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Call 4 Concern (C4C) is an NHS service that gives patients, their families and our staff the ability to directly refer to Critical Care Outreach. It triggers an urgent review if you feel an in-patient’s condition is getting worse and you are still worried after speaking to the medical team looking after them. 

Our nurses and doctors monitor all patients closely throughout their admission for any signs of deterioration, however, Call 4 Concern and Martha’s Rule gives you the power to act and be heard if you feel you or your loved one's condition is getting worse, rather than improving, despite treatment. 

During your hospital stay, you will see Call 4 Concern – Martha’s Rule posters around our °ëµºÌåÓý Park and Wexham Park hospital sites informing you, your relatives, friends and our staff how to activate the service if needed. The service is delivered by the Critical Care Outreach Team - specialist senior nurses in the management of deteriorating and very unwell adults and children.

Staff can also use the service, even if the scoring systems we use to identify deterioration are not suggesting action is required.

If you are worried you should always seek help.

• Recognise - Have you noticed any worrying changes in a patient’s condition, such as an increased breathing rate, confusion or unusual behaviour, excessive sleepiness or unusual difficulty in waking up, cold, discoloured arms and legs or other unusual physical symptoms?
• Report - If you identify these issues and are concerned speak to the Nurse in Charge and medical team on the ward. 
• Refer - If you remain worried request an urgent review by calling Call 4 Concern, any time day or night. The Critical Care Outreach Practitioner will answer and ask for the patient’s name, ward location and the nature of your concern. They will assess the situation and act as necessary.