leadership on randwick campus

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 Patient Blood management is my main passion and I have had a leadership role since 2015 when I acquired 2 ROTEM machines with $42,500 private funding for Randwick Campus. I have been working to address the gaps that exist in knowledge; teaching evidence based best practice and auditing outcomes. This technology allows the clinician to decide if coagulopathy is present and if so, whether platelets, FFP, or cryoprecipitate are needed. This has been shown to reduce the overall number of units transfused and therefore costs, whilst simultaneously improving patient outcomes largely by reducing Transfusion Associated Cardiac Overload (TACO).
Moving from the “blood pack” system to precision transfusion required much interprofessional work, many meetings with haematologists, surgeons, intensivists and many teaching sessions, including personally presenting workshops at the Blood Bank at Green Square Sydney in collaboration with Blood Bank Haematologists.
Randwick campus is the NSW leader in this field, and after writing a book chapter in 2017 on our experience locally, I have been sharing the locally developed Randwick ROTEM cardiac, obstetric and paediatric algorithms with other departments, to save them “reinventing the wheel”.
I have been mentoring 6 other hospitals in NSW and have started a NSW ROTEM committee under the suggestion of haematologist Dr Susan Macallum who chairs Randwick Campus Transfusion Committee .
I collected data showing improvement in transfusion management on our campus after the ROTEM testing was introduced. This formed the basis for a book chapter in Australasian Anaesthesia 2017 titled “Introducing Viscoelastic Haemostatic Assay Guided Blood Transfusion management to your Hospital”, and national and international presentation of our work including by Dr Macallum at an international Haematology meeting.
I established and chair the ROTEM subcommittee under the Randwick campus transfusion committee and through this committee have incorporated ROTEM as an option on the Campus Critical Bleeding Protocol. 

I have also established a NSW wide working group for rotem with 7 other campuses, and am working on a mentor program with WERFEN for new sites purchasing ROTEM machines to facilitate introduction of the new transfusion strategies.
I have designed and developed the ROTEM guided transfusion algorithms and all teaching material used across the 4 hospitals on Randwick campus, POW, RHW, SCH and POWPH for ROTEM based  I speak at Grand Rounds and Cardiothoracic meetings regularly, educating and presenting best practice and audit data on this topic,
In 2020 I also worked on introducing the 2017 European and 2019 American guidelines for transfusion practice in cardiothoracic surgery into the Randwick Campus. This included interprofessional work with the haematologists and cardiac surgeons to facilitate platelet function testing to decide timing to theatre for patients on antiplatelet medications. I implemented an algorithm for the use of platelet function testing prior to cardiac surgery and this is now used by the teams to optimise timing for emergency cardiac surgery. I then implemented teaching and guidance across cardiac surgery, anaesthesia and ICU. In November 2020 I presented these ROTEM and platelet function algorithms to a national, werfen sponsored event online with an international speaker, presenting to hundreds of anaesthetists around Australia on the use of ROTEM technology to optimise care in cardiac surgery.
 

I have created many resources, including a 2023 version of the 17 minute critical bleeding protocol video used for junior doctor education when they commence the term at Randwick. I partnered with juniors to develop this material and would like to use this for medical student education too (https://www.youtube.com/watch?v=QQxQEBWifUQ)
 

In 2023, the ethics approved ROTEM project described under “research” uses redcap to analyse the ROTEM transfusion data across campus. This has a dual educational and data collection role in relation to transfusion management in major haemorrhage on Randwick campus.
 

I have completed a 2023 revision of the algorithms and included fibrinogen concentrate as an option to create haemostasis in massive haemorrhage in severe circumstances. 

I have a collaborative relationship with industry and in March 2023 attended the WERFEN Asia Pacific meeting in person in Thailand, where I was an invited speaker and presenter. This meeting was specifically looking at better ways to assess and measure the levels of increasingly common blood thinning medications prior to elective and emergency cardiac and non-cardiac surgery.
In Europe there is a separate sub-qualification for anaesthetists/Haematologists/critical care physicians in coagulation management (The Europeans call it Haemostasiology) and this is definitely an area where I would like to create a subgroup of champions in this field to be available to give advice in emergency bleeding situations.
 

IMPACT- There is much work to be done to improve management of critical bleeding.
I have been investigating, developing resources and educating widely whilst cultivating a positive attitude towards teaching and learning PBM. I have a reputation for excellent teaching practice across colleagues, students and managers. This is reducing unnecessary transfusion and is improving patient care across NSW.
 

 During COVID I was heavily involved in leadership across the 4 hospitals on campus creating consistent PPE within the operating rooms at various stages in the pandemic. This was considering ANZCA national recommendations, and NSW health policy, as well as local infection rates, in liaison with Infectious diseases, to ensure campus wide consistency on PPE for the operating room. I also coordinated education of COVID safe intubation practice for Anaesthetists at POWPH. I was principal investigator for SESLHD area health on the nationwide COVID prevalence study in June 2020. This required great leadership and we recruited almost 500 patients in one month for PCR and serology, this was published in ANZ Journal of Surgery (see research)
IMPACT- This reassured our Chief medical team that Australia did not have a large background prevalence of asymptomatic COVID at this time when the borders where first closed. SESLHD had the highest background COVID prevalence in Australia in June 2020, it was 1% with 5 cases of positive serology.
 

 2012-2024: I was the chair of the anaesthetic committee and member of the Medical Advisory Committee for the POWPH, I organised 44 quarterly committee meetings and Morbidity Mortality meetings . This involved updating policy and procedures, writing rosters, incident evaluation and complaint/doctor management. My role was not just organising them to present their difficult cases, but also helping them reflect and learn from this exercise. Stemming from this I organised anaphylaxis kits to be available in all theatres across campus which included patient information to be given to patients post-operatively, and resources to optimise investigation and follow up with anaphylaxis clinics.
 

In 2012, I chaired the working party organising purchase of electronic Drager anaesthetic machines with centralised backup of patient data, important for incident evaluation. This included organising a “train the trainer “approach to teach all 200 anaesthetists at POWP how to test and use the new electronic machines. In 2022 I then oversaw the next generation purchase and implementation of the new fleet of machines.
 

The POWPH service and leadership also involved purchase and standardisation of all anaesthetic trolleys for all theatres at POWPH in response to incidents, to reduce error. The trolley locations of medications, with the standardised user designed layout, has been taken up and used by several hospitals within the Sydney area.
 

In my role as the POWPH committee chair I was responsible for the design of new level 5 theatres, as well as the requirements for the level 3 robotic theatre at POWP, including major equipment purchased.
 

I have also had to meet with accreditors giving me good insight into clinical governance and national standards.
 

POWPH has implemented a rostering system for obstetrics and I have helped design the on-call software requirements.
 

I also implemented the Obstetric Anaesthetic Sub- Committee, a multidisciplinary group to bring Obstetricians, anaesthetists and midwives together to improve quality care in obstetrics.
 

Prior to COVID, in 2016, I instituted annual Heads of Anaesthetic Department dinners where the Anaesthesia Heads of Department from POW, RHW, POWPH and SCH met annually for dinner at the start of each year. These connections proved invaluable when the challenges of COVID arrived.

 

 2007-2023:  I have been a member of the ANZCA Continuing Education (ACE) committee organising continuing education events for anaesthetists and this committee organises meetings within NSW twice a year. During this time, I have convened three meetings .

 I have been learning and implementing educational strategies as a member of the NSW Anaesthesia Clinical Education Committee (ACE-combined ASA and ANZCA) since 2005, evolving educational techniques and organizing both formats and content for post graduate education. For example, in 2008 I was the first convener of an ACE meeting to implement a lecture stream in the main theatre and coordinated breakout rooms with workshops and PBLD discussions. The ACE committee has also implemented interactive CPR workshops for anaesthetists, the evolution in education over the past 15 years is remarkable. I have recently stepped down from this committee to focus on student teaching. 

 2005-2014  : I was on the NSW committee of Management for the Australian Society of Anaesthetists. After leaving the management committee I remained active in creating online educational content via the CPD committee. 

 I have been the supervisor for Anaesthetic trainee projects and 6 of these became poster presentations at national meetings including May 2023 “Uterine Transplant- the anaesthetic perspective”.
 

I have also reviewed for the American Journal of Minimally Invasive Gynaecology.
 

In 2022, I began writing medicolegal reports; I am recognised for my expertise around the topic of coagulation management peri operatively with root cause analysis of such scenarios.

 

  I am an Officer Grade 5, Divisional Doctor M01 for Paddington Combined Division St John Ambulance Australia. I am overseeing the health care professionals for this division and providing first aid at various events. I patrol with my 3 teenage children.