‘Ryan’s Rule’ is a three step process that allows patients, carers, and family members of patients who are being treated in a Queensland public hospital to request a Clinical Review if they do not feel their concerns are being heard. This may be that the patient’s health is getting worse or not improving as expected.  

Ryan’s Rule applies to all patients admitted to any Queensland Health public hospital including emergency departments.  

If you are concerned that your loved one’s health condition is getting worse or you feel like your concerns are not being heard, it is important to know about Ryan’s Rule and follow these steps.  

‘Ryan’s Rule’ started after a little boy who was almost 3, tragically died in a Queensland hospital while receiving treatment. His name was Ryan Saunders. The cause of his death was found to be an undiagnosed Streptococcal infection which led to Toxic Shock Syndrome. Unfortunately Ryan was incorrectly diagnosed with mumps. Sadly, despite his deteriorating presentation, no further tests or investigations were undertaken.  

Ryan’s parents were worried that he was not getting better and did not feel like their concerns were heard.  

There was a coronial inquest into the incident. The Coroner found Ryan’s passing was likely preventable. This led to a complete review of Queensland Health procedures and policies to prevent tragedies such as this occurring in the future.  

Ryan’s Rule was developed after this tragedy, as a way for patients of all ages, families and carers to get help quickly.  

The Three Step Escalation Process

To implement Ryan’s Rule and request a Ryan’s Rule Clinical Review, you must follow the steps below.   

After you provide these details, a senior clinician will arrange for a Ryan’s Rule nurse or doctor to review the patient and address your concerns. A clinical review of the patient and the treatment they are receiving will be undertaken in a timely manner.  

This process aims to scrutinise the treatment being provided and identify any gaps. The clinician can request further tests if required and make recommendations as to treatment. This can lead to a different diagnosis or treatment pathway.  

In most circumstances a fresh set of eyes is often helpful and can lead to great results.  

Even if Ryan’s Rule does not change the course of treatment, it is a great initiative to ensure you are heard. When you or a loved one is sick, it is important to know your rights as a patient through this difficult time.  

It is important to know that Ryan’s Rule is a last resort and should only be utilised when other complaints have been exhausted.  

Ryan’s Rule is not a general complaint process and you must follow steps 1 and 2 before you can phone 13 HEALTH and request a Ryan’s Rule Clinical review.  

No, there is a common misconception that it is only for children but that is false, Ryan’s Rule is for patients of all ages.  

Despite not specifically implementing ‘Ryan’s Rule’, most private hospitals in Queensland have developed a similar rule for patient safety.  

For example, Ramsay Health Care have enacted ‘The Ramsay Rule’. This provides a 3 step process which begins by talking to the nurse, doctor or midwife regarding your concerns. Then, talking to the nurse in charge of the shift if you are still concerned. The last step is activating “Ramsay Rule” and a review of the patient will be arranged.  

If you or your loved one is being treated in a private hospital, you can ask a nurse or doctor what equivalent initiative is in place.

In NSW, there is a program called REACH. This stands for Recognise, Engage, Act, Call and Health is on the way. However, this is not state wide.  

There has been a CARE program (Call and Respond Early) implemented at Canberra Hospital. Similar to QLD, the first step is to discuss concerns with nursing staff before phoning the CARE number.  

At this stage, other states have not implemented specific programs mirroring Ryan’s Rule in Queensland. However, it is important to know that these states do have Patient Liaison Officers who can be contacted to discuss any concerns you may have.  

As a patient in Queensland, you have a right to have your concerns heard and acted upon to a satisfactory standard.  

Despite the sad history behind Ryan’s Rule, it is important to create awareness so the 3 step escalation process can be used by patients and family members if they are faced with a similar situation.