A national research programme has been launched to evaluate the implementation and impact of Martha’s Rule, a patient safety initiative that allows patients and families to request urgent independent review when they are concerned about worsening clinical condition.
What the study will examine
The three‑year evaluation is funded by the National Institute for Health and Care Research (NIHR) and is being led by the NIHR Central London Patient Safety Research Collaboration (PSRC). Delivery will be through SafetyNet in partnership with all six NIHR PSRCs in England, bringing together patient safety researchers, clinicians, patients and public contributors to examine how the rule is operating in practice.
The programme will explore:
- how trusts have implemented the rule across hospitals;
- whether the mechanism gives patients and families a clear and reliable route to escalate concerns;
- where practical improvements could strengthen the intervention.
Origins and purpose
Martha’s Rule was introduced after a serious incident at King’s College Hospital in 2021, when a teenager, Martha Mills, died following a failure to escalate her care for sepsis. The initiative is named in her memory and aims to ensure that patients and relatives have a straightforward way to say daily how a patient feels and to request an urgent review by an independent team if they believe deterioration is being missed.
Following a pilot across multiple hospitals, the rule is being implemented across NHS Trusts in England. The evaluation will assess whether the policy as rolled out achieves its stated goal of improving early recognition and response to clinical deterioration.
Research leadership and contributions
The national evaluation is led by the NIHR Central London PSRC under the stewardship of Professor Ramani Moonesinghe and John Welch, both consultants at University College London Hospitals (UCLH) and leaders within the PSRC. The NIHR Greater Manchester PSRC and researchers from the universities of Leicester and Manchester will contribute to the qualitative and health economic workstreams.
"Martha’s Rule has the potential to strengthen patient safety by ensuring that patients and families have a clear route to raise concerns when a patient's condition is deteriorating," the programme description said.
The multi‑centre design brings together expertise from across the research network to assess implementation fidelity, barriers and facilitators, and the cost‑effectiveness of the approach.
| Element | Detail |
|---|---|
| Duration | Three years |
| Funder | NIHR |
| Lead | NIHR Central London PSRC (Professor Ramani Moonesinghe; John Welch) |
| Delivery | SafetyNet in collaboration with six NIHR PSRCs |
| Key academic partners | Universities of Leicester and Manchester; NIHR Greater Manchester PSRC |
Context and implications
Patient safety initiatives that redress failures to escalate are closely watched by clinicians, managers and families because delayed recognition and response to deterioration — including sepsis — can have fatal consequences. By formally evaluating how the rule is embedded in practice, the programme aims to produce evidence on whether the policy reduces preventable harm and how it might be strengthened or standardised.
Health systems considering similar family‑centred escalation pathways will be interested in the study's findings on feasibility, staff and patient acceptability, and economic implications. The qualitative strand is expected to illuminate how patients, relatives and clinical teams experience the rule, while the health economic workstream will examine resource implications of routine adoption.
This independent evaluation will not itself change clinical protocols at individual hospitals; rather, its conclusions are intended to inform policymakers, regulators and NHS Trusts about whether Martha’s Rule should be adapted, expanded or supported by additional resources and training.
Readers concerned about symptoms of infection, sepsis or deterioration in a hospital patient are reminded to raise concerns directly with ward staff or the trust’s escalation process, and to seek clinical assessment rather than relying on lay judgement alone.
