MB BS, DPhil, FRACP
Dr Gemma Figtree is a Cardiologist at Royal North Shore Hospital (RNSH) and Senior Lecturer at the University of Sydney. Her clinical practice focuses on the treatment of coronary artery disease, particularly the rapid treatment of patients with heart attack. She has also been instrumental in establishing a cardiac magnetic resonance service at RNSH for state-of-the-art, non-invasive assessment of patients suffering from suspected cardiovascular pathology. In addition to her clinical commitment, Dr Figtree is a dedicated cardiovascular researcher committed to understanding the molecular mechanism by which the heart’s Na+-K+ pump is inhibited in a number of cardiovascular disease states. She is also committed to teaching, both supervising PhD students and lecturing at the University of Sydney Medical School.
Dr Figtree graduated from the University of Sydney in 1999. She completed her Doctorate in Cardiovascular Genetics and Molecular Biology at Oxford University supported by a Rhodes Scholarship (1999-2002), followed by her residency and Cardiology training at Royal North Shore Hospital. She was admitted as a Fellow of the Royal Australasian College of Physicians in 2008 and has practiced at RNSH as an academic Cardiologist since.
Dr Figtree has published 37 manuscripts in international peer-reviewed journals and one book. She has been an invited speaker at numerous International Meetings and a regular invited manuscript reviewer for major International medical journals and the NHMRC grant review process. In addition to a Rhodes Scholarship, she has also recently been awarded the Sydney Medical Foundation Chapman Fellowship and the Viertel Clinical Investigatorship. Although Dr Figtree is now based in Australia, she maintains strong International Collaborations with colleagues in Oxford, London, Denmark, Switzerland and Boston.
Dr Figtree’s thoughts on the redevelopment of RNSH
Over the last decade, RNSH doctors in the Departments of Cardiology, Cardiothoracic Surgery and Emergency Medicine have worked together with the NSW Ambulance Service to provide a world-leading Field Triage model of care for acute myocardial infarction (“heart attack”) that has resulted in substantial reductions in mortality and morbidity1. This model has also dramatically reduced the length of hospital stay of patients suffering heart attack to the lowest in Sydney2. Two of the critical issues that result in optimal results for critically ill heart patients are discussed below in the context of the “old” and “new” hospitals.
- The co-location of critical cardiology units: The NSW Health guidelines highlight the importance of co-location of “Cardiology Related Units”. We depend daily on the rapid access of our colleagues in the intensive care unit to patients being treated for heart attacks in the cardiac catheter laboratory. In the situation of a cardiac arrest resulting from a blocked coronary artery, the ability of intensive care doctors and nursing staff to rapidly provide resuscitation while the interventional cardiologist continues the procedure to unblock the culprit artery is critical. We have been lucky in the current RNSH to have the Intensive Care Unit, Coronary Care Unit and Cardiac Catheter Laboratories immediately adjacent to one another – a fact that has helped us achieve a world-leading, low hospital mortality of 2 per cent for our patients with ST elevation myocardial infarction1. This collocation has now become a formal recommendation by NSW Health2, which also extends to cardiothoracic operating theatres. Due to the lack of flexibility and space constraints in the “new” RNSH, this collocation has not been possible. This is a great shame for a disease that kills the most number of Australians, and which is most time-critical.
- The co-location of RNSH and North Shore Private Hospital (NSPH) Cardiology Catheter Laboratories: The co-located RNSH and NSP Cardiac Catheterisation complex was developed a decade ago. It is located on level 6 of the public hospital, with easy access for patients to and from the private hospital via a bridge.
The collaboration between the two Hospitals in this regard has been tremendously successful. It has prevented duplication of high technology facilities that would otherwise occur in the two adjacent public and private hospitals, and, in fact, has assisted in providing all our patients with “state-of-the-art” diagnostic and therapeutic services. Such efficiencies will be even more important in the future, given the rapidly advancing technology in Cardiology. The co-location of public and private Laboratories has also ensured that expert staff are concentrated in the one location. The importance of this is highlighted by recent studies that clearly demonstrate one of the most important determinants of clinical outcome in the treatment of acute heart attacks is the volume of procedures performed in the unit rather than by the physician3,4. High volume operators who work in high volume institutions produce the best outcomes. Without the co-location, staffing a 24/7 roster of nursing and allied health staff for treating infarcts would not have been possible. The “new” RNSH will be a considerable distance from NSPH. The impact on the above model will be considerable. In addition, the resulting increase in cardiac patients in the Public Hospital has not been adequately accounted for.
The Cardiology Department believe that the redevelopment of Royal North Shore Hospital provides us with an opportunity to further improve care for patients with heart disease. However, this will only happen if the above issues are adequately addressed. If successful, the new hospital will allow us to continue to provide world-class cardiac care, and to attract and concentrate the brightest and most capable of the next generation of cardiologists and cardiothoracic surgeons.
- Carstensen S, Nelson GC, Hansen PS, Macken L, Irons S, Flynn M, Kovoor P, Soo Hoo SY, Ward MR, Rasmussen HH. Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome. Eur Heart J. 2007;28(19):2313-2319.
- O’Connell T. Health Services Performance Improvement. Greater Metropolitan Clinical Taskforce, 2005. NSW Health Clinical Services Redesign Program. Models of Care for Cardiology. NSW Health Department. 2006.
- Hannan EL, Wu C, Walford G, King SB, III, Holmes DR, Jr., Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH. Volume-Outcome Relationships for Percutaneous Coronary Interventions in the Stent Era. Circulation. 2005;112(8):1171-1179.
- Jollis JG, Peterson ED, DeLong ER, Mark DB, Collins SR, Muhlbaier LH, Pryor DB. The Relation between the Volume of Coronary Angioplasty Procedures at Hospitals Treating Medicare Beneficiaries and Short-Term Mortality. N Engl J Med. 1994;331(24):1625-1629.