Second opinions in healthcare: new laws and the impact on patient safety
Sam Miles 
Date published: Apr 08, 24
In the UK, from April 2024, the NHS will be rolling out ‘Martha’s Rule’ in hospitals in England. This patient safety initiative, set to be enacted in at least 100 NHS sites, will allow patients and their families to request an urgent review if the condition of a patient begins to deteriorate. This rule was named after Martha Mills, who died from Sepsis in 2021 after concerns her family raised numerous times were not escalated, and doctors failed to recognize warning signs and transfer her to intensive care.
It follows the introduction of ‘Ryan’s Rule’ in Australia, a similar protocol to request a clinical review, that emerged after the equally avoidable death of a child in September 2007. Ryan’s rule has been used more than 7,300 times in Queensland public hospitals since it was introduced in 2013. [1]
Both ‘Ryan’s Rule’ and ‘Martha’s Rule’ have been welcomed by patients and doctors alike. The British Medical Association (BMA), said it welcomed the scheme, but said it would need to be carefully monitored before being fully rolled out. Dr Vishal Sharma, who chairs the BMA consultants committee, told the BBC: "For this to result in improvements for patients, it is essential that the current workforce crisis is addressed so that critical care outreach teams have the necessary staff they need to deliver this initiative." [2]
Are new initiatives papering over the cracks?
While initiatives like ‘Martha’s Rule’ are succeeding in raising awareness for the ability to request a second opinion or clinical review, as well as succeeding in standardizing the processes to submit such a request, the right to a second opinion has always been available within healthcare. Likewise, it doesn’t address the wide-reaching issues around staffing shortages and for teams that are already overrun with responsibilities, this could be problematic.
‘Martha’s Rule’ wouldn’t necessarily create further pressure in addition to what is already present, and that hasn’t been observed to be the case in Australia and other countries where similar schemes have been enacted. However, pre-existing issues with communication and a lack of resources create conditions where mistakes are more likely to happen.
‘Martha’s Rule’ will undoubtedly boost patient safety initiatives. But what can be done to better support healthcare professionals and patients alike? What can be done to ensure that second opinions are required with less frequency, and when they are required, intervention is carried out with speed to mitigate the worst outcomes?
Improving patient safety as a whole
‘Martha’s Rule’ introducing a standardized process for requesting a clinical review demonstrates the need for standardization and best practice across the board. That is the key to true improvement of patient safety. Here are a few key factors that should be prioritized in order to achieve that consistency of care.
Clear communication
Information on processes and procedures need to be accessed with convenience by all staff and be easily understood. This is vitally important when updating and changing policies, so that you don’t have a situation where some staff are working to older policies when a new policy has been enacted. Having this available at the point of need and centralized across departments or sites also has significant benefits.
Fostering collaboration
Interdisciplinary collaboration and knowledge-sharing across hospitals and other care settings can help harness the collective expertise of multiple professionals. This is an essential part of ‘Martha’s Rule’, in getting a clinical review of care, but it should be utilized to drive continuous improvement across all elements of patient safety.
Leverage technology
Maximizing technology like digital quality management systems and electronic health records is essential for ensuring that processes are standardized, that they are easily distributed to all staff and that you are able to monitor the engagement and acknowledgement of any new policies.
Technology like robust quality management software also ensures that information and data is captured more quickly, often as incidents and accidents happen, meaning corrective and preventative actions are carried out sooner. This facilitates trend analysis and ultimately the continuous improvement of patient safety.
Learn more about improving patient safety
If you’d like to discover more about the key factors that influence patient safety, you can download our free whitepaper on the six principles of patient safety.
Download the white paper[2] Martha's rule to be introduced in NHS hospitals from April - BBC News