phone so quickly, they were professional and the speed at which the first two people arrived after I called was incredible – because of the fast action my mum able to receive treatment and was back to normal quickly.”

Key takeaways:

• Rapid escalation saves lives: the swift response from Martha’s Rule team enabled an urgent diagnosis and treatment of a stroke
• Empowering families and staff: Martha’s Rule provided a clear, accessible route for families and frontline staff to escalate concerns.
• Patient-centred outcomes: Elaine’s full recovery highlights the value of early intervention and collaborative decision-making in acute care settings.