A “SECOND opinion” review of 150 deaths in the care of Wye Valley NHS Trust (WVT) is underway.

Confirmed to a meeting of the trust board yesterday (Thurs), the internal review takes another look at deaths across WVT between October-December last year.

These deaths have already been subject to a review. The trust board was told that fresh reviews would further help to identify - and understand - causes and actions related to them.

Death rates are an issue for the trust.

A year ago, the Trust was reported as having one of the highest death rates in England.

In December, the trust introduced a “death tracker”  registering details of deaths on a real-time database with concerns identified in initial reviews followed up by in depth secondary reviews.

The tracker went live last month, but the project’s clinical lead has since left the trust.

Latest statistics show trust’s death rates as within the expected range and reducing.

However, statistics are expected to spike again in around six months time when figures from the trust’s “winter pressures” are available – with recording done in arrears.

Board members called for clarity over the way death figures are recorded, analysed and interpreted.

WVT chief executive Richard Beeken acknowledged the “complex issues” around death figures that prompted calls for clarity.

Some clarity could be found in a special workshop session on death rate recording at local and national level that has been offered to board members.

The Hereford Times has previously reported an examination of 45 medical cases by the trust over October last year - as part of the on-going weekly mortality review system – that identified sub-standard care in 14 cases.

Then, the board was told that sub-standard care meant “things could have been done better”.

Examples given included the deaths of patients transferred to the hospital that should have stayed at care homes  and delays in receiving antibiotics or seeing doctors.

Complexities in statistical interpretation are illustrated by death  rate figures put out last year that showed the  overall mortality rate for the trust between April 2013 and March 2014  as significantly higher than expected.

That overall rate is expressed as Summary Hospital-level Mortality indicator (SHMI) which covers deaths after hospital treatment and up to 30 days after discharge.

SHMI values for each trust are published along with bandings indicating whether a trust’s  SHMI value is ‘as expected’, ‘higher than expected’ or ‘lower than expected’.

The Hospital Standardised Mortality Ratio (HSMR), which compares the expected rate of death in a hospital with the actual rate of death, identifies three groups that have attracted statistically significant higher deaths than expected across the trust.

 They are acute myocardial infarction (heart attack), septicaemia (except in labour) and acute and unspecified renal failure.

These figures showed the trust’s overall HSMR rate between August 2013 and July 2014 to be within the expected range.

All deaths across the trust are reviewed  and, where there is any indication that safe care had not been given, a root cause analysis is undertaken.

The sub standard care cases identified in the October review have been sent on to the relevant clinical directors, service unit directors and the quality and safety department for further investigations.

Working groups now meet monthly to progress identified actions relating to safe care.

In January last year, statistics from the health and social care information centre put the trust’s death rates amongst the highest in England, based on mortality ratios between 2011-2013.

The resulting report, however, also showed that in each of the quarters over the past year  the trust’s mortality rates had been as expected.

As such, the trust challenged the statistical finding to say the “highly derived and complicated” statistics needed careful interpretation as indicators and not absolute measurements.