Keywords
Biography
I am a clinician scientist with over 30 years' experience as a cardiac and obstetric anaesthesiologist, largely on Randwick Campus at Prince of Wales Hospital.
Graduating in Medicine from UNSW Sydney with the University Medal, I completed an internship and Anaesthetic registrar training at St. Vincent's Hospital in Sydney, and Royal Hospital for Women, Paddington. With a keen interest in all things Cardiothoracic, I completed a fellowship in...view more
I am a clinician scientist with over 30 years' experience as a cardiac and obstetric anaesthesiologist, largely on Randwick Campus at Prince of Wales Hospital.
Graduating in Medicine from UNSW Sydney with the University Medal, I completed an internship and Anaesthetic registrar training at St. Vincent's Hospital in Sydney, and Royal Hospital for Women, Paddington. With a keen interest in all things Cardiothoracic, I completed a fellowship in Cardiothoracic Anaesthesia, including paediatric cardiothoracic anaesthesia at Prince of Wales & Sydney Children's Hospitals.
I have been a Consultant Anaesthetist on Randwick Clinical Campus since 1999, working predominantly in obstetrics and cardiothoracic surgery, both specialties where haemorrhage is a real risk.
I became a Conjoint Senior Lecturer at UNSW in 2018. My main two areas of research interest currently are in patient blood management on Randwick Campus and with the Grace Institute UNSW.
In 2015 I personally acquired funds to purchase two ROTEM machines, and subsequently implemented evidence based VHA Algorithms using ROTEM to guide coagulopathy management across the three public and one private hospital on campus. I established and am the chair of the Randwick campus ROTEM working party, an interdisciplinary team of doctors and nurses working with blood bank across all 4 hospitals and alongside haematologists under the umbrella of the Randwick transfusion Committee. I have led the implementation of ROTEM beyond Randwick, mentoring many other hospitals across New South Wales as far as afield as Nepean, Wollongong, Port Macquarie, and Lismore.
I am now known as a leader in patient blood management (PBM), a medical specialist Anaesthetist, and part of the Critical Care stream on Randwick Clinical Campus. My thought leadership and civic engagement has promoted evidence based, sustainable, transfusion practice, including introducing viscoelastic haemostatic assays (VHA) and has spanned for over two decades. More recently, I have given lectures for Red Cross Lifeblood and engaged with industry, including CSL and Werfen international, bringing this expertise to the education of UNSW medical students, research with ILP students and incorporating PBM into the 2027 Medical curriculum redesign.
The World Health Organisation has mandated the evidence based, ethical, and economic argument to implement evidence based PBM globally; a sentiment that has been reinforced by our Australian National Blood Authority. This mandate will become more important over time as our population ages, alongside the current decreasing trend in blood product donations.
Effective management of perioperative blood loss, bleeding and acquired coagulopathy improves patient outcomes, and as a corollary, reduces the risk of a need for transfusion; this is particularly important to the anaesthetist. We know that with unnecessary transfusions come increases in patient morbidity, mortality and hospital length of stay. By empowering clinicians to use evidence-based methods to guide transfusions, we can improve patient outcomes and support a more sustainable health system.
With the GRACE institute, the goal is to improve health outcomes for women with projects investigating pelvic pain, endometriosis and heavy menstrual bleeding as well as the uterine transplant project.
My Grants
2014-Philanthropic grant $60,000 to purchase ECMO machine via SCH foundation
2015- Philanthropic grant $42,500 to purchase 2x ROTEM machines for viscoelastic testing during critical bleeding
2023/2024- small grants $600 then $1000 from POW Foundation towards ROTEM project
2025 SEED funding UNSW $5000 for ROTEM access data base establishment statistical advice + ILP/Honours analysis
2025 POW Foundation $10K grant to proceed with RCT on Timing for surgery in patients on platelet inhibitors
My Qualifications
1992-UNSW Medicine MBBS First Class Honours and University Medal Valedictorian
1999 - FANZCA -Fellow of Australian and New Zealand College of Anaesthetists -Cecil Gray fellowship Medal Valedictorian
2019- University of Melbourne Masters in Clinical ultrasound
2020 Learn to Lead course -Australian Graduate School of Management UNSW
2024 and 2025- repeated each annual updated Learn to Lead course -Australian Graduate School of Management UNSW
My Awards
2024 - Conferred Academic Titleholder Engagement Award -Collegiality, Engagement and Leadership
1997- ANZCA Fellowship Examination- CECIL GRAY PRIZE, for the best performance in the Primary Examination for the Australian and New Zealand College of Anaesthetists
1995- ANZCA Primary Examination- RENTON PRIZE, for the best performance in the Primary Examination for the Australian and New Zealand College of Anaesthetists
1992-UNSW Medicine MBBS University medal
1992- UNSW Combined Teaching Hospitals Senior Staff Prize for the best performance by a female student throughout the Bachelor of medicine, Bachelor of Surgery Course
1992- The medical Women's Society of NSW Prize, for the best performance by a female student throughout the Bachelor of medicine, Bachelor of Surgery Course
1992- The Wallace Wurth prize, for the best overall performance in the Bachelor of medicine, Bachelor of Surgery Course
1989- The Prize in practical Anatomy for the best performance in practical and radiological anatomy by a student in year two of the MBBS course
1986- Holy Cross College Woollahra, NSW, Year 12 DUX Valedictorian
My Research Activities
My main two areas of research interest currently are in patient blood management on Randwick Campus and with the Grace Institute UNSW.
PATIENT BLOOD MANAGEMENT
Critical Bleeding Management:
I organised funding, purchased two ROTEM machines in 2015, and have established the ROTEM working party, implementing Viscoelastic testing for critical bleeding scenarios across Randwick Clinical campus. I now speak regularly on this topic at national and international meetings and courses, currently writing a book chapter for Australasian Anaesthesia.
I am the co-ordinating Principal Investigator on the ethics approved (2019/PID12980) project called "A prospective audit monitoring the use of ROTEM for transfusion in critically bleeding patients" (approved until 2029) and have a small amount of POW Foundation funding. I have created a data base of transfusion practices across campus which is currently the project of a UNSW ILP/Honours student, with another student joining in 2026.
This research project is looking at compliance with evidence based ROTEM algorithms, and clinician beliefs around whether they have followed the algorithm compared to objective evidence. We are also researching the response to the treatment algorithm doses when given correctly, and the effect on subsequent test parameters and bleeding response. This is important because it shows the efficacy and compliance of local treatment algorithms for critical bleeding and is translatable to any clinical site where critical bleeding may occur.
Timing of Surgery for patients on Platelet inhibitors: RCT plan will be presented by Catherine at the ANZCA Clinical Trials network meeting in Adelaide in August 2025.
In 2021, in conjunction with coagulation haematologists, I implemented an algorithm for platelet function testing to decide timing of surgery for CABG for patients on platelet inhibitors. The audit has been presented, and I am putting in an ethics submission to REGIS for an RCT comparing this to standard of care. This is important because patients wait for 5 days on the wards for their clopidogrel to wear off whilst up to 1 in 3 patients are actually non-responders. By recognising this we can expedite surgery saving time, money, hospital beds and getting patients treated earlier. This has potential major impact well beyond our walls, nationally and internationally. I have applied for POW Foundation funding.
GRACE INSTITUTE UNSW
I have been involved in clinical trials with Prof Jason Abbott for more than 2 decades, overseeing study protocols and helping recruitment and collection of samples.
In recent years, I have been involved via the Grace institute, and in 2024 co-supervised a UNSW ILP/Honours student on a Pelvic Floor Pain project. In 2025, I co-supervised another ILP/Honours student on a pain management endometriosis project and in 2026 there will be two students, one endometriosis and one heavy menstrual bleeding project.
The Uterus transplant project at the RHW has been celebrated with two babies now born, and I have been involved in protocols and have had accepted for publication in IJOA our article called "Anaesthetic Considerations for Uterine transplant surgery and Post-Transplant Obstetric care-The Austraian-Swedish collaborative", this is in collaboration with Prof Abbott, Prof Deans and the Swedish transplant team.
CLINICAL TRIALS
I am the Principal Investigator for the DECIDE trial at Prince of Wales Hospital. This multicentre triple blind, placebo-controlled, randomised trial will evaluate whether dexmedatomidine improves days alive and free of delirium after cardiac surgery. Recruitment commenced January 2025 and the trial runs till December 2028. (2023/PID02119)
I have been involved as associate investigator on several other clinical trials including ITACS, IV iron treatment of Anaemia before Cardiac Surgery (2021/PID 01408), and TRICS-IV, Transfusion requirements in younger patients undergoing cardiac surgery (2023/PID02725) currently recruiting.
During COVID, I was the Principal Investigator for Prince of Wales private Hospital for the multicentre study: Prevalence of Asymptomatic SARS Cov-2 Infection in Elective Surgical patients in Australia (2020/PID01529) where I oversaw recruitment of almost 500 patients checking nasal PCR and serology during elective surgery in May-June 2020. We were one of three sites chosen for NSW.
Over the past decades I have been involved in numerous other projects, and these are listed on my website downs.com.au.
My Research Supervision
Supervision keywords
Areas of supervision
PATIENT BLOOD MANAGEMENT
Critical Bleeding Management: 2025 UNSW ILP/Honours student, with another student joining in 2026.
I am the co-ordinating Principal Investigator on the prospective audit monitoring the use of ROTEM for transfusion in critically bleeding patients
I have created a data base of transfusion practices across campus which is currently the project of a UNSW ILP/Honours student
This research project is looking at compliance with evidence based ROTEM algorithms, and clinician beliefs around whether they have followed the algorithm compared to objective evidence. We are also researching the response to the treatment algorithm doses when given correctly, and the effect on subsequent test parameters and bleeding response. This is important because it shows the efficacy and compliance of local treatment algorithms for critical bleeding and is translatable to any clinical site where critical bleeding may occur.
GRACE INSTITUTE - 2024 and 2025 UNSW ILP/Honours student on a Pelvic Floor Pain project, and 2026 two students as below
I have been involved in clinical trials with Prof Jason Abbott for more than 2 decades, overseeing study protocols and helping recruitment and collection of samples.
In recent years, I have been involved via the Grace institute, and in 2024 co-supervised a UNSW ILP/Honours student on a Pelvic Floor Pain project. In 2025, I co-supervised another ILP/Honours student on a pain management endometriosis project and in 2026 there will be two students, one endometriosis and one heavy menstrual bleeding project.
Currently supervising
2025
UNSW ILP/Honours Anthony Yap
UNSW ILP/Honours Sophie Dien
2025 examining two ILP/Honours student manuscripts for Dr Favero and A/Prof Grant
2026
UNSW ILP/Honours Tony Zhang
UNSW ILP/Honours Julia Seldon
UNSW ILP/Honours Sabrine Wang
My Engagement
My work involves collaboration with industry, particularly Werfen International, where I have presented for the last two years on faculty for the annual international patient blood management course. This course is run across over 80 countries and to more than 2500 participants. I presented alongside a speaker from the WHO on 19 October 2024.
I regularly engage with Lifeblood Red Cross and presented a Viscoelastic Guided Transfusion lecture to their haematologists and trainees on ROTEM and TEG at the Lifeblood clinical transfusion course 2024. In this I created a new teaching tool combining TEG and ROTEM targets onto a single algorithm for learning purposes. I also reviewed the content for the 2025 new Critical Bleeding Module for Lifeblood. I have created a new connection between ANZCA college of Anaesthetists and Lifeblood whereby a memorandum of understanding has been achieved and a module being created teaching the content created for the Lifeblood course in a module for all Anaesthesiology consultants across Australia and New Zealand.
Bringing this experience and broad engagement to the UNSW, I have been a conjoint senior lecturer at Randwick clinical campus since 2018. I have contributed to the education of UNSW medical students during their term at the Royal Hospital for Women, using obstetric bleeding simulations alongside Dr. Siobhan Lee.
I have also supervised one ILP/Honours student in 2024 and two ILP/Honours in 2025, including one on the patient blood management project. That student is analysing data on local practice, compliance with algorithms and gain a thorough understanding of evidence-based sustainable practice in the management of coagulopathy.
I will supervise three ILP/Honours in 2026, one on Blood management and two co-supervising with Conjoint A/Prof Nesbitt-Hawes from GRACE.
I have also engaged with UNSW, marking written papers and oral exams as well as giving lectures, recently on oxygen therapy to the phase 2 students.
The 2027 curriculum redesign has also been looked at with this PBM lens. I attended multiple sprint sessions in 2024 aiming to ensure that PBM is incorporated into the new curriculum as sustainable use of blood products will only become more important for the next generation.
To summarise, my greatest strengths are in collegiality, leadership and engagement. I am a leader within critical care, especially PBM. My thought leadership, civic engagement and collaboration with industry and Red Cross Lifeblood are well known, advancing the reputation and engagement of UNSW with the community at large.
Connecting this work to UNSW involves education of medical students during their obstetric and critical care terms, including simulations as well as research, curriculum redesign and in 2025, a significant research project with the ILP students.
My Teaching
I teach ILP/Honours students as above
I teach the phase two curriculum specifically respiratory assessment and oxygen therapy. This is coordinated by Mel Kuru
I also do marking of assignments usually Adult health 1 and 2
Location
Department of Cardiothoracic Anaesthesia
Level 3, Campus Centre
Barker street
Randwick