Home Hospitals Specialist Hospital Royal National Orthopaedic Hospital (RNOH)

Royal National Orthopaedic Hospital (RNOH)


The RNOH is the largest specialist orthopaedic centre in the UK performing highly specialized surgery. The hospital has 220 beds and the theatre suite has 10 theatres.

A wide range of surgeries is performed both in paediatric and adult population. These include primary and revision joint replacement surgery, bone tumour surgery, peripheral nerve injury repairs, spinal deformity and spinal injury; urological procedures in patients with neuropathic bladders.

The ITU has 6 adult ICU beds, 6 adult HDU beds and 4 Paediatric HDU beds mainly catering for the post surgical patients.

The Chronic pain service provides interventional management therapies in addition to outpatient services. A well-supported Anaesthetic Consultant led acute pain service is also available.

The spinal injuries unit (40 beds) admits both acute spinal injuries and patients for spinal rehabilitation and has consultant anaesthetist support.

The anaesthetic department also provides anaesthesia in the two radiology suites for scans and interventional procedures and runs a long-term venous access (PICC line) service.

The pre-assessment unit is anaesthetic led and has consultant high-risk clinics.

There is no Accident and Emergency department in this hospital.

The RNOH is situated in North West London on the A41 and next to junction 4 on the M1 motorway (exit only if travelling south). Ample parking is available on site. Access is also possible by underground: Stanmore (Jubilee) and Edgware (Northern). The bus service to the hospital is better from Edgware station. RNOH courtesy car service (free) is available from Stanmore tube station to the RNOH (every 15 minutes Mon-Fri).

 

On call rooms: We are one of the few hospitals, which still have an on call room with shower facilities, free of charge for trainees. We do look after you!

Parking: one of the few hospitals where it is Free!!

Food: There is a shop and Starbucks in outpatients, Starbucks in the new hospital block and Staff restaurant (Broccles) – all are open only in daytime hours.

Free hospital wide wi-fi is available. Please use whatsapp/ FaceTime/ emails/free Wi-Fi enabled calls, as mobile signal is poor.

 

Hospital typeSpecialist Hospital
AddressBrockley Hill Stanmore Middlesex
HA7 4LP
Modules and
Training opportunities 

Orthopaedics – Higher and Advanced
Regional anaesthesia – Higher (Advanced Regional anesthesia fellow )
Paediatrics - Higher
Pain – Higher and Advanced
Chronic Pain – Higher and Advanced
Perioperative Medicine – Higher
Non-theatre
Sedation

Management – Higher
Annexe G – collate WPBAs for Teaching, Management, Audit

We can support trainees achieve intermediate competencies for any of the above modules. Pre-fellowship trainees are well supported by consultants with an interest in exam guidance and viva practice and are released for courses in the school.

At any one time we can support a maximum of two trainees for higher paediatric module. Trainees need WPBAs about acute management of children / APLS to get module sign off. We can also support completion of the module for trainees who have had some prior Paediatric training and WPBAs.

The RNOH provides a Consultant led service, so trainees get to do very few solo lists compared to other hospitals. Hence it offers very good supervision. For trainees who need to do a solo list for advanced modules/ALMAT / going to CCT soon, upon liaison with the consultant for the list in advance, this can easily be organised.

This is not prescriptive and trainees can contact the college tutor well before they come to the RNOH to discuss their needs and a plan agreed. Trainees are assigned an educational supervisor with whom they must meet within first two weeks to agree an educational plan.

Educational activities

Weekly departmental educational meetings: Wednesday morning 8-9am. Includes M &M, Audits, journal club, Anaesthetic MDT, airway training, local QI and guidelines presentations. Trainees are expected to present a topic at these meetings once every 3 months.
Weekly Trainee teaching: Wednesdays 9-11 am
Consultant delivered tutorials, protected time
Hospital wide audit meting including M&M: Bimonthly
Hospital Schwartz rounds, multi-professional : Monthly
Paediatric Spinal surgery inpatients MDT: weekly wednesdays; Contact Dr. Mel Speakman/ Dr Ben Clevenger
Pre-op Complex Medical Case MDT: weekly, Wednesday AM; Contact Senior Pre-admission sister Roz Veitch
Spinal Injury Unit: Long term ventilation and tracheostomy care Contact Dr Matt Henley
ICU case conference/ M &M: Contact Dr John McGrath
High risk Anaesthetic Pre-assessment clinics: daily, Contact Dr. Paul Flynn
Regional anaesthesia course: RCoA 5CPD pts, RAUK approved course, free for past and current RNOH trainees; annual; Contact Dr. M Sebastian
Resuscitation courses: EPLS and ALS – free places for local trainees; Contact Trust Resuscitation Officer/ Dr. Rachel Baumber

Management training for senior trainees: Contact College tutor for a tailored programme to suit you. Led by Dr Roxanneh Zarnegar, Deputy Medical Director and Consultant Anaesthetist

Library: in the Herbert Seddon teaching centre; accepts UCL Partners library membership

Plenty of opportunities for publications, research and audit exist. It is possible to join an ongoing project and collaborate with other trainees I,e you can be involved at any stage- consenting, literature review, data collection ( e.g. PQUIP) and analysis.

Department audit lead – Dr Ram Krishnan
Department Research Lead – Dr Rachel Baumber

Opportunities for Trainees to be teachers:
There are several opportunities for the ST5 and above trainee to get teaching experience. These include:

Joint school: patient education – This is monthly and trainees do this in rotation
Recovery nurses teaching
Pre-assessment nurse teaching
ICU nurses airway teaching
Multi-professional Simulator teaching with Dr. Kate Adams

Research activities

Major blood loss surgery: including complex spinal surgery, bone tumour surgery, long bone reconstruction surgery. Cell salvage and using TEG monitoring routinely used.
Regional anaesthesia: Complex joint/limb reconstruction, shoulder and elbow surgery; complex foot and ankle surgery; weekly sonoclub; opportunities for audits and posters
Paediatric cases: including musculoskeletal syndromes for major orthopaedic surgery; major blood loss management in children; whole body plaster jacket applications on a suspended frame
Peripheral nerve injury repairs: including Erb’s palsy repairs in infants
Remote anaesthesia: CT/MRI lists under GA for bone tumours biopsies and RF Ablations
Difficult intubations: Opportunities for Fibreoptic intubations, Airtraq and Glidescope use in cervical spine surgery and rheumatoid arthritis patients
TIVA skills: All spine surgery and peripheral nerve repairs are done under TIVA with Depth of anaesthesia monitoring

Management and Leadership training for senior trainees: Deputy Medical Director and Chief Executive shadowing, Clinical governance and trust board meetings observance, active participation in a trust QI project

Advanced regional fellowship: One post advertised as a fellowship. Competitive appointment by the trust, not the school. You will need to get OOPE approval from TPD if you want to do it pre-CCT. Post includes on call service commitment in addition to regional lists.

Advanced pain training: Interested trainees need to apply via the London APT programme

Rota

The SpRs work a resident on call shift pattern rota with prospective cover. We have total 8 trainees: 7 trainees from North Central School and 1 trainee from Imperial School. The current Rota is compliant with the new contract regulations and devised by previous trainees. It is a 3 month rolling rota, has 8 lines and the total number of theatre days, off days and shifts worked are essentially the same for everyone with minor differences.
HR sends the rota template with the job contract, which details the hours. Trainees should contact the anaesthetic department coordinator for the actual rota.
Work Pattern
Theatre days - for lists in theatre
Long days and Nights on call - cover the adult ICU and Paediatric HDU.
Days off – to make up for the hours

Trainees do not cover out of hours emergency theatre. There are several tiers of Consultant Cover out of hours – first on call Consultant for theatre emergencies, Second Consultant Anaesthetist on call for paediatrics, separate Consultant anaesthetist on call for ICU/HDU and Consultant Pediatrician on call for support with Paediatric emergencies.

Consultant and permanent staff

Dr K Adams Paediatric anaesthesia, Simulation Co-ordinator
Dr K Agyare Resuscitation, Intensive Care, Scoliosis surgery
Dr R Anker Intensive care and anaesthesia
Dr J Barcroft Regional anaesthesia
Dr R Baumber Intensive Care, vascular access and tumour surgery
Dr J Cernovsky Paediatric anaesthetist, Scoliosis surgery
Dr M Chandra Clinical Director, regional anaesthesia for upper limb
Dr B Clevenger Paediatric anaesthetist, ACSA Co-lead
Dr J Cremin Intensive Care, Preop Assessment, Equipment Lead
Dr M Cooper Paediatric anaesthesia and tumour surgery
Dr G Edge Paediatric anaesthesia
Dr M Fennelly Intensive care, Scoliosis surgery
Dr P Flynn Pre-Assessment Lead
Dr R Gad El-Rab Pre-Assessment
Dr P Gunning Clinical Governance, ITU and Vascular Access
Dr M Henley Chronic Spinal Injury, Clinical Audit
Dr J Kaur Spine Surgery, ACSA Co-lead
Dr R Krishnan Paediatric anaesthetist/Vascular Access/Audit Lead
Dr J McGrath ITU Lead, Intensive care and Vascular Access
Dr S Nadaraja Pre-Assessment, Anaemia Lead and Pathology services lead
Dr P Panagoda Intensive Care, Peri-op Medicine
Dr V Ramesh Critical incidents, lower limb arthroplasty
Dr F Salim Clinical Lead, Intensive care, vascular access, Scoliosis surgery
Dr J Sambhani College Tutor, Airway Lead
Dr M Sebastian Regional anaesthesia, Acute Pain
Dr A Sell Regional Anaesthesia and Intensive care
Dr S Shanmuganathan Regional anaesthesia, Acute Pain
Dr R Sharma Joint reconstruction
Dr M Speakman Paediatric anaesthesia, Lead for Paediatric High Dependency Unit
Dr J Taylor Lead Paediatric anaesthetist

Dr R Zarnegar Chronic pain management
Dr R Berman Chronic pain management
Dr T Fernandez Chronic pain management
Dr D Mihaylov Chronic Pain Management
Dr M Hetreed Acute Pain Management

Further information and contacts

Jyothi Sambhani
College Tutor
Responsible for educational supervision and training.


 

 

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