A/Professor Neil Orford

MBBS, FCICM, FANZCA, PGDipEcho, PhD

Neil is a senior staff specialist in Intensive Care at University Hospital Geelong. His interests include clinical leadership and culture, shared decision-making, clinical research into long term outcomes, philanthropy, and writing for the public.

Neil was Director of UHG ICU from 2008-2020, the COVID Clinical Lead for Geelong Hospitals during the pandemic, and most recently Clinical Director of Medicine, Specialist Medicine and Emergency Medicine at Barwon Health.

He is a Board Director of the College of Intensive Care Medicine of Australia and New Zealand, where his roles include Lead of the Culture in ICU program, Chair of the Hospital Accreditation Committee, and Deputy Censor.

His Leadership training includes the Harvard Kennedy School Art and Practice of Leadership Development Course, Harvard School of Public Health International Leadership Development Program for Physicians, and Harvard Law School Negotiation Master Class.

His research interests include long-term outcomes, particularly critical illness induced osteoporosis, and shared decision-making. He is currently CIA for an MRFF $1.9M multicentre RCT on the role of antiresorptives to prevent bone loss after critical illness. He is Associate Professor for Deakin University School of Medicine, Monash University’s ANZIC-RC, and Melbourne University Department of Critical Care.

Neil’s philanthropic interests include providing Intensive Care Specialist support for Open Heart International, a volunteer program that provides cardiac surgery to the Pacific Islands.

Since 2015 Neil has engaged in public conversation about the human side of healthcare through writing opinion pieces and editorials. In 2022 he completed the Harvard Medical School Certificate Program in Effective Healthcare Writing.

As a leader, Neil’s roles include

  • College of Intensive Care Medicine (CICM) of Australia and New Zealand
    • Board Director
    • Chair, Culture of ICU Program
    • Chair, Hospital Accreditation Committee
    • Deputy Censor
    • Co-convenor Directors Meeting
  • Barwon Health
    • Board Safety and Quality Committee
    • Clinical Director Projects / Redesign
    •  Clinical Lead iValidate Shared Decision-Making Program
  • Research Management Committee
    • Bone Zone Trial
    • NOTACS Trial
    • Blender Trial
    • EXCEL database
    • ECMO Rehab
    • iCARE
    • Early Mobilisation NHMRC Guideline
    • RECOMMEND Platform Trial

Past roles include;

  • Member, Victorian Government Intensive Care Pandemic Co-ordination Group 2020-2021
  • Geelong Hospitals Pandemic Clinical Lead 2020-2021
  • Director of ICU, Barwon Health 2008-2020
  • Board Director, Intensive Care Foundation 2014-2017
  • Member, ANZICS CTG National Executive 2013-2015
  • Victorian Intensive Care Advisory Committee 2012-2015

He has undergone leadership and culture improvement training;

  • Harvard Kennedy School Art and Practice of Leadership Development (2023)
  • Harvard International Leadership Development Program for Physicians (2018)
  • Harvard Negotiation Masterclass (2019)
  • Partnering with the Nous Group to develop Barwon Health’s ICU Culture Program

Neil is active in clinical research, with authorship on over 60 peer reviewed publications. This includes;

Top 5 publications in the last 5-years

  1. Hodgson CL…Orford N, for the EXCEL Study Investigators. Incidence of death or disability at 6 months after extracorporeal membrane oxygenation in Australia: a prospective, multicentre, registry-embedded cohort study. Lancet Respir Med. 2022 Nov;10(11):1038-1048. CI Orford was an AI for the EXCEL registry NHMRC Partnership grant and investigator for subsequent trial, including this prospective multicenter cohort study describing the outcomes for patients requiring ECMO support in Australian and New Zealand ICUs.
  2. Fujii T, et al…Orford N. The VITAMINS Randomized Clinical Trial. JAMA 2020 Feb ;323(5):423-431. CI Orford was an Investigator and Management Committee member for this novel RCT investigating the effect of a combination of vitamin C, thiamine, and hydrocortisone for septic shock in critically ill patients.
  3. Orford N. Grief After Suicide. 2020 May 5;323(17):1720-1721. This opinion piece was selected as one of the most influential “Piece of My Mind” articles for the JAMA Anniversary Edition. This reflects CI Orford’s contribution to the “human” side of healthcare through writing for the public, and his skill as a writer, a crucial role for research teams.
  4. Angus DC…Orford N et al. Effect of Hydrocortisone on Mortality and Organ Support in Patients with Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomised Clinical Trial. 2020 Oct 6;324(13):1317-1329. This international, multicenter trial was a product of the ongoing adaptive platform REMAP-CAP trial and describes the role of intravenous hydrocortisone in patients with severe COVID-19. Importantly CI Orford has gained experience in the design and implementation of adaptive platform trials through this program.
  5. Milnes S, Orford N, Berkeley L, et al. A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital. BMJ SPC 2019;9:92-9. This paper describes the prevalence and long-terms outcomes of patients with life limiting illness referred a tertiary Australian ICU. It represents the early publications of the iValidate Investigator Group, and a structured research and clinical change program to improve person-centred care.

Bone loss after Critical Illness

Neil is the Chief Investigator for a research program investigating bone loss after critical illness. Over the last 15 years this  program has investigated the incidence and extent of bone loss, established a national research group, performed a single centre pilot study of antiresorptives after ICU, and is now conducting a 25 centre, MRFF funded, 450 participant RCT in this area  – the “Bone Zone” Trial.  

Shared decision making for life limiting illness

Neil is the Clinical lead and Chief Investigator for a unique program that aims to improve shared decision-making for patients with life limiting illness, particularly in the acute hospital setting. This was designed in 2015, won the 2017 Barwon Health Quality Award for “Our Consumers at the Forefront”, and is implemented in various jurisdictions across Australia and New Zealand. Our current focus is;

  • Nation-wide education: Through a virtual and face-to-face 2-day communication skills program that trains over 120 participants per annum.
  • High risk surgery program: We are designing and implementing a shared decision-making program for high-risk surgical patients, measuring goal concordant care and clinical and economic outcomes.
  • Research program: We have developed a progressive research program aiming to examine the prevalence, effectiveness, and impact of shared decision-making interventions in hospital settings.

Grants

  • Current
    • 2023: AI MRFF MNHS Grant: Generating new evidence to reduce complications and improve the safety and efficacy of extracorporeal membrane oxygenation (ECMO) in patients with severe cardiac and respiratory failure: THE RECOMMEND Platform Trial. $2,985,992.73.
    • 2023: CI MRFF: iCare – An interactive online portal to improve health and wellbeing for people living with complex cancers, and their informal carers: a Phase II randomised controlled trial. $826,731.86
    • 2020: CIA MRFF RCRDUN Grant APP1199726: Bone loss prevention with zoledronic acid or denosumab in critically ill women – A randomised controlled trial. $1,905,282.70
    • 2020: AI NHMRC CRE Grant: The Centre for Research Excellence in Extracorporeal Membrane Oxygenation for Acute Cardiac and Respiratory Failure (CRE-ECMO)
  • Past
    • 2018: AI NHMRC Partnership Grant GNT1152793: The EXCEL Project: A collaborative approach to improve outcomes of Australian patients with acute heart failure and cardiac arrest requiring extracorporeal life support. $692,656.80
    • 2017: Orford N. Effect of denosumab on bone turnover markers in critically ill women – A safety and feasibility, randomised, placebo, controlled trial. Malcolm Fisher Intensive Care Foundation Grant. $14,638
    • 2015: Orford N. I-validate research program. Barwon Health Program Grant. $250,000
    • 2016: Lambert N, Orford N. End-of-life communication for high-risk patients referred to ICU. Sydney Parker Fellowship, $75,000
    • 2014: Simpson N, Orford N. Implementation of a critical care tele-health program in South-Western Victoria. Victorian Govt Dept of Health. $250,000.
    • 2012: Orford N. Changes in Bone Mineral Density in the Year after Critical Illness. Intensive Care Foundation Grant. $28,000.
    • 2008: Orford N. Implementation and outcomes of a severe sepsis protocol in an Australian tertiary hospital. South-Western Victoria Program Grant. $40,000.

Management Committee Clinical Trials

  1. RECOMMEND Platform Trial. Generating new evidence to reduce complications and improve the safety and efficacy of extracorporeal membrane oxygenation (ECMO) in patients with severe cardiac and respiratory failure
  2. iCare: iCare – An interactive online portal to improve health and wellbeing for people living with complex cancers, and their informal carers: a Phase II randomised controlled trial
  3. EXCEL Project: A collaborative approach to improve outcomes of Australian patients with acute heart failure and cardiac arrest requiring extracorporeal life support
  4. BLENDER: Blend to Limit oxygEN in ECMO:a ranDomised controllEd Registry trial
  5. BONE ZONE: Chief Investigator for Antiresorptives in Critical Illness Research Program.
  6. REMAP-CAP: Ventilation Domain
  7. TRANSFUSE: Standard Issue Transfusion versus Fresher Red-Cell Use in Intensive Care. Randomised Controlled Trial Management Committee

Since 2015 Neil has contributed to public conversation about health issues. These include;

Neil is undertaking training in writing, including;

At a philanthropic level Neil is the Intensive Care Specialist for Open Heart International Fiji, a volunteer program providing cardiac surgery for rheumatic heart disease. He is co-developer and Director of Crit-IQ, an international website providing education for critical care doctors, providing free resources to low-middle income countries.

2023

  • Milnes S, Hutchinson A, Kerr D…Orford N. Effect of communication skills training on documentation of shared decision-making for patients with life-limiting illness: an observational study in an intensive care unit.Crit Care and Resusc. 2023. April accepted for publication.

 2022

  • Orford N. We need silence in the noise of a pandemic. MJA Insightplus. 2022 Feb 14. https://insightplus.mja.com.au/2022/5/we-need-silence-in-the-noise-of-a-pandemic/
  • Hodgson CL, Higgins AM, Bailey MJ…Orford N, for the EXCEL Study Investigators on behalf of the International ECMO Network and the ANZICS CTG. Incidence of death or disability at 6 months after extracorporeal membrane oxygenation in Australia: a prospective, multicentre, registry-embedded cohort study. Lancet Respir Med. 2022 Nov;10(11):1038-1048. doi: 10.1016/S2213-2600(22)00248-X.
  • Thackeray M, Kotowicz MA, Pasco JA, Mohebbi M, Orford N. Changes in body composition in the year following critical illness: A case-control study. J Crit Care. 2022 Apr 23;71:154043. doi: 10.1016/j.jcrc.2022.154043
  • Short-Burchell RJ, Corke CF, Carne RP, Orford NR, Maiden MJ. Documentation of neurological status in patients admitted to an intensive care unit after cardiac arrest: A 10-year cohort study. Aust Crit Care 2022 Sep;35(5):557-563. doi: 10.1016/j.aucc.2021.08.008
  • Low Y, Lyon C, Lakey K, Finnis ME, Orford NR, Maiden MJ. Frailty is not independently associated with intensive care unit length of stay: An observational study. Aust Crit Care. 2021 Aug 27:S1036-7314(21)00106-5. doi: 10.1016/j.aucc.2021.06.012.

 2021

  • Thackeray M, Mohebbi M, Orford N, etal. Lean mass as a risk factor for intensive care unit admission: an observational study. Crit Care. 2021 Oct 18;25(1):364.doi: 10.1186/s13054-021-03788-y.
  • Thackeray M, Orford NR, Kotowicz MA, Mohebbi M, Pasco. Estimation of whole-Body and Appendicular Lean Mass from Spine and Hip Dual energy X-ray Absorptiometry: A Cross-Sectional Study. Calcif Tissue Int. 2021 Oct 13. doi: 10.1007/s00223-021-00922-4.
  • Maiden M, Trisno R, Finnis ME, Norrish CM, Mulvey A, Nasr-Esfahani S, Orford N, Moylan S. Long-term outcomes for patients admitted to an Intensive Care Unit with intentional self-harm. Anaesth Intensive Care. 2021 May;49(3):173-182. doi: 10.1177/0310057X20978987.
  • Milnes S, Mantzaridis Y, Simpson N…Orford. Values, preferences and goals identified during shared decision making between critically ill patients and their doctors. Crit Care Resusc. 2021;23(1):76-85.
  • Dunning T, Martin P, Milnes S, Simpson N, Lee GB, Orford N. Discussing diabetes, palliative and end of life care: choosing the “right” language. Ann Palliat Med. 2021 Apr;10(4):3739-3749. doi: 10.21037/apm-20-1548.
  • REMAP-CAP Investigators. Interleukin-6 Receptor Anatagonists in Critically Ill Patients with Covid-19. N Eng J Med. 2021 Apr 22;384(16))1491-1502.

 2020

  • Angus DC, Derde L, Al-Beidh F….Orford N et al. Effect of Hydrocortisone on Mortality and Organ Support in Patients with Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomised Clinical Trial. JAMA. 2020 Oct 6;324(13):1317-1329.
  • Bone A, Elderkin T, Maiden M, Orford N. Patients with pre-existing life-limiting illness in the intensive care unit: A point prevalence study. Crit Care Resusc.2020 Sep;22(3):285-286
  • Cioccari L, Luethi N, Duong T…Orford NR. Cytokine and lipid metabolome effects of low-dose acetylsalicylic acid in critically ill patients with systemic inflammation: a pilot, feasibility, multicentre, randomised, placebo-controlled trial. Crit Care and Resusc. 2020 Sep;22(3):227-236.
  • Fulcher BJ, Nicholson AJ, Linke NJ…Orford N, on behalf of the EXCEL Study Investigators and the International ECMO Network. The perceived barriers and facilitators to implementation of ECMO services in acute hospitals. Intensive Care Medicine. 2020Nov;46(11):2115-2117.
  • Linke NJ, Fulcjer BJ, Engeler DM…Orford N, on behalf of the EXCEL Study Investigators and the International ECMO Network. A survey of extracorporeal membrane oxygenation practice in 23 Australian adult intensive care units. Crit Care Resusc. 2020 Jun
  • Orford N. Grief After Suicide. 2020 May 5;323(17):1720-1721.
  • Linke NJ, Fulcher BJ, Engeler DM…Orford N, et al for the EXCEL Investigators. A survey of extracorporeal membrane oxygenation practice in 23 Australian adult intensive care units. Crit Care Resusc. 2020 Jun;22(2):166-170
  • Thurston LM, Milnes SL, Hodgson CL, Berkovic DE, Ayton DR, Iwashyna TJ, Orford. Defining patient-centred recovery after critical illness – A qualitative study. J Crit 2020 Feb 6;57:84-90. doi: 10.1016/j.jcrc.2020.01.028
  •  Fuji T, Luethi N, Young P…Orford N, et al for the VITAMINS Trial Investigators. Effect of Vitamin C, Hydrocortisone, and Thiamine in Patients with Septic Shock: The VITAMINS Randomized Clinical Trial. 2020 Feb ;323(5):423-431. doi: 10.1001/jama.2019.22176
  • Ragg J, Ragg M, Milnes S, Bailey M, Orford N. Patients with life-limiting illness presenting to the emergency department. Emerg Med Australia. 2020 Apr;32(2):288-294.

2019

  • Orford N. What is an intensive care specialist? Med J Aust 2019; 211(7): 312-313
  • Fujii T, Udy AA, Deane AM, et al. Vitamin C, Hydrocortisone and Thiamine in Patients with Septic Shock (VITAMINS) trial: study protocol and statistical analysis plan. Crit Care Resusc. 2019;21(2):119-125.
  • Simpson N, Milnes S, Martin P… Orford N.  iValidate – A communication-based clinical intervention in Life Limiting Illness. BMJ Supportive & Palliative Care. 2019 Apr 11.
  • Orford NR, Milnes S, Simpson N, et al. Effect of communication skills training on outcomes in critically ill patients with life-limiting illness referred for intensive care management: a before-and-after study. BMJ Supportive & Palliative Care. 2019;9(1):e21-e21.
  • Orford NR, Pasco JA, Kotowicz MA. Osteoporosis and the Critically Ill Patient. Crit Care Clin. January 2019:1-13.
  • Livingston A, Brooks L, Orford N, etal. Excessive Supplemental Oxygen Delivery to Mechanically Ventilated Patients is Based on Unit Culture. Australian Critical Care. 2019;32:S9.

2018

  • Orford N. Grief After Suicide. JAMA. 2018;320(18):1861-1862.
  • Orford NR, Bailey M, Bellomo R, et al. Changes in bone mineral density in women before critical illness: a matched control nested cohort study. October 2018:1-10.

2017

  • Anstey, M., Watts, N., Orford, N. et al. (2017). Does anyone ever expect to die? Anaesth Int Care, 45(4), 466–468.
  • Cooper DJ, et al; TRANSFUSE Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults. N Engl J Med. 2017 Sep 27.
  • Milnes S, Corke C, Orford NR, Bailey M, Savulescu J, Wilkinson D. Patient values informing medical treatment: a pilot community and advance care planning survey. BMJ Support Palliat Care. 2017 Mar 2.
  • Orford NR, Bailey M, Bellomo R, Pasco JA, Cattigan C, Elderkin T, Brennan-Olsen SL, Cooper DJ, Kotowicz MA. The association of time and medications with changes in bone mineral density in the 2 years after critical illness. Crit Care. 2017 Mar 21;21(1):69.

2016

  • Orford N. Respect the strong, selfless women in your life. The Age. 216, May 5th. https://www.smh.com.au/opinion/a-day-to-celebrate-the-selfless-love-of-mothers-20160504-gomkie.html
  • McCaffrey J, Orford NR, Simpson N, et al. Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital. Crit Care Resusc. 2016;18(4):235-241.
  • Orford NR, Milnes S, Lambert N, etal. Crit Care Resusc 2016. Prevalence, goals of care and long-term outcomes of patients with life-limiting illness referred to a tertiary ICU. Crit Care Resusc 2016;18(3):181-8.
  • Gabriel L, Bailey M, Bellomo R, et al. Insurance status and mortality in critically ill patients. Crit Care Resusc 2016;18(1):43-9
  • Orford NR, Lane SE, Bailey M, et al. Changes in Bone Mineral Density in the Year after Critical Illness. Am J Respir Crit Care Med 2016 Apr;193(7):736-744.
  • Dixon B, Smith R, Santamaria JD, Orford N, et al. A trial of nebulised heparin to limit lung injury following cardiac surgery. Anaesth Intensive Care 2016;44(1):28-33
  • Verma B, Luethi N, Cioccari I, Lloyd-Donald P, et al. A multicentre randomised controlled pilot study of fluid resuscitation with saline or Plasma-Lyte in critically ill patients. Crit Care Resusc 2016;18(3): 205-12

 2015

  • Orford N. Give death its due in a system focused on life. The Age. 2015, July 7th; https://www.smh.com.au/opinion/hospitals-must-shift-focus-of-endoflife-care-from-disease-to-people-20150707-gi6joz.html
  • Milnes S, Orford NR, Berkeley L, et al. A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital. BMJSPC, 2015.
  • Entesari-Tatafi D, Orford N, Bailey MJ, et al. Effectiveness of a care bundle to reduce central line-associated bloodstream infections. Med J Aust 2015 Mar;202(5):247-250.
  • Reddy SK, Young PJ, Beasley RW, et al. Overview of the study protocols and statistical analysis plan for the Saline versus Plasma-Lyte 148 for Intravenous Fluid Therapy (SPLIT) research program. Crit Care Resusc 2015 Mar;17(1):29-36.
  • Iwashyna TJ, Hodgson CL, Pilcher D, et al. Towards defining persistent critical illness and other varieties of chronic critical illness. Crit Care Resusc 2015 Sep;17(3):215-218.

 2014

  • Orford NR, Bailey M, Kaukonen K, et al. Glycaemic control and long-term outcomes following transition from modified intensive insulin therapy to conventional glycaemic control. Anaesth Intensive Care 2014 Mar;42(2):239-247.
  • Orford N, Cattigan C, Brennan SL, et al. The association between critical illness and changes in bone turnover in adults: a systematic review. Osteoporos Int 2014 Oct;25(10:2335-2346.
  • Simpson RW, Nicholson GC, Proietto J, et al. Efficacy and safety of oral methazolamide in patients with type 2 diabetes: a 24-week, placebo-controlled, double-blind study. Diabetes Care 2014 Nov;37(11):3121-3123.
  • Phillips L, Orford N, Ragg M. Prospective observational study of emergent endotracheal intubation practice in the intensive care unit and emergency department of an Australian regional tertiary hospital. Emerg Med Australas 2014 Aug;26(4):368-375.
  • Fowler RA, Mittmann N, Geerts WH, et al, Canadian Critical Care Trials Group, Australia and New Zealand Intensive Care Society Clinical Trials Group. Economic evaluation of the prophylaxis for thromboembolism in critical care trial (E-PROTECT): study protocol for a randomized controlled trial. Trials 2014 Dec;15:502.
  • Fowler RA, Mittmann N, Geerts W et al, Canadian Critical Care Trials Group, Australia and New Zealand Intensive Care Society Clinical Trials Group. Cost-effectiveness of dalteparin vs unfractionated heparin for the prevention of venous thromboembolism in critically ill patients. JAMA 2014 Nov;312(20):2135-2145.
  • Kaukonen KM, Bailey M, Egi M, Orford N, et al. Stress hyperlactatemia modifies the relationship between stress hyperglycemia and outcome: a retrospective observational study. Crit Care Med 2014 Jun;42(6):1379-1385.

2013

  • Cook D, McDonald E, Smith O, et al; PROTECT Research Coordinators, PROTECT Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group. Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences. Crit Care 2013;17:R1.
  • Bucca K, Spencer R, Orford N, et al. Early diagnosis and treatment of necrotizing fasciitis can improve survival: an observational intensive care unit cohort study. ANZ J Surg. 2013 May;83(5):365-70.

 2011 and before

  • Orford NR, Saunders K, Merriman E, etal. Skeletal morbidity among survivors of critical illness. Crit Care Med 2011 Jun;39(6):1295-1300.
  • Pettila V, Westbrook AJ, Nichol AD, et al; Blood Observational Study Investigators for ANZICS Clinical Trials Group. Age of red blood cells and mortality in the critically ill. Crit Care 2011;15(2):R116.
  • Blood Observational Study Investigators of ANZICS-Clincal Trials Group.  Transfusion practice and guidelines in Australian and New Zealand intensive care units.  Intensive Care Med 2010 Jul;36(7):1138-1146
  • Corke C, Milnes S, Orford N, et al.  The influence of medical enduring power of attorney and advance directives on decision-making by Australian intensive care doctors.  Crit Care Resusc 2009 Jun;11(2):122-128
  • Orford NR, Faulkner C, Flintoff W, et al. Implementation and outcomes of a severe sepsis protocol in an Australian tertiary hospital. Crit Care Resusc 2008 Sep;10(3):217-224.
  • Broad L, Lee T, Conroy M, et al. Successful management of patients with a drug-eluting coronary stent presenting for elective, non-cardiac surgery. BJA 2007; 98(1):19-22
  • Conroy M, Bolsin SN, Black SA, Orford N. Perioperative complications in patients with drug-eluting stents: A three year audit at Geelong Hospital. Anaesth Intensive Care. 2007 Dec;35(6):939-44.
  • Orford NR. Intensive insulin therapy in septic shock. Crit Care Resusc 2006 Sep;8(3):230-234.
  • Orford N. Intensive insulin therapy: does it improve outcomes and is it safe? Crit Care Resusc 2006 Dec;8(4):281.
  • Simpson N, Orford N. Early transoesophageal echocardiography (TOE) in cardiac arrest: a case study. Crit Care Resusc 2006; 8(1):31-5.
  • Orford N, Stow P, Green D, Corke C. Safety and feasibility of an insulin adjustment protocol to maintain blood glucose concentrations within a narrow range in critically ill patients in an Australian level III adult intensive care unit. Crit Care Resusc 2004 Jun;6(2):92-98.
  • Bolsin S, Orford N. Renal dysfunction following anaesthesia and surgery. Br J Anaesth. 2001 Oct;87(4):648.

Since 2015 Neil has contributed to public conversation about health issues. These include;

Neil is undertaking training in writing, including;

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