In 2011, four-year-old Martha died of sepsis after being sent home from an emergency department with a diagnosis of tonsillitis.


The impact of Martha’s Rule on paediatric emergency care in the UK

Her parents, who had taken her to the hospital twice in 24 hours, were told that she was not seriously ill and that they were overreacting. Martha’s death sparked a public outcry and a campaign for better recognition and treatment of sepsis in children.

As a result, the UK government introduced a new guideline in 2016, known as Martha’s rule, which states that any child who returns to an emergency department within 72 hours of being discharged should be seen by a senior doctor and receive a full screening for sepsis.

Martha’s rule

Martha’s rule has had a significant impact on the way paediatric emergency care is delivered in the UK. According to a study published in the Emergency Medicine Journal, the implementation of Martha’s rule led to a 32% increase in the number of children who received a sepsis screening and a 12% increase in the number of children who received antibiotics within an hour of arrival.

The study also found that the rule did not increase the overall admission rate or the length of stay in the emergency department, suggesting that it did not lead to unnecessary or excessive interventions.

The authors of the study concluded that Martha’s rule is a simple and effective way to improve the quality and safety of paediatric emergency care in the UK.

For all emergency departments

They recommended that the rule should be adopted by all emergency departments and that further research should be done to evaluate its long-term outcomes and cost-effectiveness.

They also highlighted the importance of involving parents and carers in the decision-making process and providing them with clear and consistent information about the signs and symptoms of sepsis in children.

One of the challenges of implementing Martha’s rule is ensuring that all staff members are familiar with the guideline and follow it consistently.

Once again, training is key

Staff training is therefore a crucial component of the rule’s success. It is recommended that staff training should include the following elements:

  1. A clear explanation of the rationale and evidence behind Martha’s rule, as well as its benefits and limitations.
  2. A demonstration of how to perform a sepsis screening and document the results in the electronic health record system.
  3. A review of the clinical criteria and tools for sepsis screening in children, such as the Paediatric Early Warning Score (PEWS) and the National Early Warning Score (NEWS).
  4.  A simulation of various scenarios involving children who return to the emergency department within 72 hours of being discharged, and how to apply Martha’s rule in each case.
  5. A feedback session to address any questions or concerns that staff members may have about the rule and its implications for their practice.
  6. Staff training should be delivered in an interactive and engaging way, using a variety of methods such as lectures, videos, role plays, and quizzes. Staff training should also be updated regularly to reflect any changes in the guideline or the evidence base.



Furthermore, staff training should be complemented by other strategies to support the implementation of Martha’s rule, such as:

  • Providing posters, leaflets, and stickers in the emergency department to remind staff and families of the rule and its steps.
  • Establishing a designated sepsis team or coordinator in the emergency department to oversee the screening process and provide guidance and feedback to staff.
  • Monitoring and evaluating the adherence and impact of the rule on the quality and outcomes of paediatric emergency care, and sharing the results with staff and stakeholders.


Through our educational programmes we are pleased to be supporting the adoption of Martha’s Rule for all paediatric emergency care courses.

If you would like to discuss your training needs and how we can help, please call us on 0800 112 3205.