Nearly 200 patients have died in the county's hospitals since the start of the year

But the number of deaths saw a significant decline between  January and March.

The overall 180 deaths recorded represents a total for inpatients at Wye Valley NHS Trust  hospitals.

Broken down by month the figures are:

- January - 87

- February - 66

- March - 27

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.

While conceding that “system issues” are still being ironed out, the trust reports a good level of engagement in the process.

The Clinical Commissioning Group has already agreed to identify a GP to assist with the validation of coding for deaths in community hospitals.

Coding is where a patient’s clinical condition is turned into a set of electronic codes from the written record.

Difficulties have arisen around coding capacity, and agency coders have been employed by the trust to improve timeliness.

 Other data inconsistencies in the trust’s Patient Administration System (PAS) are also acknowledged as impacting on the initial validation of coding.

Validation or reviewing of the community hospital deaths is due to start this month – at the earliest.

Of the 87 deaths in January, 87 per cent have had coding applied – the percentage being the number of deaths  where a senior clinical coder has gone through the patients’ notes and coded the patients record in PAS

Sixty per cent of the deaths have had coding validated by consultants - where the consultant has then signed off that they are happy with the coding and are ready to perform a review.

Fourteen January deaths have been reviewed with another four reviews started but still to be completed.

The statistics for February are:

- 66 deaths

- 73 per cent coding applied

- 21 per cent coding validated by consultants

- No reviews with one underway

Statistics for the 27 deaths in March are not yet available.

In February, the Hereford Times reported that a “second opinion” review of 150 deaths in the trust’s care was underway.

This internal review takes another look at deaths across the trust between October-December last year.

These deaths have already been subject to a review. Fresh reviews have been ordered to further identify 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.

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.

The trust board has called for clarity over the complex way death figures are recorded, analysed and interpreted.

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.

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