4.1 Call trends over time

Calls have increased in line with increasing implementation of the programme. Figure 2 highlights that the highest proportion of Martha’s Rule escalation calls came via the family/carer escalation process (73%). Not all sites respond each month and the data excludes submissions that had to be removed due to data quality issues. Please refer to the response rates for context.

Figure 2: Number of Martha’s Rule calls per month by escalation process. Reporting period from September 2024 to October 2025.

 

Table 2: Number of Martha’s Rule calls by escalation process. Reporting period from September 2024 to October 2025.

4.2 Martha’s Rule calls by NHS England region

Figure 3: Number of calls and number of phase 1 or phase 2 sites per NHS England region. Phase 2 sites started reporting data from August 2025. This figure is an aggregate of phase 1 and phase 2 sites from September 2024 to October 2025.

 

Table 3: Number of calls and number of sites per NHS England region. Phase 2 sites started reporting data from August 2025. Reporting period from September 2024 to October 2025.

4.3 Martha’s Rule call flow analysis

Figure 4: Number of calls by escalation process and whether the call was related to acute deterioration. Reporting period from September 2024 to October 2025.

 

Table 4: Flow of calls by escalation process and whether the call was related to acute deterioration. Reporting period from September 2024 to October 2025.

5.1 Data consolidation

In addition to the number of calls, the Martha’s Rule Data Collection also collects high-level information on the outcomes of these calls. In June 2025, the outcomes collected were refined using insight from the pilot to strengthen learning. Additional response outcomes for those calls related to acute deterioration were also added in August 2025 to strengthen insights in relation to children and young people. For the purpose of this report, outcomes have been consolidated into groups where clinically similar.

For acute deterioration calls, the number of possible outcomes expanded from six to eleven, and are grouped into three as follows:

• Documented advice (no intervention), where following acute deterioration review, no further changes were made to patient care.
• Transfers of care, which includes transfers to adult ICU/HDU, paediatric HDU (paediatric critical care [PCC] 1 & 2), paediatric ICU (paediatric critical care [PCC] 3), enhanced levels of care, tertiary centres or referral/transfer to specialists or a specialist ward.
• Other change in treatment, which includes changes to nursing, surgical or medical management such as investigations or diagnostics, new medications including antibiotics or the commencement of IV fluids or oxygen. These changes in treatment do not require transfer of a patient from a ward in-patient setting.

For the calls not related to acute deterioration, the number of possible outcomes expanded from five to eight, and are grouped into five as follows:

• Clinical concern (including medication issues, management of long-term conditions and delayed investigations)
• Communication issue (including discharge planning)
• Non-clinical concern
• Signpost to another service/team
• Other

These groups are used for Figure 5 and tables 5a and 5b, with the full outcomes data provided in tables 5c and 5d.

5.2 Outcome flow analysis

• Of the 8,171 Martha’s Rule escalation calls, 2,942 (36%) related to acute deterioration.
• 377 calls (5% of acute deterioration calls) required transfers of care to adult and paediatric ICU/HDU, enhanced levels of care, tertiary centre or referral/transfer to specialists or a specialist ward.
• 1,149 (14% of acute deterioration calls) required other changes in treatment.

Figure 5: Flow of escalation calls from initial contact through to outcomes. Reporting period from September 2024 to October 2025. Note that from June 2025, sites could select up to three outcomes for each acute deterioration call. Only the primary outcome has been visualised here.

Table 5a: Table of outcomes for acute deterioration calls. Reporting period from September 2024 to October 2025.

Table 5b: Table of outcomes for calls not related to acute deterioration. Reporting period from September 2024 to October 2025.

5.3 Ungrouped outcomes

Table 5c: Full table of outcomes for acute deterioration calls. Reporting period from September 2024 to October 2025. Note that these outcomes relate to all patient age groups.

Table 5d: Full table of outcomes for the calls not related to acute deterioration. Reporting period from September 2024 to October 2025.

6.1 Acute deterioration calls where the Patient Wellness Question was asked

The patient wellness question, one of the three components of Martha’s Rule, is a structured way of asking (at least daily) how the patient is feeling and if they are getting better or worse. Between June 2025 and October 2025, the patient wellness question was asked for 690 of 989 acute deterioration calls (70%). Where asked, the patient wellness question was not itself the reason for the call in most cases (79%), which is as expected since most calls currently originate via the family/carer escalation route. However, for those cases where the patient wellness question was the reason for the call (21%), this mostly led to a transfer of care or other change in treatment (15%; 63%). This indicates that the patient wellness question is identifying patients in need of further clinical interventions in addition to those patients identified via other means.

Figure 6: Sankey diagram showing number of acute deterioration calls where the Patient Wellness Question was asked, if this was or was not the reason for the Martha’s Rule escalation call, and the call outcome. Reporting period from June 2025 to October 2025. Note that this measure was not collected prior to June 2025.

Table 6: Table showing outcomes for when the Patient Wellness Question was or was not the reason for Martha’s Rule escalation call. Reporting period from June 2025 to October 2025. Note that this measure was not collected prior to June 2025.

6.2 Acute deterioration calls where the Early Warning Score was recorded prior to the Martha’s Rule call

An early warning score is a standardised method of measuring physiological parameters in patients, such as heart rate and temperature, in order to identify and triage those who are acutely deteriorating. Between June 2025 and October 2025, an early warning score was recorded prior to 914 of 989 Martha’s Rule calls which related to acute deterioration (92%). For most of these calls, the early warning score recorded prior to the call would not otherwise have triggered escalation (82%), and of these, most led to a transfer of care or other change in treatment (15%; 54%). This indicates that Martha’s Rule is identifying patients in need of further clinical interventions where this need would not have been identified via an early warning score.

Figure 7: Sankey diagram showing number of acute deterioration calls where the early warning score was recorded prior to the Martha’s Rule call, if this would or would not have triggered a review via standard escalation processes, and the call outcome. Reporting period from June 2025 to October 2025. Note that this measure was not collected prior to June 2025.

Table 7: Table showing outcomes for when the early warning score recorded prior the Martha’s Rule call would or would not have triggered a review via standard escalation processes, and the call outcome. Reporting period from June 2025 to October 2025. Note that this measure was not collected prior to June 2025.

6.3 Acute deterioration calls where the Early Warning Score was recorded at the time of the Martha’s Rule review

Data is also collected as above but where an early warning score was recorded at the time of the Martha’s rule review. The distribution of data is broadly similar at the two points in time.

Figure 8: Sankey diagram showing number of acute deterioration calls where the early warning score was recorded at the time of the Martha’s Rule review, if this would or would not have triggered a review via standard escalation processes, and the call outcome. Reporting period from June 2025 to October 2025. Note that this measure was not collected prior to June 2025.

Table 8: Table showing outcomes for when the early warning score recorded at the time of the Martha’s Rule review would or would not have triggered a review via standard escalation processes, and the call outcome. Reporting period from June 2025 to October 2025. Note that this measure was not collected prior to June 2025.

Measuring the balance of benefits and risks in relation to these interacting processes is complex and this data is released as management information rather than to conduct statistical comparisons of escalation tools, so caution should be taken when interpreting these figures.