{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:53Z","timestamp":1783491533353,"version":"3.55.0"},"reference-count":9,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:p>Martha\u2019s Rule allows patients and families to escalate concerns about safety to Critical Care Outreach teams in real time. This service evaluation aimed to investigate understanding of patients and their families in two key settings; paediatric and adult secondary care. We undertook an opportunistic survey of 168 patients and relatives recruited at a single District General Hospital in North Wales, where patient and family activated escalation had been in place for more than two years and was widely advertised throughout the hospital and through communication in regional and national media. 93% of the interviewees were unaware of the service. Further barriers identified were confusion around terminology and the need for such a service, and fear of perceived \u201cwhistleblowing\u201d. We explored the differences found in understanding between patients and relatives on adult or paediatric wards. Our findings suggest the need for a review of strategy of the present national information campaign.<\/jats:p>","DOI":"10.3389\/frhs.2026.1812956","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:57:46Z","timestamp":1783490266000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient and relative understanding of Martha\u2019s Rule: identifying barriers to patient-activated escalation in a mature system"],"prefix":"10.3389","volume":"6","author":[{"given":"Alexander","family":"Jeffrey","sequence":"first","affiliation":[{"name":"North Wales Medical School, Bangor University","place":["Bangor, United Kingdom"]},{"name":"School of Medicine, Cardiff University","place":["Cardiff, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirian","family":"Edwards","sequence":"additional","affiliation":[{"name":"Ysbyty Gwynedd, Betsi Cadwaladr University Health Board","place":["Bangor, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manohar","family":"Joishy","sequence":"additional","affiliation":[{"name":"Ysbyty Gwynedd, Betsi Cadwaladr University Health Board","place":["Bangor, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Subbe","sequence":"additional","affiliation":[{"name":"North Wales Medical School, Bangor University","place":["Bangor, United Kingdom"]},{"name":"Ysbyty Gwynedd, Betsi Cadwaladr University Health Board","place":["Bangor, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2514","DOI":"10.1016\/j.fhj.2025.100223","article-title":"Giving patients, families and staff a reliable voice in acute care: expert guidance for implementation of Martha\u2019s Rule in UK hospitals","volume":"12","author":"Welch","year":"2025","journal-title":"Future Healthcare J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1111\/hex.12496","article-title":"Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review","volume":"20","author":"Albutt","year":"2017","journal-title":"Health Expect"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e609","DOI":"10.7861\/fhj.2021-0134","article-title":"When patients (and families) raise the alarm: patient and family activated rapid response as a safety strategy for hospitals","volume":"8","author":"Bucknall","year":"2021","journal-title":"Future Healthcare J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1177\/25160435231199338","article-title":"Patient activated rapid response \u2013 the \u2018999\u2019 for patients admitted to hospital","volume":"28","author":"Ntumba","year":"2023","journal-title":"J Patient Saf Risk Manag"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2067","DOI":"10.1136\/bmj.p2067","article-title":"Martha\u2019s Rule: what could the proposed changes mean for doctors?","volume":"382","author":"Dyer","year":"2023","journal-title":"Br Med J"},{"key":"B6","year":"2024"},{"key":"B7","year":"2016"},{"key":"B8","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1097\/01.NAJ.0000460672.74447.4a","article-title":"Hospital system barriers to rapid response team activation: a cognitive work analysis","volume":"115","author":"Braaten","year":"2015","journal-title":"Am J Nurs"},{"key":"B9","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.ijnurstu.2018.12.009","article-title":"Routines of resistance: an ethnography of the care of people living with dementia in acute hospital wards and its consequences","volume":"96","author":"Featherstone","year":"2019","journal-title":"Int J Nurs Stud"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1812956\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:57:46Z","timestamp":1783490266000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1812956\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":9,"alternative-id":["10.3389\/frhs.2026.1812956"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1812956","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"article-number":"1812956"}}