EVERY patient to die in the care of Wye Valley NHS Trust is to have a “death tracker” on their case.

In January this year, the trust was reported as having one of the highest death rates in England.

An examination of 45 medical cases by the trust over October - as part of the on-going weekly mortality review system - identified sub-standard care in 14 cases.

Associate medical director Dr Vicky Alner told the trust board this week that sub-standard care meant “things could have been done better”.

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

The board heard that the trust is now ready to test a mortality tracking system with senior clinicians ahead of its intended launch next month.

Details of deaths will be registered on a real-time dashboard with concerns identified in initial reviews followed up by “in depth” secondary reviews.

Outcomes of all reviews will be stored in the system’s database.

The overall mortality rate for the trust between April last year and March this year is - at 116.61 - statistically 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.

At 105.91, the trust’s overall HSMR rate between August last year and July this year is within expected.

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, 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.

In April this year, the trust faced an  investigation by the NHS ombudsman into the death of a patient under critical care at Hereford County Hospital.

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