The South Australian Government has announced plans to introduce new medical escalation rules that will give hospital patients and their families a stronger voice when they believe their concerns about deteriorating health are not being addressed.
The proposed system is inspired by programs used in other Australian states, including Ryan’s Rule in Queensland, which allows patients, families and carers to request an independent clinical review when they feel a patient’s condition is getting worse or not improving as expected.
The announcement follows the death of Ryan Bowman, a 33-year-old man from Mount Gambier, whose family said their concerns about his declining condition were not adequately heard during his final hospital admission. An independent review later found delays and problems in the management of his care.
Ryan had lived with complex medical conditions throughout his life, including congenital heart defects, a brain injury from childhood surgery and a history of Hodgkin lymphoma. His family said they had extensive knowledge of his medical needs and wanted their concerns included in decisions about his treatment.
Following Ryan’s death, his family established the Ryan Bowman Legacy of Care Foundation, campaigning for a formal escalation pathway so patients and carers can quickly request further medical assessment when they believe something is wrong.
South Australian Health Minister Blair Boyer said the new protocols would be developed with healthcare professionals, patient advocates and people with lived experience. The aim is to create a process that improves communication between families and medical teams while strengthening patient safety.
The proposed rules are expected to follow a similar model to Ryan’s Rule, which has operated in Queensland since 2013. Under that system, patients or carers first raise concerns with their treating nurse or doctor. If concerns remain unresolved, they can speak with the nurse in charge, and if needed request a formal clinical review through the escalation process.
Health advocates say family members and carers often notice subtle changes in a patient’s condition because they know the person’s normal behaviour and medical history. They argue that including carers as active members of the healthcare team can help identify problems earlier.
Supporters of the initiative say escalation systems are not designed to replace doctors’ decisions but to create an additional safety pathway when communication breaks down or families feel their concerns have not been addressed. Research into patient and family escalation systems has highlighted their role in improving communication and identifying possible deterioration.
The South Australian protocols will now be developed over the coming months before being trialled in hospitals. The government says the goal is to provide greater confidence for patients and families while supporting clinicians to deliver safer care.
