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When a Patient Goes Downhill

Most patients in a hospital get better and go home. But they can also develop unexpected new symptoms, such as a new and unexplained pain or fever, or unfavorable changes in their vital signs. This downward trend can sometimes be difficult to distinguish from the normal ups and downs of illness or recovery, but it can go on for hours or days if not addressed. We call this patient deterioration.

In the quest for patient safety and well-being, recognizing and responding to the signs of a deteriorating patient is paramount. This compilation of resources offers valuable insights, tools, and perspectives to empower patients, families, and healthcare professionals in safeguarding against adverse outcomes. From poignant personal stories to evidence-based guidelines and global charters, these resources provide a comprehensive toolkit for understanding, identifying, and addressing the early warning signs of patient deterioration. Together, they advocate for a collaborative approach to healthcare, where communication, education, and proactive engagement play pivotal roles in ensuring the best possible care outcomes.

Links and Resources

Merope Mills, The Guardian
How shocking hospital mistakes led to our daughter’s death

BBC Today: Call for right to second opinion after tragic teen death
Moving interview with Merope Mills that led to the call for reform

Implementation of Martha’s Rule
National Health Service, England

Signs of a Deteriorating Patient
‘Soft signs’ that can help detect deterioration without measuring vital signs

Patient Wellness Questionnaire
Asking patients about their well-being can detect deterioration earlier.

Quick Tips for Families
Raising concerns with health professionals in the hospital

Raising concerns about a hospital patient
What families and friends should know

World Patients Alliance webinar
The Deteriorating Patient: When a hospital patient unexpectedly goes downhill, what can families do?

MDCalc by Gary Smith
Calculates the degree of illness of a patient based on NEWS 2 vital signs and recommends next steps

NHS National Early Warning Score (NEWS 2)
A tool for assessing patient deterioration

Tools for speaking to health professionals
Communication tactics from TeamSTEPPS®

When patients (and families) raise the alarm
Patient and family activated rapid response as a safety strategy for hospitals.

Martha's rule
The complementary roles of clinicians and patients in improving safety of patients deteriorating in hospital

Why It is Important to Know your Rights as a Patient
By Regina Kamoga and Cecilia Nantume

World Patients Alliance
Patient Safety Bill of Rights

World Health Organization
Patient Safety Rights Charter

World Medical Association
Declaration of Geneva: The Physician’s Pledge (The modern “Hippocratic Oath”)

World Medical Association
Declaration of Lisbon on the Rights of the Patient


How do you raise concerns about a patient’s condition in the hospital?


¿Cómo expresar preocupaciones sobre la condición de un paciente en el hospital?