SA to Implement 'Ryan's Rule' for Patient Escalation of Concerns

Ryan Bowman's family felt their concerns went unheard during his final visit to the Mount Gambier Hospital.

Mr Bowman was born with five congenital heart defects, had an acquired brain injury from a childhood surgery and survived a battle with Hodgkin lymphoma.

But as his condition deteriorated after he was hospitalised with double pneumonia, his mother Deb Brooks and stepfather Chris Brooks said their intimate knowledge of his medical history was ignored.

"In our situation, it was the fact that Ryan was end-of-life and we had a plan, but the plan wasn't followed," Mr Brooks said.

"If we'd had this escalation protocol in place at the time, things may be a little bit different."

After Mr Bowman's death, Mr and Mrs Brooks launched the Ryan Bowman Legacy of Care Foundation to call for change.

The foundation called for a framework for patients to escalate their concerns about their condition in hospital.

Following lobbying from the foundation and other patient advocates, the South Australian government has announced it will pursue new protocols for patients and their carers to call for an urgent re-evaluation of their condition.

The protocol would mandate that the review take place and is based on similar initiatives in Queensland, New South Wales and Victoria.

SA Health Minister Blair Boyer said the government would develop the South Australian protocols over the coming months.

"When families and carers raise concerns, they deserve to be heard," he said.

"This protocol will build on lessons from other jurisdictions as we develop an approach that strengthens safety, supports our clinicians and provides greater confidence in our health system."

Ryan's Rule

In Queensland, Ryan's Rule was developed in 2011 after the death of two-year-old Ryan Saunders from an undiagnosed streptococcal infection, which resulted in toxic shock syndrome.

His parents had raised concerns about his condition while he was in hospital and a coronial inquest found those treating him "failed to detect and respond to the infection in a sufficiently timely manner".

After first discussing their concerns with hospital staff, patients and their carers can call 13 HEALTH (13 43 25 84) to request a Ryan's Rule clinical review.

Health experts, families and advocacy groups will help develop the laws over the coming months before trials are undertaken in SA hospitals.

Carers SA chief executive Julia Overton said the organisation had been pushing for an initiative similar to Ryan's Rule for years.

"Concerns can be overlooked because the clinicians think that there's a protocol, there's a process, there's set parameters under which health concern is escalated," she said.

"The carer knows that person that they care for best and they can see when something isn't right."

Ms Overton said while there had been initial concerns in other jurisdictions about protocols being overused, these had failed to eventuate.

"It hasn't been used to escalate concerns spuriously," she said.

"It has been used to escalate concerns appropriately and where later it has been found that that escalation has, in fact, led to better health outcomes for the patient."

Carers 'part of the journey'

The independent review into Mr Bowman's death found his condition started declining about 1:30am, but it took until 7am for a doctor's review to be undertaken.

A second review at 9:30am prompted a shift to palliative care, but pain relief was not administered until 1:30pm.

Mr Bowman died a short time later.

Mr Brooks said if the protocols were in place, it would have led to a more comfortable death for Mr Bowman.

"In a lot of cases with people that go to hospital, there's a carer involved, particularly with rare diseases and rare cancers and anything that's out of the norm," he said.

"That carer is mostly ignored."