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My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home, where we provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) ventilation without tracheostomy at home, where we provide tailor-made solutions for tracheostomy clients without ventilation at home, where we provide ventilation weaning at home, tracheostomy weaning at home, cough assist management at home. We provide home total parenteral nutrition (TPN) and home intravenous (IV) fluids, home IV potassium, home IV antibiotics, home IV magnesium, and other electrolyte infusions, central line, peripherally inserted central catheter (PICC) line, Hickman’s line, and port management at home. We provide indwelling urinary catheter (IDC), suprapubic catheter (SPC) management at home, nasogastric tube, nasojejunostomy tube, PEJ (Percutaneous Endoscopic Jejunostomy) tube, percutaneous endoscopic gastrostomy (PEG) tube management, as well as palliative care management at home. We provide Level 2 and Level 3 National Disability Insurance Scheme (NDIS) support coordination as well as Transport Accident Commission (TAC) case management.

 

Today I want to answer a question from Frieda, whose father was given a tracheostomy four weeks ago after two weeks in intensive care, and who is now on an ENT ward struggling with low oxygen levels, a tracheostomy infection, and ongoing secretions.

 

Before I get into the clinical picture, I want to say this clearly, Frieda. You are doing exactly what every family member of a critically ill loved one should be doing. You are asking questions, you are noticing when care standards slip, and you are pushing back on a consultant whose explanations are not quite adding up to you. That instinct is not difficult family member behavior — it is advocacy. That is what your dad needs. It is very often the family member who asks the uncomfortable questions who ends up protecting their loved one from further harm.

 

Here is Frieda’s message:

 

“Hi Patrik, 

My father was given a tracheostomy four weeks ago. He was in intensive care for two weeks and then moved up to the ENT ward. He has issues with his oxygen levels, but the care of his tracheostomy — like cleaning it every day — I feel was lacking in the intensive care unit (ICU). He ended up getting an infection in it, and he was told he could possibly go on to a ventilator if his oxygen levels did not get better, but that also would mean he would need to go back into intensive care. He is still having secretions. This is after three weeks, and his oxygen level is very compromised. To be quite honest, I do not feel that the consultant knows what they are talking about, and it is really frustrating. Can we take him home with Intensive Care at Home? He is desperate to leave the hospital.

 

From Frieda.”

 

Before I go into explaining Frieda’s and her dad’s options, you might be wondering what makes me qualified to talk about topics such as patients in intensive care, patients in hospitals, and patients with Intensive Care at Home. I have worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over five years in intensive care. I was involved in Intensive Care at Home in Germany in the early 2000s where I was working for the first provider setting it up there, and then I brought the concept to Australia successfully since 2012.

 

Breaking Down What Frieda Is Describing

There are actually three separate but connected problems here — not just one.

Number 1 — a tracheostomy that was placed four weeks ago and has since become infected at the stoma site.

 

Number 2 — persistent ongoing secretions three weeks after the initial ICU stay, which tells me his airway clearance is not being managed well enough.

Number 3 — compromised oxygen levels serious enough that the medical team has raised the possibility of going back onto a ventilator.

 

Any one of these on its own is something an experienced tracheostomy nursing team should be actively managing. All three together, three to four weeks post tracheostomy, tells me his day-to-day tracheostomy care has not been consistent. That is very often what happens once a patient is stepped down from the ICU to a general ward like an ENT ward that is not set up for hour-by-hour tracheostomy management — because that is what a tracheostomy needs. This is why I have been saying on this channel for nearly 15 years that a tracheostomy needs management by 24-hour critical care registered nurses (CCRNs), which is evidence-based, and I will come to the evidence in a moment.

 

Why This Happens — The ICU-to-Ward Care Gap

This is a pattern I see over and over again, and I have been calling it out on this channel for over a decade. It is exactly why I built Intensive Care at Home.

In the ICU, your father would have had one nurse potentially looking after only one or two patients, monitoring his tracheostomy, his secretions, and his oxygen saturation continuously. The moment he was stepped down to an ENT ward, that ratio changed dramatically — often to one nurse for four, six, or even eight patients, sometimes ten patients overnight, most of whom do not have a tracheostomy at all.

 

Tracheostomy stoma cleaning, inner cannula changes, and proactive suctioning are time-consuming, hands-on tasks. When a ward nurse is stretched across a full patient load, tracheostomy care is one of the first things that slips — not because staff do not care, but because they simply do not have the time and often not the specific tracheostomy training either. An infected stoma and ongoing secretions three weeks later are a direct, predictable consequence of that gap.

The full evidence-based clinical guidelines are available on our mechanical home ventilation guidelines on our website at intensivecareathome.com, and I will link to them in the show notes. It is worth reading in full if you want to understand exactly what safe, evidence-based tracheostomy and ventilation management should look like, whether that is in hospital or at home. It always requires 24-hour critical care registered nurses.

 

Treatment Options Going Forward

Based on what Frieda has described, here is what I would be pushing the treating team on right now.

 

Number 1 — a formal wound swab and infection review of the stoma site, with a clear antibiotic plan and a stoma care protocol that is actually documented and followed — not just verbally promised.

Number 2 — a structured secretion management plan. This includes regular competent suctioning, adequate humidification of inspired air, and where appropriate, chest physiotherapy or cough assist management to help him clear secretions instead of them sitting in the airway and driving further desaturation and infection risk.

Number 3 — a clear, honest conversation about why his oxygen levels are compromised. Is this the tracheostomy and secretions alone, or is there an underlying respiratory issue such as pneumonia, atelectasis, or a partially obstructed airway that has not been fully worked up?

Number 4 — if mechanical ventilation genuinely becomes necessary, that is not the end of the road. It can be managed safely at home with the right critical care nursing team 24 hours a day, and it should never be used as a reason to keep him in hospital indefinitely.

 

It all comes back to needing 24-hour critical care registered nurses — and not just any ward nurse — for this type of care. The reality also is that if Frieda’s dad needs ventilation, he needs to go back into the ICU anyway, or he can go home with Intensive Care at Home.

 

Medical Records Advocacy

One of the most powerful things you can do right now, Frieda, is formally request his medical records and nursing notes — vital signs, ventilation parameters, tracheostomy size, management documentation, lab results, medication results, fluid balance charts, specialist reports. Everything. Leave no stone unturned.

You also specifically need to look at the tracheostomy care charting and suction frequency logs from the last three to four weeks. This is not about being confrontational — it is about having an objective written record of what was actually done, how often, and by whom, rather than relying on a consultant’s verbal reassurance that you have told me you do not fully trust.

 

If the documentation shows gaps in stoma care or suctioning, that record becomes your evidence for requesting a case conference, a second opinion from a respiratory or ENT consultant, or an escalation of his care plan. You are entitled to ask for all of this, and you should.

 

If you want tailored independent advice on your father’s specific situation — how to get him home, what questions to ask the ICU team or the ENT consultant, how to interpret what is in his medical records, how to plan a safe discharge, or how to advocate for home care funding — contact us here at intensivecareathome.com, call us on one of the numbers on the top of our website, or call me directly on my mobile phone — 0410 942 230. You can also send an email to [email protected].

 

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities, regional and remote areas, and in all states and territories.

To answer Frieda’s question directly — yes, in principle, a patient in your father’s situation — tracheostomy, oxygen therapy, ongoing secretion management, mechanical ventilation potentially, cough assist management if it comes to that — can be cared for safely at home with the right 24-hour critical care nursing team in place.

 

Intensive Care at Home is the only home intensive care nursing provider in Australia that is actually third-party accredited specifically for Intensive Care at Home nursing — against ISO 9001:2015 as well as NDIS registered. You can review our full accreditation on our website at intensivecareathome.com/accreditation_quality.

 

Accreditation matters because it means our clinical governance, our critical care registered nurses, the staffing model, and our infection control protocols have been independently audited — not just self-declared. Unlike a general ward, our model puts a dedicated critical care registered nurse with your father in his own home, with the time and skill to do daily tracheostomy care properly, monitor his oxygen levels continuously, manage secretions proactively, and escalate immediately if anything changes — the exact kind of care that appears to have slipped once he left the ICU.

 

We provide this for tracheostomy care with and without ventilation, BiPAP and CPAP with and without tracheostomy, and tracheostomy without ventilation as well. We do it short-term, long-term, and medium-term — ongoing care at home with the goal to improve quality of life, make sure our clients are at home permanently and predictably with regular stable teams, improve your and your family’s quality of life, and also help hospitals to free up high-acuity beds — ICU beds in particular — and cut the cost of an ICU bed by approximately 50%.

 

The bottom line is this, Frieda — your father does not have to choose between staying in a hospital environment where his tracheostomy care has already fallen short once, or going home with no clinical support at all. There is a middle path — third-party accredited, CCRN-led Intensive Care at Home, built specifically for patients exactly like your father.

 

With all of that said, with Intensive Care at Home, we are currently sending our critical care nurses into the home 24 hours a day. Therefore, we are providing a genuine alternative to long-term stay in intensive care for:

• Ventilation
• Tracheostomy
• Home BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure)
• Tracheostomy care without ventilation
• home TPN (Total Parenteral Nutrition)
• Home IV potassium
• Home IV magnesium
• Home IV antibiotics
• Home IV fluids

We’re providing:

• Cough assist management at home
• Ventilation weaning management at home
• central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line as well as port management at home
• nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home
• IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home
• Palliative care services 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 Health District’s In Touch program, saving approximately $2,000 per patient that we keep at home instead of them going into an emergency department.

 

That also means we’re in a position to cut the cost of an ICU bed by around 50%. An intensive care bed costs between $5,000 to $10,000 per bed day depending on location. Intensive Care at Home costs approximately 50% of that, 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.

 

Our Coverage and Accreditation

With Intensive Care at Home, we’re currently operating all around Australia, in all major capital cities, as well as in all regional and rural areas. We are an NDIS approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria as well as the Department of Veterans Affairs all around Australia.

 

We’re also ISO 9001:2015 accredited. 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 the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2025. We have been achieving this high level of accreditation since 2012. No other provider in Australia has achieved the Intensive Care at Home level of accreditation in the community and 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. And that enables us to look after the highest acuity adults and children in the community in Australia safely.

 

If You Need Help

If you’re at home already and you’re watching this or you’re stuck in an ICU and you realize that you don’t have the right level of support, I can give you many examples where we helped clients with funding, how we advocate for funding. We had to advocate successfully for funding from our first case study to many other case studies where we had to advocate successfully for funding with the right evidence of course because it is crystal clear that disability support workers for example or registered nurses without ICU experience cannot look after ventilated clients at home whether adults or children with or without a tracheostomy and it’s simply dangerous and negligent.

 

There are plenty of examples where clients with support worker models or even RN (registered nurse) models without ICU experience have died at home and I have evidence to back up everything that I’m saying here because it’s a bit like flying the airplane with a cabin crew instead of the pilot and it could simply be deadly.

 

This can be avoided by having simply 24-hour critical care nurses at home because our clients are at high risk of medical emergencies or worse without critical care nurses 24 hours. This is actually also evidence-based in the community and is documented in our evidence-based Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com.

 

Think about it: in an intensive care unit in a hospital, you wouldn’t have support workers or general registered nurses looking after a critical care patient on a ventilator with a tracheostomy. So why would anyone in their right mind do that in a home care environment where there are fewer resources?

 

Clients that have found us have been at home long-term predictably and permanently with critical care nurses. Their alternative would have been to either die or stay in ICU long-term, and our clients don’t go back to ICU. They stay at home permanently and predictably and the insurance bodies save half of the cost of an ICU. But it’s a win-win situation all around.

 

We can do the same for you if you’re stuck in ICU or if you’re not safe at home, which includes the advocacy for funding and the network that goes along with it. We have always successfully advocated for our clients or we have the network to successfully advocate for you and for your family member, otherwise we wouldn’t be in business. The same again is applicable for those stuck in an ICU which is similar to many of our, if not most of our cases.

 

Our Support Coordination Services

This is also why we are providing Level 2 and Level 3 NDIS support coordination. We have a team of experienced NDIS support coordinators, and they have a wealth of knowledge. 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 or a social worker from another organization or a hospital watching this and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for nursing care for your participants and you don’t know how to go about it and how to advocate for it, what evidence to provide, I encourage you to reach out to us as well. We have the network to make that happen. We will help you with the right level of funding and with the right level of advocacy.

 

We’re also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

 

Join Our Team

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

 

If you’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, Albury-Wodonga, Bendigo, Geelong, Warragul, and also in Wyelangta in Victoria.

 

If you have worked in critical care nursing for a minimum of two years, adult ICU, pediatric ICU, ED and you have already completed a postgraduate critical care nursing qualification, we will be absolutely delighted hearing from you.

I have a disclaimer though: Because we are offering tailor-made solutions for our clients which includes regular staff, our clients do also want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular, reliable staff.

 

If you’re looking for agency work where you can come and go, this will not be the right fit for you. We’re 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 relationships with us and with our clients. Reliability is also a must.

 

For Medical Professionals and Healthcare Executives

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 to 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 settings, and you get the same level of care and simply more patient and family satisfaction because you also want to partner with your consumers.

 

If you are a hospital executive watching this, we can help you free up your ICU and ED beds.

 

International Support

If you’re in the U.S. or in the UK 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, click the like button, 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, and share this video with anyone who has a family member in intensive care long-term or needs to see this.

Thank you so much for watching.

 

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

 

Take care for now.