Using Miya Precision to Deliver ‘Martha’s Rule’ Functionality

Giving patients and families a voice in recognising deterioration at South Tees Hospitals NHS Foundation Trust

Overview

South Tees Hospitals NHS Foundation Trust is among the early adopters of Martha’s Rule, the national initiative aimed at ensuring that patients and families can easily request a clinical review if they are worried about deterioration.

To support this, South Tees designed and implemented a digital Patient Wellness Questionnaire (PWQ) within Alcidion’s Miya Precision platform. The new functionality combines patient, relative, and nurse input to create a structured “early concern” assessment that automatically alerts clinicians when additional review is required.

The result is a digitally enabled, real-time safety net that empowers patients and families, supports clinical judgement, and strengthens communication between patients, relatives, and staff

Challenge

Prior to this work, South Tees already had two elements of Martha’s Rule in place, a critical care outreach service and a “Call for Concern” process for families. What was missing was a systematic way to capture patient and relative concerns on the ward, and to confirm those concerns triggered a timely, clinically appropriate response.

Traditional approaches relied on NEWS2 scoring and clinical observation alone, which risked missing subtle signs of deterioration, particularly in:

• Patients who could not communicate how they felt (due to cognitive impairment, learning disabilities, delirium, or language barriers)
• Situations where family or nursing staff might not initially recognise early change

The Trust’s nursing and digital leadership teams saw an opportunity to use Miya Precision to operationalise this first component of Martha’s Rule supporting every inpatient to have a structured opportunity to share how they feel, twice daily, as part of routine care.

Solution: The Digital Patient Wellness Pathway

Co-design and governance

Development was led by Jacqueline Jones, Lead Nurse for Acutely Ill Patients and Miya Precision, alongside Lindsay Garcia, then Deputy Director of Nursing (now Group Director of Nursing).

A Martha’s Rule Implementation Group was established, bringing together the Acutely Ill Patient team and the Critical Care Nurse Consultant, consultants from critical care and renal medicine, the Trust’s Learning Disabilities Nurse, patient experience leads and a patient representative, NHS England’s Martha’s Rule programme lead Paula Elliott, data experts from NECS and Health Innovation North East & North Cumbria, and the Trust’s digital, CNIO and CCIO teams.

Working in close collaboration with Alcidion’s development team, the group designed a dual-pathway digital form in Miya Precision:

1. Patient Wellness Questionnaire (PWQ) – based on the Bradford Patient Wellness Score for patients who can self-report.
2. Questions include: “How are you feeling today?” and “How are you feeling compared to yesterday?”
3. A score is automatically calculated, guiding next steps and escalation.
4. STOP & WATCH assessment – adapted from the North Cumbria Learning Disabilities Network tool for those unable to self-report.
   1. The assessment captures subtle behavioural or physical signs of deterioration via simple yes/no prompts.

Both pathways converge at the same final steps, asking:

1. Whether the patient’s relative or carer has concerns
2. Whether the nurse caring for the patient has concerns

Miya Precision’s logic enables the greatest level of concern to always triggers escalation, even if others report “no concern”.

An exemption was added for patients receiving end-of-life or comfort care, where the assessment is not appropriate.

Implementation

The PWQ assessment was configured in Miya Precision as a twice-daily task (day and night shifts) to support continuous visibility of wellness across 24 hours and to include relative participation during visiting times.

Initial feedback about timing and workflow led to refinements in scheduling, completion flexibility, and user guidance. Clinical educators supported staff training to reinforce that the PWQ is not “another task”, but a vital patient safety check linked to Martha’s Rule.

The system is now fully embedded in routine nursing practice across pilot wards, with escalation routes integrated into existing outreach and medical review processes.

Results and Early Findings

Ongoing audit data from the Trust shows strong early impact:

Metric	Finding
Monthly reviews	~100 positive assessments audited each month
Total assessments reviewed to date	301
Patients unable to self-report (Stop & Watch pathway)	56%
Patients self-reporting via PWQ	44%
Assessments involving a relative	227
Relative concern recorded	39
Nurse concern recorded	71
Actions triggered (escalations)	131
Patients scoring highest wellness band (8) – requiring senior review	7

Key insight: more than half of the positive assessments came from patients unable to speak for themselves, demonstrating the value of having both pathways.

Clinical teams also identified cases where the PWQ triggered concern before changes were reflected in NEWS2, providing an additional layer of early warning.

Staff Feedback and Cultural Change

Staff surveys have shown meaningful shifts in practice:

• 45% reported a positive impact on their clinical practice after using the PWQ.
• Several nurses said they had never previously asked structured “how do you feel?” questions, suggesting the tool encourages more compassionate and proactive care.
• Some staff initially viewed the assessment as additional workload, but this perception improved as understanding grew of its link to patient safety and Martha’s Rule.

The team continues to refine workflow timing and education to maximise engagement.

Benefits

• The solution empowers patients and families to express concern safely and visibly, giving them a formal and recognised route to raise worries about deterioration.
• Detection of deterioration is enhanced the beyond physiological scores, capturing early warning signs that numbers alone may miss.
• Vulnerable patients are protected through the adapted STOP & WATCH pathway, supporting subtle changes to be identified even when patients cannot communicate.
• Escalation is standardised using digital logic so that “the greatest concern wins,” bringing consistency and fairness to decision-making.
• Communication and situational awareness is strengthened between patients, families, nurses and doctors, creating a shared understanding of risk and need.
• Cultural change is promoted by embedding the patient voice into everyday care, shifting teams toward more collaborative and responsive practice.
• And finally, seamlessly integration within existing Miya Precision observation workflows allows clinicians to act without interruption or additional burden.

Lessons Learned
The implementation highlighted that early co-design between clinical teams, digital colleagues, and patient representatives is essential to create a tool that genuinely works at the bedside. The project also showed that simple workflow logic—allowing staff to branch and re-join pathways easily—is often far more effective than complex scoring systems. Ongoing auditing and regular feedback proved vital in refining usability and maintaining staff engagement, while clear education that explicitly links the digital tool to the principles of Martha’s Rule has been key to sustaining adoption and confidence across the organisation.

Next Steps

The Trust is extending evaluation to explore the correlation between PWQ triggers and clinical outcomes such as sepsis, escalation activity and ICU transfers, to identify where additional training may help relatives and carers recognise deterioration, and to support broader rollout across wards with future inclusion in the Trust’s patient safety dashboards, while Alcidion and South Tees continue to share their learning nationally with other early-adopter Trusts and NHS England’s Martha’s Rule community.

What clinicians say:

“This digital tool has given our patients and families a stronger voice. It helps nurses have better conversations, pick up subtle changes earlier, and gives everyone confidence that concerns will be heard and acted on.” –  Jacqueline Jones, Lead Nurse for Acutely Ill Patients and Miya, South Tees Hospitals NHS Foundation Trust

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