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“ICU to home: Tracheostomy, dialysis, and complex care with 24/7 CCRN.”

My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies and where we also provide Home BIPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) ventilation without tracheostomy, home tracheostomy care without ventilation, Home TPN (Total Parenteral Nutrition), home IV potassium, home IV magnesium, home IV antibiotic infusions, PICC (Peripherally Inserted Central Catheter) line, central line, Hickman’s line, as well as port management at home, cough assist management at home, nasogastric tube, nasojejunostomy (NJ) tube, PEG (Percutaneous Endoscopic Gastrostomy) tube, PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home, including ventilation weaning and palliative care at home as well.

So, what if I told you that one of the biggest crises in healthcare today isn’t the lack of hospital beds, but the lack of imagination? That’s right. We have critically ill patients needlessly stuck in expensive, stressful intensive care units or long-term care facilities simply because the system has not grasped the concept fully of Intensive Care at Home.

We recently reviewed the case of a 55-year-old gentleman. Let’s call him Peter for simplicity, who is currently receiving their care at an ICU. Peter is what we call a “chronically critically ill patient.” His needs are complex, but fundamentally, his condition is stable.

So, why Peter’s stable complex needs belong at home and not in a hospital or in ICU? Peter’s medical profile outlines a patient whose care needs are high acuity but chronic, making him an ideal candidate for a smooth transition from an ICU to his own home with a fully staffed 24/7 critical care nursing team. His stability is demonstrated by his unchanged neurological status, awake, not following commands, his afebrile status, and his hemodynamically stable condition.

Keeping him in a facility or in a hospital subjects him to unnecessary risks and costs, and of course, poor quality of life. His complex but stable needs include tracheostomy dependence. He’s on a tracheostomy collar with low flow oxygen, 5L or 28% of FIO2 (Fraction of Inspired Oxygen). The need for high-level respiratory monitoring and care is critical, but the fact that he’s not on a mechanical ventilator indicates a stable respiratory baseline that a CCRN can safely manage at home 24/7.

He’s also on renal support on dialysis. Peter has end-stage renal disease, also known as ESRD (End-Stage Renal Disease), and is receiving routine in facility hemodialysis, 3 times a week. While Peter’s current regimen is hemodialysis, many patients with end-stage renal disease are excellent candidates for home-based therapies like peritoneal dialysis as well.

Peritoneal dialysis is a needle-free treatment that uses the abdominal lining to filter waste, and it offers great flexibility often being performed overnight while the patient sleeps or through exchanges during the day. It’s a gentler form of dialysis and could eliminate the need for routine transport to a center.

Next, infection and wound care. He’s receiving IV antibiotics, Zosyn for a Staphylococcus infection associated with a deep sacral decubitus ulcer stage 3. IV medication administration and complex wound care are routine procedures for a critical care registered nurse and can be delivered safely and consistently at home.

Let’s look at the essential role of 24/7 CCRN care at home. For a patient like Peter, the level of skill required is non-negotiable. It must be critical care level. This is exactly why services like Intensive Care at Home follow rigorous protocols. ICU at home, the non-negotiable standard providing 24/7 critical care registered nurses (CCRNs) care means:

1. Safety

Continuous monitoring of Peter’s vital signs and neurological status, replicating the ICU’s vigilance in a comforting environment.

2. Holistic management

Seamless coordination of his complex schedule including tracheostomy care, IV medication administration, PEG tube feeding, and managing Peter’s dialysis needs.

3. Expert respiratory care

You can see the high standards required for even more complex patients by reading our detailed evidence-based guidelines on mechanical ventilation at home, including tracheostomy, the Mechanical Home Ventilation Guidelines.

Even though Peter is only on a tracheostomy collar, the underlying need for high acuity respiratory management remains, which is the domain of the CCRN and a CCRN only.

Why keep a patient with tracheostomy dependency and stable, manageable end-stage renal disease locked up in ICU or any other long-term acute care facility? The answer is simple, they shouldn’t be. The solution is providing 24/7 CCRN care with Intensive Care at Home that delivers the ICU standard of monitoring and care management, right where Peter belongs in his own home.

Now, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. We are providing the following:

• Home care services for ventilated adults & children with tracheostomies with critical care nurses 24 hours a day
• Genuine alternative to a long-term stay in intensive care or at long-term acute care
• Tracheostomy care for clients without ventilation
• Home care services for patients on non-invasive ventilation such as Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure)
• Home TPN (Total Parenteral Nutrition), which is also known as IV nutrition
• Home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics
• Providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home.
• Providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home
• Use cough assist machines for our clients for airway clearance at home
• Palliative care services at home
• Ventilator weaning at home

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of them going to an emergency department.

That also means, we’re also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our services costs between $2,500 to $3,000 per bed day, and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders. Of course, quality of life is much improved surrounded by families and by a team of dedicated intensive care nurses in the home care setting instead of in an intensive care unit.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We work with NDIS (National Disability Insurance Scheme) clients all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, Department of Veteran Affairs (DVA) all around Australia. Our clients and we, as a service provider, have also received funding through public hospitals, private health funds, as well as Departments of Health.

We are having policies and procedures for Intensive Care at Home nursing and we’ve built all the intellectual property for Intensive Care at Home since 2012. No other provider in Australia has created more intellectual property when it comes to Intensive Care at Home nursing than we have. This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do, which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this, or you’re stuck in an ICU long-term, or if you’re going to the hospital and ED all the time, and you realize that you don’t have the right level of support at home, or if you are stuck in an ICU, I’ll give you a real-world example today, how we can help you.

One of our first clients when we first got started in 2012, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers are not equipped to look after a client at home on a ventilator with a tracheostomy. That is dangerous and it’s simply negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with a cabin crew instead of the pilot. Because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies 24/7, or even at high risk of dying if they don’t have a team of dedicated critical care nurses looking after them 24/7 at home. This is actually evidence-based and is documented in our Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

Think about it, in an intensive care unit in a hospital, you wouldn’t have support workers looking after your critically ill loved one or after any critically ill patient on a ventilator with a tracheostomy. So, why would anyone in their right mind do that in the home care environment in the community?

So, this client at the time found out about us eventually, and the ICU that he was basically living in also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with this particular client, we sent him critical care nurses, 24 hours a day. He never ever went back into ICU ever again, as long as we were working with this client.

We can do the same for you if you’re not safe at home and help you with keeping you at home predictably. Otherwise, we would not be in business. Again, the same is applicable for those stuck in an ICU, similar to this case study that I’ve just given you, or if you’re going back to ED all the time, please reach out to us. We can help you with taking you through the right steps, including how to get funding with different funding bodies.

This is also why we are providing NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS support coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

If you’re an NDIS support coordinator or a case manager from another organization watching this, and you’re looking for nursing care for your participants, please reach out to us as well. If you need more evidence for nursing care, we are also writing NDIS nursing assessments with legal nurse critical care consulting nurses.

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, and high performing team of critical care nurses in the community, we’re employing hundreds of years of critical care nursing experience combined. You can join this high performing team if you are a critical care nurse.

If you are looking for a career change as a critical care nurse, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I do have a disclaimer though, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular staff. So, if you’re looking for agency work, where you can come and go, this will not be the right fit for you. We are looking for consistency and our clients are looking for consistency. So please, only apply with us if you can give us regular and consistent availabilities for shifts, and you’re really keen on building solid relationships with us and with our clients.

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well. We can also help you eliminate your bed blocks in your ICU and in your ED for your long-term patients, or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it is so much more cost-effective than what you’re paying for in ICU and ED, and you get the same level of care.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, or for home TPN, please reach out to us as well. We can help you eliminate your bed blocks very fast.

If you’re in the U.S. and in the U.K. and you’re watching this, and you need help, we want to hear from you as well. We can help you there privately with one-on-one consulting and with hiring nurses privately.

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

If you like my videos, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care. Click the like button, click the notification bell, share this video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.

Take care for now.