Giving patients, families and staff a reliable voice in acute care: Expert guidance for implementation of Martha's Rule in UK hospitals.

'Failure to rescue' in patients with documented signs of deterioration results in an estimated five potentially avoidable deaths at each acute trust in England each month. One common cause is inattention to concerns of patients or their families about acute deterioration. Martha's Rule requires reliable methods for (1) patients or their families to escalate worries and concerns about deterioration and (2) to routinely input their understanding of their illness/wellness and trajectory into the health record. This paper sets out the rationale for these approaches. Following review with staff from the first wave of British units that have introduced Martha's Rule or similar systems, the authors suggest tested and evidence-based methods for implementation and describe gaps in current understanding of such systems. Importantly, the paper outlines answers to frequently voiced concerns about these sorts of methods and a set of suitable metrics for organisations to measure the impact of implementation on processes and outcomes in acute care.