Clinical News: issue 001

In focus

What’s in a name?

Our names are a big part of our identity. They are one of the first things we learn about someone and what we attach their story to as we get to know it. Our names and nicknames often reflect a role, a place or a characteristic of our past, or even the history of an ancestor. They link us to the stories in our past and are the anchor from which we imagine our future.

As professional people, our good name is important to us. Many of us have tried in this life and in our work to make ‘names for ourselves’. In the present, this association with reputation (as set out in the stories told by others) means that names are associated with our status and behaviours.
And I suppose therein lies a choice. As clinicians we have considerable power and status in the eyes of others. Some of us seem to collect titles or post-nominals that do reinforce our status. They shine a light on if not intelligence, at least perseverance in surviving various exams and course to reach great achievements.

The My Name Is initiative recognises the power in a name and aims at compassion and equality. It is about having the confidence to leave status and accolades at the consulting room door or the office door. Then, the courage to show the vulnerability necessary to meet others as equals, be that in a clinical consultation as shared decision makers or a professional situation with a colleague.

A single syllable should do me fine. If I can get people to use it, barriers to communication start to recede and the real conversations can begin. So please help me out and call me “Matt” when you see me. For my part I will resolve to do more to live up to that name; when I meet new people, to introduce myself and explain who I am. Hopefully, that compassion and humanity will rub off on me more and more over time.

Matt Revell
Executive Medical Director

Clinical strategy update

MSK Transformation Programme

The ROH continues to lead the Birmingham and Solihull MSK Transformation Programme along with partners across the ICS, in public health, and the voluntary sector.

Key highlight:

A new system-wide MSK pathway has been agreed (see below) which will streamline referral routes into services, as well as standardising clinical decision making and supporting patient access to information, advice and guidance about their condition(s).

Programme Summary:

The programme is made up of five key streams, which are each supported with representation from each BSOL NHS provider.

Standardising High Level Clinical Pathways

A series of MSK pathway development workshops were held in November 2021 across hips & knees, spinal, shoulder, foot & ankle and hand – focussing on high volume, low complexity conditions. You can read a summary of those workshops here.

The programme has commenced a 6 month pilot for a new clinical decision making tool called Orthopathways. The programme will be deployed in primary care to ensure patients are referred to the most appropriate services in secondary, tertiary and/or community care. Representatives from each sub-speciality (across ROH/UHB/BCHC) are now meeting to build in the specifics for each condition into the digital tool.

Patient information

The patient information stream is evaluating existing patient information across the region and looking to review and standardise the advice and guidance available to patients. This stream is also evaluating accessibility of patient information and how we can improve this.

Digital Supported Self-Management

The digital group are in the process of procuring a new patient-facing, supported self-management app; Getubetter. The app would be ‘prescribed’ in primary care, and support patients with short- and long-term conditions. The app provides different methods of day-to-day pain relief, as well as evidence-based exercises and stretches to support their specific condition. The app is personalised to track a patient’s progress and provides feedback directly into the patient’s health record. It will also direct patients with red-flag symptoms to emergency care. The app can be used as treatment in its own right, or to support a patient waiting for other treatment types such as surgery.

Health Promotion & Prevention

The BSOL ICS has recently commissioned a regional Population Health Needs Assessment, which will provide population specific health related data and outcomes. This is due to be completed in April 2022. The results of which will help further develop the aims of the Health Promotion & Prevention team, who are in the meantime working with stakeholders (such as the Commonwealth Games, Occupation Health providers, Versus Arthritis and other third sector charities).

Workforce

The final stream of the programme aims to develop the MSK clinical workforce across the region, starting with a gap analysis of the existing workforce. This stream is also developing an ‘MSK Academy’, which will be an integrated hub of MSK excellence that delivers accessible education and information to our patients, carers, community, as well as specialised training for MSK practitioners.

Quality improvement and audit update

The below chart shows the number of Clinical Audit/Service Evaluation projects registered of December 2021.

There was one completed project in November 2021:

The overall observations identified from the findings are:

Areas of good practice:

  • 90% of Patients were comfortable on the day of operation.
  • All were patients had some form of physiotherapy on Day 1.
  • Most of the patient’s pain were reasonably controlled on Day 1.

Areas for improvement:

  • Needs to implement enhanced recovery pathway.
  • Role for pre-emptive analgesia needs to be investigated.
  • Local infiltration by Surgeons needs to be uniform.
  • Post analgesia should not alter by the ward doctors without pain review.

The Clinical Audit was presented at the Anaesthesia Clinical Audit Meeting on 28th September 2021.

An audit of acute kidney injuries at the ROH

Acute kidney injury (AKI) is an abrupt reduction in renal function that leads to increased morbidity and length of stay. It is largely preventable in surgical patients and has NICE guidelines in place to aid in optimising treatment.

This audit was carried out by RRT between 1st July 2020 and March 2021 and looked at all AKIs that were identified by blood results on PICS. It looked at compliance with guidance regarding recognition, escalation and management of AKI.

Overall, 91 AKIs were identified over nine months of which the majority were aged over 65 years old. The most important modifiable risk factor was that almost half of the patients had hypotension recorded prior to the AKI. By being more aggressive treating low blood pressure with IV fluids, we might be able to reduce kidney injury and improve outcomes.

Almost all of the patients (82%) had a fluid balance recorded prior to the AKI with 60% had a documented episode of oliguria. Of these only 60% were escalated to medical or RRT staff. This shows that we are good at monitoring urine output but not so good at recognition of oliguria and escalating it to the correct staff. Therefore, we would recommend increasing education of the staff who record and document urine output of when to escalate it. Unfortunately, PICS does not pick up on oliguria and issue a warning as it does for other vital parameters.

Going forward, we will look at flagging up those patients at risk via the new electronic pre-operative record so that they can be looked at more closely during their stay. We would encourage more aggressive treatment of low blood pressures, even if they don’t trigger hypotensive scores on NEWS and aim to increase knowledge on the wards of oliguria and escalation.

Training and Medical Education update

Consent Module

The BMJ have recently updated their subscriptions and they are now requiring subscription to access the Consent e-learning module. We are currently arranging suitable access with BMJ learning, where consultants will have full access to their learning suite. We will confirm directly once this has been finalised.

Resuscitation Training

The Trusts new Resus Officer, Marion Santos, has introduced eLearning elements to our Resus training for ILS. If you are booked to attend an ILS course you will be instructed on the new requirements and the expectation is that the elearning elements will be completed before attending the training session. Going forward all clinical staff will attend Hospital Life Support as we have ceased delivery of Basic Life Support, so HLS will become the minimum requirement for clinical staff.

Core Mandatory training e-learning

Following a review of the Core Mandatory training policy and aligning with the Core Skills Training Framework we have produced a new guide to help you enrol onto the modules through ESR or e-learning for health.

From March a new face to face session is now held on the first Wednesday of the month, with competencies requiring yearly renewal taking place in the morning and three yearly competencies taking place in the afternoon. Please book on via ESR.

Training Diary click link to view the diary by date or by course title.

New Consultants and Medical Staff

A welcome bag including the first 100 day’s induction booklet is awaiting you (please collect from the Knowledge Hub), this guide support all our new staff on settling into their role and provides a useful checklist and reflective journal.

Are you interested in being recognised as a Clinical or Educational Supervisor?

To support a medical trainee, either as an educational supervisor or as a clinical supervisor, you must be accredited by the GMC. Accreditation is a one-off process and once you are recognised, the Education and Training team will notify the deanery and the GMC. Please contact Mr Matt Newton Ede and Brett Ellis (This email address is being protected from spambots. You need JavaScript enabled to view it. )– Medical Education Manager, for more information on the next steps to fulfil the criteria.

Clinical and Educational supervisor upcoming courses:

https://www.e-lfh.org.uk/programmes/educational-and-clinical-supervisors/

https://www.boa.ac.uk/events/virtual-training-orthopaedic-educational-supervisors-v-toes-8.html

FRCS revision courses for registrars

https://mailer.revive.digital/t/ViewEmail/j/6E95E9C9B12A0D652540EF23F30FEDED?alternativeLink=True

There will be a new Junior Doctor induction 2nd February 2022 and 3rd August 2022. If you would like to support, or offer any suggestions on the Junior Doctor Induction programme, please contact This email address is being protected from spambots. You need JavaScript enabled to view it.

Safe and Effective Wellbeing Conversations – Webinar

Health and wellbeing conversations are intended to be regular, supportive, coaching-style one to one conversations that focus on the wellbeing of our NHS people. This webinar is suitable if you are involved in patient conversations, and in line management conversations.

Wellbeing conversations – Our NHS People

NHS England » Having safe and effective wellbeing conversations

Alongside a range of national resources that were published in March 2021, NHS England and NHS Improvement has launched a national training programme that has been designed to support NHS colleagues in having safe and effective wellbeing conversations. You can find a list of training dates to book here. More information about the training programme can be found here.

IT and digital update

Digital Request Form

If you have a paper process or form in your area that you think can be made electronic, please submit a request via DigitalRequest (roh.nhs.uk) or contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. if you would like to discuss your query with a member of the team.

MS Teams Acceptable Use Agreement

If you use MS Teams for your work at ROH you need to complete the acceptable use agreement here. This is supported by the Governance, IT and Digital teams. It’s important we all understand the data security and confidentiality implications when using MS Teams. If you have any questions, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Vickie Pring is currently building a site which will contain guidance on Teams and SharePoint usage, in the meantime please visit the Digital 365 page for support or contact This email address is being protected from spambots. You need JavaScript enabled to view it.

RMS- Referral Management

The MSK Spinal triage service went live with RMS on 19th January and will now be triaging all their referrals electronically.

Dr Doctor/Synertec

As of 25th January, patients who have clinic letters sent via Synertec will now be able to view these via the Dr Doctor portal providing they have a valid mobile number on PAS and choose the option. The patient will still have the option to have these printed if they wish and patients without a mobile phone number will be sent in the post via Synertec.

Innovation and research update

ICONIC Mr Parry leading the study funded by bone cancer research trust.

ICONIC is prospective observational cohort study. With the overall aim to improve treatment and outcomes for patients with osteosarcoma (OS) by establishing a clinically annotated cohort of newly diagnosed patients with OS with longitudinal collection of biospecimens. The platform will support continuous collection, analysis and interrogation of data to generate hypothesis driven questions quickly for further evaluation. This project extends the Bone Cancer Research Trust tumour banking initiative with funding allocated to provide the infrastructure to optimise collection and storage of tissue samples in the 5 diagnostic and surgical bone tumour centres in England, and includes the development and validation of clinically relevant biomarkers to identify patients at high risk of relapse and patients suitable for therapeutic studies. As a surgical site we consent patients during their pathway and following them up according to pathways working with the patients and chemotherapy centres to provide data and tissue samples.

POWER Gareth Stephens, ROH and Derby clinical trials support unit.

A feasibility study looking at patients who are on the elective waiting list for rotator cuff repairs. Patients are asked to provide informed consent to be randomised to either a physiotherapy programme designed to reduce pain and symptoms of the tear or standard of care which currently is watch and wait up until surgery. Patients are followed up and to complete questionnaires six weeks, three months and six months, looking in to whether the patient went on to have surgery or not and comparing this to the arm of treatment they received on the POWER study. This study is hoping to reduce the need for surgery for patients in turn reducing extensive waiting times.

We have some fascinating studies that have come through to the Research Tissue Bank including:

  • The Role of Oestrogen in Chondrosarcoma Using Patient-Derived Xenograft Mouse Models: A Pilot study – this study looks if oestrogen has a protective effect on chondrosarcoma. Donated Chondrosarcoma samples will be cultured in the laboratory and then add oestrogen directly to them to see if it changes the way they behave. Furthermore, the chondrosarcoma samples will set up a mouse model as well. “Post-menopausal” will be used as mice ovaries are taken out and once the tumour is growing, we will give the mice oestrogen to see if this stops the progression of the disease. Finally, genes changes will be identified and see which are switched on or off in the tumour samples, to better understand how the tumour develops.
  • Development and optimisation of multi-functional bioactive materials for bone cancer therapy – this study short titled as Bioglass aims to develop and use novel controlled release radioactive gallium doped biomaterials for treating metastatic cancers that commonly locate in bone. The aim is to develop materials capable of (1) enhancing new bone formation to help regenerate regions excised during surgery and (2) to simultaneously provide a controlled release of gallium ions to kill any residual cancer cells present within the close margins to prevent local reoccurrence.
  • We also have a long relationship with University of East Anglia looking at bone cancer and RNA as well. Currently we have a study titled Single cell sRNA-mRNA co-seq. A new hot topic driven by their research group is the hypothesis that cancer is more than just seizing control of the cell’s operations. Cancer is an engineer that is capable of constructing entirely new disease promoting networks out of raw materials readily available in the cell. One example would be a metastatic cell’s capability to edit pre-existing RNAs to produce novel functional RNAs. Because these novel transcripts are unique to metastatic cells, their therapeutic targeting does not affect normal cells. For the current project, they will survey and detect novel functional RNAs in single metastatic primary bone cancer cells.
  • RACER Hip is a randomised, controlled trial looking at the effectiveness of robotic assisted arthroplasty versus standard surgical technique. Participants will be blinded so they won’t know what type of surgery they have received. The study uses the MAKO Smartrobotics system. There is already an ongoing study looking at the effectiveness of robotic assisted arthroplasty in knees. Peter Wall is the Chief Investigator for the trial and the study will be run across at least 5 centres in the UK