Health support and crisis numbers

Aug

05

2025

Preadmission anaesthetic clinic changes at Coffs Harbour Health Campus

Message from Dr Rosmarin Zacher, anaesthetic lead for preadmission clinic (PAC) and high-risk perioperative care at Coffs Harbour Health Campus:

Preadmission anaesthetic clinic (PAC) and high-risk perioperative medicine update

Dear colleagues; it is a pleasure to introduce myself as the new anaesthetic lead for preadmission clinic (PAC) and high-risk perioperative care at Coffs Harbour Health Campus. In the coming months, you can expect there to be some small changes to PAC in general, and in particular how high-risk patients are managed perioperatively.

In response to our perioperative services review, and a recent district-wide analysis of hospital-associated complications (HACs), there is ongoing the need for a more comprehensive approach to perioperative care, especially in our patients who are at higher risk for complications. I am grateful for executive support to work in this space with the aim of improving outcomes for our shared patients.

Partnering with our local general practitioners is an important part of this enhanced perioperative care, and it is hoped that ongoing collaboration will allow us to provide the best care possible for our patients and community.

 Information required to expedite the triaging process for your patients

To ensure the effective and efficient triaging process, PAC will be transitioning to an enhanced triaging model. This additional level of triaging may require more information than we currently obtain from the Request for Admission (RFA). As such we kindly request that referrals for surgery at CHHC include:

Essential: Consider providing a copy for the patient to include with their RFA that they submit their form to the hospital to book surgery (or faxing directly to Pre-Admission Clinic)

  • Copy of your GP Summary (for Patients who have comorbidities, including for BMI >35 and potential untreated OSA). This is used to screen the RFA on arrival at CHHC and determine the likely need for PAC, and whether patients can be offered an OT date prior to anaesthetic review.

Desirable (where available):

  • Any additional investigations including imaging reports, and
  • Specialist correspondence (such as cardiology, respiratory, endocrine, renal, or other).

 

In addition, we ask that, especially for patients being referred for urgent surgery, that you check if they are due or overdue for specialist reviews and prompt the patient to attend as soon as possible.

Please ensure, for new referrals that results/correspondence are copied to the CHHC Pre-admission clinic: Pre-Admission Clinic CHHC (Fax: 02 6656 7491; email MNCLHD-CHHC-PAC-Clinic@health.nsw.gov.au).

High risk patients and shared decision-making pathways

We are aiming to streamline the flow of patients through their pre-operative assessment, optimisation and preparation for surgery. Your assistance in this process is critical in helping us all to improve efficiency and reduce unnecessary delays to surgery.

Elderly patients often have elements of frailty or cognitive dysfunction, and are at increased risk for perioperative complications. As such, please consider referral for a comprehensive geriatric assessment pre-operatively. Your expertise in helping patients to navigate Advance Care Planning is also invaluable in this setting.

Changes to perioperative GLP1-agonists, anticoagulants and antiplatelets – Implementation 4 August 2025 – in line with two new clinical practice guidelines

  1. Clinical Practice Recommendations regarding patients taking GLP-1 receptor agonists and dual GLP-1/GIP receptor co-agonists prior to anaesthesia or sedation for surgical and endoscopic procedures. A consensus clinical practice recommendation endorsed by the Australian Diabetes Society (ADS), National Association of Clinical Obesity Services (NACOS), Gastroenterological Society of Australia (GESA), and Australian and New Zealand College of Anaesthetists (ANZCA). Published April 2025
    1. Patients will continue taking their GLP1-a regardless of the indication (ie. For weight loss or diabetes)
    2. These patients must undertake an extended 24-hour modified (clear) fluid diet to mitigate the risk of aspiration of gastric contents with anaesthesia and sedation (including for endoscopy)
  2. Guidelines on Periprocedural Management of Anticoagulant and Antiplatelet Agents. ​ Sydney: Clinical Excellence Commission NSW. Published March 2025.
    1. There are minor changes especially in relation to last dose preoperatively for DOACs, and when to restart based on bleeding risk of the procedure

Changes to bowel prep in Coffs Harbour – implementation September 2025

PlenVu bowel preparation has now been approved for use at CHHC. The main change is that dose timing depends on whether a patient is booked on a morning or afternoon list. It is hoped that our renal and heart failure patients will have less fluid shifts in association with this bowel prep.

 

I look forward to sharing more about perioperative processes as they develop, and welcome stakeholder engagement by inviting all craft groups to collaborate in this space. Please do not hesitate to reach out should you wish to be involved more closely. I would also be very happy to present on perioperative-related topics at craft group meetings, upon invitation.

Many thanks in advance for your assistance in providing high value care to our patients and community.

 

Kindest regards,

 

Dr Rosmarin Zacher
BApSc (Med Sci) MBBS (Hons1) FANZCA ClinDip (Pall Med) GChPOM
VMO Anaesthetist, Supervisor of Training, DSRT
Anaesthetic Lead, Preadmission Clinic and High Risk Periop
Coffs Harbour Health Campus, Gumbaynggirr Country
Conjoint Lecturer, Coffs Harbour Rural Clinical School, UNSW
PR: 408192KK
Email: Rosmarin.Zacher@health.nsw.gov.au

 

You can also find a Word version of this letter here.

 

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Our regional partners

  • Local Health District partners in our footprint: Mid North Coast Local Health District (MNCLHD) & Northern New South Wales Local Health District (NNSWLHD)
  • Aboriginal Medical Services (AMS)
  • The Royal Australian College of General Practitioners (RACGP)
  • Australian College of Rural and Remote Medicine (ACRRM)
  • Rural Doctors Network (RDN)
  • Rural Clinical Schools & Regional Training Hubs
  • General Practitioners
  • Registrars and International Medical Graduates
  • North Coast Allied Health Association (NCAHA)
  • Local Councils
    Pharmaceutical Society of Australia (PSA)
  • Universities including: Charles Sturt University (CSU), University of New South Wales (UNSW), Southern Cross University (SCU)

Aged Care Disaster Management Planning

Strategic Priority Area: One team

North Coast is identified as the region most likely to be impacted by climate change in Australia and also forecasted greatest growth in those 65+.

Healthy North Coast takes a lead role in ensuring the older population and the sector that supports them are prepared for, can respond to and recover from disasters and other emergencies.

We have led eight regional disaster management capacity building workshops, bringing together SES, community organisations and the aged care sector.

We have also developed disaster preparedness tip sheets for both residential and community aged care providers.

Read the media release: Aged Care Homes Prepare for Disasters

Voluntary Assisted Dying

Strategic Priority Area: One team

In May 2022, the NSW Parliament passed the Voluntary Assisted Dying Act 2022. Effective from Tuesday, 28 November 2023, eligible people have the choice to access voluntary assisted dying. 

Healthy North Coast has developed a webpage for both health professionals and consumers, with links to available information and resources.

Visit the Voluntary Assisted Dying webpage

Living with Dementia resources

Strategic Priority Area: No one is left behind

Healthy North Coast has worked with people living with dementia, their families and local service providers to develop an information booklet that will help them connect with local and national supports along their journey.

Highly regarded by a range of professional supporting those on or starting the dementia journey, the booklet includes commonly asked questions for people to ask their GP and/or specialist.

“It’s a fantastic resource and I give it to everyone on their first diagnosis. Its easy to read, so well planned and thought through and has lots of really useful information, tailored to the region.
I also find it very helpful when educating clinical staff.”

−Geropsychiatric Nurse Practitioner, Mid North Coast.

The resource is available in digital and printed copies, with more than 5,000 distributed across the region. An e-version is available to clinicians via the Dementia and Cognitive Impairment HealthPathway.

View the Living with Dementia booklet (PDF)

Deteriorating Resident Triage Tool

Strategic Priority Area: One team

Empowering aged care teams to deliver safer, more consistent care.

The Deteriorating Resident Triage Tool (DRRT) supports aged care staff to confidently recognise and respond to signs of resident deterioration. It enables timely, evidence-based decisions, strengthens communication with health services, and promotes early intervention and effective care planning, helping residents receive the right care, at the right time, in the right place. By doing so, it reduces unnecessary Emergency Department presentations and improves resident outcomes.

Developed in collaboration with a specialist geriatrician and informed by input from Residential Aged Care Managers, NSW Ambulance, GPs, and clinical experts across the Mid and North Coast Local Health Districts, the DRRT is practical, relevant, and aligned with contemporary best practice.

Aligned with the Strengthened Quality Standards:

  • Standard 1 – The Person: Respects resident preferences and Advance Care Directives.
  • Standard 2 – The Organisation: Strengthens governance and clinical oversight.
  • Standard 5 – Clinical Care: Supports early recognition and escalation of clinical deterioration.
View the deteriorating resident response tool

North Coast care finders program

Strategic Priority Area: No one is left behind

Care finders is a free service to assist older adults connect to aged care services and supports. Care finders support older people who experience significant barriers to accessing services, and walk alongside their clients at their own pace, to understand their individual situation and support them to work through the steps to address their needs. Care finders assist people with access to other supports in the community. They can provide connections both with accessing services for the first time, and with changing or finding new services and supports if their needs change.

Care finders can:

  • Provide information about local aged care services
  • Help to set up an assessment with My Aged Care to access support, and
  • Find services that are targeted and available to help.

The care finder program has been extended to June 2029 and is provided by the following organisations. Each (Lismore, Coffs Harbour, Clarence Valley, Richmond Valley, Port Macquarie-Hastings, Kempsey, Nambucca and Bellingen) and Footprints (Kyogle, Tweed, Byron and Ballina).

Download the HNC Needs Assessment for older people.
Learn more about care finders including referral path and local providers.
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Psychological services in residential aged care homes

Strategic Priority Area: Improving Lives Now

Healthy North Coast commissions two service providers to deliver psychological therapies and supports for older people with, or at risk of developing, a mental illness and who are living in residential aged care homes (RACHs).

The aim of the program is to both provide direct support to residents and their families and carers, as well as upskill the RACH workforce to respond to the needs of residents presenting with mental health concerns.

Visit the commissioned services listings to find out more, including service contact information.​

Healthy Towns. Healthy Communities.

Strategic Priority Area: Securing a Healthier Future

Connection and a sense of belonging are protective factors for both individual and community health and wellbeing. Evidence highlights that the social determinants of health play a critical role in addressing many of our regions health challenges.

That’s why Healthy North Coast has long been committed to supporting communities to strengthen and to build social health. Our initiatives, including contemporary ‘Social Prescribing’, help people to connect to activities, supports and each other, and assist communities to integrate services and bridge gaps.

Visit the Healthy Me Healthy Community service page
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Telehealth in Residential Aged Care

Strategic Priority Area: Improving Lives Now

The Royal Commission into Aged Care Quality and Safety identified several critical areas affecting aged care residents and our health system. Key challenges include:

  • Limited access to general practitioners (GPs) and allied health professionals in aged care facilities.
  • Difficulties accessing out-of-hours services

Telehealth offers valuable opportunities to enhance support for residents living in aged care homes. Funded by the Commonwealth Department of Health and Aged Care, this initiative provides telehealth equipment and staff training as part of the response to the Royal Commission’s findings.

By improving access to primary care clinicians, specialist services, and other service providers through telehealth, we can significantly enhance health outcomes for residents, reducing unnecessary hospital transfers and emergency department visits.

The selection of telehealth equipment was guided by our Healthy Ageing Strategy (HAS), a comprehensive digital discovery questionnaire, and consultation workshops with various stakeholders. These efforts included interviews with residents to understand their attitudes toward telehealth, ensuring the initiative meets their needs and preferences.

For more information, visit the Telehealth in Residential Aged Care​ webpage
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Greater Choice at Home Palliative Care Program

Strategic Priority Area: Improving Lives Now

Aims to provide people who have life limiting conditions the opportunity to exercise choice and receive high quality care at home, harnessing improved and better coordinated supports and services that meet their individual needs.

Program objectives:

  • Improve access to palliative care at home and support end-of-life care systems and services (in primary health care and community care)
  • To enable the right care at the right time and in the right place (to reduce unnecessary hospitalisation)
  • Generate and use data to support continuous improvement of services across sectors
  • Use available technologies to support flexible and responsive palliative care at home, including in the after-hours.

These objectives will contribute to achieving the following intended overarching outcomes of:

  • Improved capacity and responsiveness of services to meet local needs and priorities
  • Improved patient access to quality palliative care services in the home
  • Improved coordination of care for patients across health care providers and integration of palliative care services in their region.
Read more about the Greater Choice at Home Palliative Care Program
Download the 2023 Palliative and End-of-life Care Needs Assessment (PDF)

Education & training funding elibility

Funding is open to all primary care providers within disaster affected communities across the Healthy North Coast footprint.

References

  1. Healthy North Coast Health Needs Assessment, 2022-2025
  2. Northern Rivers Community Foundation (2023). Northern Rivers Vital Signs, 2023
  3. Northern Rivers Community Foundation Flood Impact Report, May 2023
  4. Ang, C., Abdo, M., Rose, V., Lim, R., and Taylor, J. (2023). Participatory Grantmaking: Building the Evidence. Centre for Evidence and Innovation. 
  5. Lee, G., Vine, K., Atkinson, A-R., Tong, M., Longman, J., Barratt, A., Bailie, R., Vardoulakis, S., Matthews, V., & Mizanur Rahman, K. (2023). Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review. International Journal of Environmental Research and Public Health, 20, 6285. 
  6. Sewell, T., Stephens, R., Dominey-Howes, D., Bruce, E., & Perkins-Kirkpatrick, S. (2016), Disaster declarations associated with bushfires, floods and storms in New South Wales, Australia between 2004 and 2014. Scientific Reports (6). 
  7. Dominey-Howes, D., Bruce, E., Stephens, R., Perkins-Kirkpatrick, S., & Sewell, T. (2016). Natural disasters are affecting some of Australia’s most disadvantaged communities. The Conversation. 

Workforce Locum support and R&R funding criteria

  • Available to primary care services in disaster impacted communities within the Healthy North Coast footprint.
  • Available to support short-term workforce coverage, allowing clinicians to rest and recover.
  • Workforce-support funding in total is capped for each site, over a 12-month period:
    • $10k for GPs and/or
    • $5K for nursing and/or
    • $5k administration support and/or
    • $5K allied/pharmacy and other.
  • Funding is not to be used to fill gaps in staffing that have not been able to recruit to and not to replace existing staff.
  • Healthy North Coast will assess requirements and approve available funding directly with the service requesting support.
  • Priority will be given to sites that have immediate, short-term workforce support needs.
  • Requests will be reviewed and supported on a case-by-case basis.
  • Program funding administered via RCTI Agreement (Recipient Created Tax Invoice) to be paid monthly, or on completion of the placement (whichever comes first).
  • Practices will be required to complete a request for payment form monthly, or on completion of the placement (whichever occurs first).

Wellbeing Flexible Funding Criteria & Eligibility

  • Open to all primary care providers within disaster affected communities across the Healthy North Coast footprint.
  • Activity must be purposeful, with the aim of increasing the wellbeing of your team.
  • Requests will be assessed on a case-by-case basis, with funding allocated based on team size.*
  • Following approval by Healthy North Coast, funding will be administered via RCTI Agreement (Recipient Created Tax Invoice) upon providing proof of expenses.
  • Funding cannot be used for the purchase of alcohol, or any other goods or services where the vendor cannot quote their Australian Business Number.
  • Planned activities must occur prior to 30th June 2024.
  • Funding will not be available for retrospective activities.
*Team Size
(Total staff and contractors)		Funding Available
Small (1-5)$500-$1500
Medium (6-20)$1500-$4000
Large (>20)$4000-$5000

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