Martha’s Rule

University College London Hospitals are committed to improving patient safety. Martha’s Rule ensures critical concerns of patients and those that know them best are listened to and acted on.    

Martha’s Rule is a system for our staff to work together with you and your family / visitors to spot if your condition is getting worse. 

This page explains how Martha’s Rule works at our hospital. 

What we do routinely

When a patient is becoming more unwell, we usually see changes in their breathing, pulse rate, oxygen level, blood pressure and temperature.  We check and record these regularly. 

We will also ask how you are feeling — using simple words like “better” or “worse.” 

This is called the Patient Wellness Question. It helps us understand how you feel and work with you to keep you safe. 

What you can do

You, your family, or friends might notice changes in your health before we do. Anyone can speak to our staff if they notice any changes. Your concerns are important.

Some changes you may notice:  

• You feel or look different from usual 
• You are behaving differently or feel more confused 
• You just do not feel like yourself 
• Your breathing, dizziness, or pain is getting worse 
• You are not getting better as expected

What to do if you are worried a patient is worse 

1) Standard ward process: Talk to the ward team first.

Our ward team are experts in the care of their patients and complications of illness. If you are worried that your condition is getting worse while you are in hospital, speak to your nurse or doctor.

If you still feel that your concerns have not been acted on, you can also speak to the Nurse in Charge or Ward Manager.

The ward staff will ask the Critical Care Outreach Nurse for an additional assessment if there are signs that you are becoming more unwell.

2) Martha’s Rule call:

If you have spoken to our staff and still feel that your health concerns have not been acted on, you can make a Martha’s Rule call. This will prompt a review by a Critical Care Outreach Nurse.

Call this number: 07816 196122

When you call, please give these details:

• the patient’s name and location (which of our hospitals the patient is in, the name of the ward, and the bed number)
• your concerns
• your name, your relation to the patient and your phone number.

This service is available 24 hours a day, 7 days a week. You may need to leave a voice message if the nurse is busy with another emergency. They will aim to call you back within an hour.

If you need to raise any other type of concern

Martha’s rule calls are for patients who may be seriously unwell. 

For other worries or complaints about other issues, such as the food, the bed area, staff, parking, visiting, and transport – please talk to the Nurse in Charge. 

If you are still not satisfied - contact Patient Advice & Liaison Service (PALS): 020 3447 3042 / email uclh.pals@nhs.net 

Martha’s Rule is not a Second Opinion

A Martha’s Rule call is only for when a patient is becoming more unwell. It allows you to ask for a review by a Critical Care Outreach Nurse. 

A second opinion allows patients and their families to ask for a different Consultant to discuss a diagnosis or treatment plan. This process can take time to arrange. 

If you would like a second opinion, speak directly to your doctor or Consultant. You can also talk to the Ward Manager for help with arranging a second opinion.