Ryan’s Rule

Ryan's rule stepsRyan's Rule is a three step process to support patients of any age, their families and carers, to raise concerns if a patient’s health condition is getting worse or not improving as well as expected. Ryan’s Rule applies to all patients admitted to any Queensland Health public hospital—including the emergency department—and in some Hospital in the Home (HITH) services.

Ryan’s Rule has been developed in response to the tragic death of Ryan Saunders, who died in 2007 from an undiagnosed Streptococcal infection, which led to Toxic Shock Syndrome. When Ryan’s parents were worried he was getting worse they did not feel their concerns were acted on in time. In light of his death, the Department of Health made a commitment to introduce a patient, family, carer escalation process (Ryan’s Rule), to minimise the possibility of a similar event occurring.

The Ryan’s Rule escalation process is as follows:

  • Step 1: Talk to a nurse or doctor about your concerns. If you are not satisfied with the response, go to the next step.
  • Step 2: Talk to the nurse in charge of the shift. If you are not satisfied with the response, go to the next step.
  • Step 3: Phone 13 HEALTH (13 43 25 84) or ask a nurse to phone for you, and request a Ryan’s Rule Clinical Review. You will need to provide the following:
    • Hospital name
    • Patient’s name
    • Ward and bed number (if known)
    • Your contact number

Once the rule is enacted, a nurse or doctor will undertake a Ryan’s Rule clinical review of the patient and the treatment they are receiving.

Download the Ryan’s Rule Brochure

Ryan’s Rule brochure-Aboriginal and Torres Strait Islander

Currently there are 173 sites across all Hospital and Health Services in Queensland using Ryan’s Rule.

When not to use Ryan’s Rule

Ryan’s Rule should only be used for concerns related to the patient’s condition getting worse or not improving as expected. It is only used whilst the patient is in hospital or receiving care via a Hospital in the Home service.

Ryan’s Rule is not for general complaints. Hospital staff can help you lodge a complaint or you can visit the Queensland Health website.

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The development of Ryan’s Rule

Since 2011, Patient Safety and Quality, Clinical Excellence Queensland, has led extensive and ongoing collaboration with key stakeholders, consumers and the Saunders Family in the development of the Ryan's Rule process and associated resource material. The following stakeholders have been involved in the development of Ryan's Rule:

  • Health Consumers Queensland
  • Clinicians - representation from each Hospital and Health Service to form a Ryan's Rule working group
  • Recognition and Response to Clinical Deterioration (RRCD) statewide reference group
  • Clinical governance units - representation from each Hospital and Health Service
  • Queensland Health Quality and Complaints Commission (HQCC)
  • Australian Commission on Safety and Quality in Health Care
  • 13 HEALTH
  • Smart Services Queensland

Patient Safety and Quality provides training and ongoing support to local Ryan's Rule coordinators.

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Last updated: 9 August 2023