Development of Ryan's Rule

The formative development of Ryan’s Rule began in 2011 led by Patient Safety and Quality (PSQ) in consultation with hospital and health services (HHSs).

Ryan’s Rule consists of a series of steps that a patient, their family member or carer can take to raise their concerns when the patient in hospital is getting worse or not doing as well as expected. These steps facilitate a clinical review of the patient. The patient, family member or carer can continue to escalate through the series of steps if they are not satisfied with the outcome after each step.

Find out more about the steps for initiating Ryan's Rule.

The Ryan’s Rule model and guidelines were launched in July 2013, enabling each HHS to develop a plan for local implementation. PSQ provided training and ongoing support to the local HHS Ryan's Rule coordinators, who were key to the incremental roll out across the state and remain vital in ensuring the continued support for this process.

Each HHS and/or facility self-selected a start date based on their self-assessed readiness and successfully passing unscheduled, fictitious test calls and emails to all contacts. The first facility went live on 2 December 2013 and Ryan’s Rule was implemented in the final Queensland Health facility 17 months later, on 19 May 2015.

Ryan’s Rule continues as a core system for patient, family carer escalation. Queensland Health’s Health Contact Centre and Department of Science, Information, Technology and Innovation’s Smart Services Queensland (SSQ) were engaged and contracted to enable the use of 13 HEALTH (13 43 25 84) as a single point of contact for all callers in Queensland Health.

  • Queensland was the first state or territory in Australia to implement a statewide approach using one phone number, 13 HEALTH (13 43 25 84) for the patients, families and carers to escalate concerns in the public hospital system.

    The first point of contact to raise concerns is to speak with a nurse or doctor. The last escalation point of Ryan’s Rule is to contact the centralised call centre, 13 HEALTH (13 43 25 84) who will contact a Senior Clinician at the hospital to coordinate a clinical review by a nurse or doctor and review the patient.

    The individual review process varies from facility to facility but in the majority of cases the clinical review takes place in person by a senior clinician not directly involved in the care of the patient. If the Ryan’s Rule request comes from a smaller / remote facility the review may take place using Telehealth services (video or phone) depending on the available equipment. Ryan’s Rule is activated an average of approximately 3 times per day across the state.

    All Queensland public hospitals are required to be accredited using the National Safety and Quality Health Service Standards, specifically Ryan’s Rule helps Queensland Public Hospitals to meet Standard 9.9 Enabling patients, families and carers to initiate an escalation of care response.

  • All 114 (100%) acute public hospitals in Queensland had implemented Ryan’s Rule by 19 May 2015.

  • The evaluation consists of a clinical evaluation form and caller feedback questionnaire. The completion of these evaluations (required within 72 hours) is monitored and tracked by online customer relationship management systems and all data is transferred to a data warehouse, where hospital and health services can access their own data.

    Average number of calls

    Ryan’s Rule is activated an average of approximately 3 times per day across the state.

  • Ryan's Rule was developed in collaboration with individual HHSs and was made possible by the following factors:

    • A willingness of the Hospital and Health Services to voluntarily participate in the project
    • The pre-existence of a statewide Health Contact Centre with trained non-clinical customer service advisors to receive incoming calls
    • The pre-existence of a suitable single dial-in number that patients, family members or carers could call which could then be relayed to an independent senior clinician in a local facility to coordinate a clinical review.

    The lessons learned from this project included:

    • engage executive support
    • engage clinical workforce
    • undertake an incremental rollout
    • test the readiness of the service implement the process before the launch of the patient family career escalation process in each service. To ensure that:
      • the ability to provide a 24-hour response, seven days per week
      • oversight provided by a local governance committee
      • development of a localised, internal procedure based on the guidelines
      • three nominated staff/roles able to receive a ‘warm transfer’ of the caller from 13 HEALTH and to initiate a clinical review of the patient.

    At least 80% of staff had completed training to raise awareness and increase knowledge of Ryan’s Rule.

  • Queensland Health’s Health Contact Centre and Department of Science, Information, Technology and Innovation’s Smart Services Queensland (SSQ).

  • All Queensland Health Hospital and Health Services supporting their public hospitals, all acute public hospitals in Queensland, some primary healthcare facilities.

Last updated: 3 May 2024