Martha’s Rule – simply listening to patients and family misses the point. We need a system to catch subtle changes.

I Agree

While making sure the concerns of parents and patients are not ignored this is not going to be enough to prevent avoidable harm in healthcare. Although some problems are missed because clinicians do not listen, for the majority it is just not clear whether a minor change indicates serious disease.

Doctors are well aware of this uncertainty and know that not every cough is lung cancer, and not every rash is sepsis. In the early stages, the chances of a patient who has just one clinical finding actually having the condition is low. And it becomes quickly apparent that there are not enough beds to admit every patient who could possibly have sepsis to ITU.

We need to embrace the fact that we are going to mistake some patients as stable who are going to become very sick. Family are no better than clinicians at spotting what is wrong but they can spot something has changed. We therefore need a system to respond to changes.

The critical first step is that family and ward staff feel able to call for help. They need to know that most likely they will be mistaken, and they won’t be judged for it. False alarms should be celebrated as opportunities for learning because unless we call “wolf” when concerned, we will miss the wolf and get eaten.

Equally critical, there must be someone experienced to come and check the patient. This cannot be yet another job dumped on the overworked Medical Registrar, it needs proper resourcing and an experienced team.

These schemes are called Rapid Response Systems, and they reduce hospital mortality and cardiac arrest in both adults and children [1]. For Martha’s Rule to be more than window dressing this is what we need.

[1] Maharaj et al. Rapid response systems: a systematic review and meta-analysis Critical Care (2015) 19:254

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Electronic Publication Date: 
Friday, February 23, 2024 – 18:27
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Martha’s Rule – simply listening to patients and family misses the point. We need a system to catch subtle changes.

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Cain R
Retired GP
BMJ: Additional Article Info: 
Rapid response

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