Supporting the Implementation of Marthas Rule across England:

An example of co-located infrastructure working together to push projects along the innovation pathway

Poor clinical monitoring in hospital has been identified as a leading cause of preventable death (Hogan et al, 2019). Despite UK wide implementation of the National Early Warning Score system that requires the monitoring of vital signs and escalation should the scores reach pre-defined thresholds, undetected deterioration continues to contribute to patient harm in hospitals.

In 2017, based on anecdotal evidence that patients and families might have an important role to play detecting and escalating deterioration, the NIHR YH PSRC and the Yorkshire Quality and Safety Research Group set out to better understand this with funding from NIHR ARC YH. The Yorkshire Quality and Safety Research Group published a systematic review, co-designed a patient wellness questionnaire with patients and staff and tested the extent to which this score was able to predict patient deterioration (Albutt et al, 2017-2022). We found that patients are in a unique position to detect deterioration but they do not always speak up and, when they do, may be ignored. With funding from NIHR YH PSRC via a NIHR Short Placement Award for Research Collaboration (SPARC) award we went on to evaluate the use of our invention- patient wellness questionnaire in paediatrics and gathered further data to evaluate the predictive utility of the measure (Albutt et al., 2022) In 2023, the NHSE Worry and Concern Collaborative was established, testing and adapting these ideas. We supported this collaborative, offering guidance throughout the programme.

Impact:

By supporting the widespread implementation of Martha’s rule across 143 NHS Trusts in England (June 2024), there is now a requirement that patients are asked about their condition every 24 hours. Our patient wellness questions are being adopted across England to deliver on this aim. You can find guidance on how to implement the patient wellness questionnaire as part of Martha’s rule here.

With funding from the NIHR Policy Research Unit for Quality, Safety and Outcomes and supported by the six NIHR Patient Safety Research Collaborations in England, we are now undertaking an evaluation of the implementation of Martha’s rule.

For more information please see: NHS England » Martha’s Rule and contact yharc@bthft.nhs.uk