Renee Williams lay unconscious and deteriorating in a ward of a busy Brisbane public hospital with not a doctor in sight.
The 23-year-old's mum, Tracie, was "terrified".
When Tracie had left Renee at the Princess Alexandra Hospital emergency department with a raging fever, headaches and back pain the day before, her only child was extremely unwell but still awake and talking.
When she returned, Renee was "not even conscious" after having been admitted to a cancer ward — the only bed available at the time — even though they did not have cancer.
For hours, Tracie said, nurses kept calling doctors for a clear direction on Renee's treatment, only to be ignored.
"They weren't returning their calls," she said.
"Nobody was updating the chart so the nurses were left with no clue what they were supposed to be doing."
Tracie was close to tears as she recalled being unable to rouse Renee, who had pneumonia and a urinary tract infection, which had developed into sepsis — a potentially life-threatening reaction — in September, 2021.
Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure and death.
The worried mum felt she had no choice but to call Ryan's Rule – a process allowing Queenslanders with concerns about a public hospital patient's condition to receive an urgent review.
"I just said to the nurse: 'I don't know what else to do. The only thing I can think of is to call Ryan's Rule, but I don't want that to reflect badly on you guys. It's the doctors that are not responding, which is preventing you from being able to do your job'," Tracie said.
The nursing staff backed Tracie's decision to call Ryan's Rule, telling her: "There is nothing else you can do. We've run out of options."
'I do believe I could have died without it'
Within minutes of her calling 13 HEALTH to enact Ryan's Rule, a doctor arrived and soon after, a Ryan's Rule nurse walked into the ward.
Tracie said the Ryan's Rule nurse found Renee's vital signs were so concerning, a "code blue" – medical speak for a patient emergency – was called, triggering the dispatch of a rapid response team to Renee's bedside.
"The room was flooded with people … at which point they actually started going through everything," she said.
Renee was started on antibiotics and spent seven days in hospital before being discharged.
Nine months on from that medical emergency, Tracie said it horrified her to think of what could have happened if she had not called Ryan's Rule.
Renee believes Tracie's decision was lifesaving.
"Once I knew what was going on, I was very glad that mum called Ryan's Rule because I do believe I could have died without it."
Huge increase in Ryan's Rule being called
Figures provided by Queensland Health show rising numbers of people are activating Ryan's Rule, described by the executive director of the department's patient safety and quality improvement service, Kirstine Sketcher-Baker, as "a gold standard for patient-led safety".
Ryan's Rule was activated by patients or their loved ones about 1,600 times in 2021, an average of 31 times a week — a 25 per cent jump on 2020 and a 145 per cent spike on 2016.
The process has been used more than 7,300 times in Queensland public hospitals since it was introduced in 2013.
It was activated 1,271 times in 2019, 1,014 times in 2018, 840 times in 2017 and 654 times in 2016.
Ms Sketcher-Baker described the increasing number of Ryan's Rule cases as a "really good thing".
"What we're really happy about is more and more people seem to be knowing about Ryan's Rule," she said.
"We try through every different means to promote this."
Brochures on Ryan's Rule, which can be enacted at any time of the day or night, have been translated into 10 languages other than English.
'It's better to be safe than sorry'
Ryan's Rule was established following the death of Ryan Saunders from an undiagnosed streptococcal infection, which resulted in toxic shock syndrome, in 2007, just shy of his third birthday.
Ryan's 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".
"That's how the name Ryan's Rule came about – as a legacy to a young boy whose life, in all likelihood, could have been saved if we had listened to his parents," Ms Sketcher-Baker said.
She said the introduction of Ryan's Rule had "definitely" led to safer care for public hospital patients in Queensland.
"There's no doubt in my mind," Ms Sketcher-Baker said.
"Families and carers often know the patients better than anyone else and they can actually detect whether there's some sort of deterioration in the patient and they're able to flag that with the relevant people.
"I think the really important message to people is: Do it quickly. Do it as soon as you've got a concern because the quicker the clinicians know, the quicker they're able to act and the better the outcome will be for the patients.
"They should feel empowered to be able to speak to any clinician in the hospital about any concerns that they've got."
Renee and Tracie are hoping that telling their story will make more Queenslanders aware of Ryan's Rule and that it does not just apply to children in hospital.
"You can use it at any point in a life span. It's not just for kids," Renee said.
"It's better to be safe than sorry.
Tracie added: "If anyone out there is thinking of calling it, if you're ever in a position where you think it could benefit you, call it. Don't be afraid. Just do it because it could be the difference between life and death for your loved one."
