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Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home and where we also provide tailor-made solutions for hospitals and intensive care units at home whilst providing quality care for long-term ventilated adults and children with tracheostomies at home, otherwise medically complex adults and children at home, which includes Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), home tracheostomy care for adults and children that are not ventilated, Home TPN (Total Parenteral Nutrition), home IV potassium infusions, home IV magnesium infusions as well as home IV antibiotics. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management as well as Hickman’s line management and we also provide palliative care services at home.
We are also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully for the Western Sydney Local Area Health District, their in-touch program saving $2,000 per ED bypass service. Basically, if we send a critical care nurse into the home of a client or into a residential aged care, we’re saving the healthcare system $2,000 by using our critical care nurses, which costs a fraction of that only. With an intensive care bed, we’re saving even more by providing an intensive care nurse in the community. We’re saving half of the cost of an intensive care bed, which is around $3,000.
So, in this week’s blog, I want to actually read out a study about hospital in the home again. The study, I’ve just seen it last week, it says, “Alternative Strategies to Inpatient Hospitalization for Acute Medical Conditions – A Systematic Review” from Jared Conley, MD, Colin W. O’Brien and Bruce Leff.
Now, let’s read this out. It’s just another testimonial really that treating patients at home make a lot more sense than treating them in hospital. So, let me read these out.
Key points and I will link towards the study below.
“Can patients with acute medical conditions conventionally managed through hospitalization be treated in alternative management strategies, while maintaining similar or improved health outcomes, patient satisfaction, and costs?
Well, with costs in particular, home care is always more cost-effective. So, I don’t even know why they are asking that question. The study continues:
Evidence demonstrates that a range of acute medical conditions can be safely treated without hospitalization, at lower cost, and with neutral-to-positive impact on patient satisfaction. Further robust evaluation is warranted for some conditions and alternative management strategies.
In the management of acute medical conditions, conventionally requiring hospital admission, opportunities for health system redesign exists that enable better alignment of health needs with the appropriate setting of care.
That’s what we’ve been doing with Intensive Care at Home since 2012. No need for hospital readmissions, even long-term intensive care patients can stay at home predictably, saving the healthcare system millions of dollars plus the added-on benefit of having a free ICU bed.
Then the abstract continues:
Determining innovative approaches that better align health needs to the appropriate setting of care remains a key priority for the transformation of US healthcare;
So, it’s a US study, but it’s the same in Australia and in the U.K., or in any other country for that matter.
However, to our knowledge, no comprehensive assessment exists of alternative management strategies to hospital admission for acute medical conditions.
To examine the effectiveness, safety, and cost of managing acute medical conditions in settings outside of a hospital inpatient unit.
MEDLINE, Scopus, CINAHL, and the Cochrane Database of Systematic Reviews (January 1995 to February 2016) were searched for English-language systematic reviews that evaluated alternative management strategies to hospital admission. Two investigators extracted data independently on trial design, eligibility criteria, clinical outcomes, patient experience, and health care costs. The quality of each review was assessed using the revised AMSTAR tool (R-AMSTAR) and the strength of evidence from primary studies was graded according to the Oxford Centre for Evidence-Based Medicine.
Twenty-five systematic reviews (representing 123 primary studies) met inclusion criteria. For outpatient management strategies, several acute medical conditions had no significant difference in mortality, disease-specific outcomes, or patient satisfaction compared with inpatient admission. For quick diagnostic units, the evidence was more limited but did demonstrate low mortality rates and high patient satisfaction. For hospital-at-home, a variety of acute medical conditions had mortality rates, disease-specific outcomes, and patient and caregiver satisfaction that were either improved or no different compared with inpatient admission. For observation units, several acute medical conditions were found to have no difference in mortality, a decreased length of stay, and improved patient satisfaction compared to inpatient admission; results for some conditions were more limited. Across all alternative management strategies, cost data were heterogeneous but showed near-universal savings when assessed.
For low-risk patients with a range of acute medical conditions, evidence suggests that alternative management strategies to inpatient care can achieve comparable clinical outcomes and patient satisfaction at lower costs. Further study and application of such opportunities for health system redesign is warranted.
It just goes to show that we are just scratching the surface with home health, hospital in the home, and Intensive Care at Home. Even though Intensive Care at Home has been around in Germany now for over 25 years, it has been a successful model and evidence-based model in Germany and in Australia. In Australia since 2012, we have been saving the healthcare system millions and millions of dollars over the years, by providing an alternative to a long-term stay in intensive care for predominantly long-term ventilation, tracheostomy care, but also tracheostomy for non-ventilated clients, ventilation without tracheostomy, and so forth. So, it is an absolute no-brainer.
Now, I just want to make one mention with mortality rates. Some of what we are doing is also palliative care, that means some of what we are doing is end of life care and our clients respond very well to that. They want end of life care at home, not in a hospital.
Once again, I think some studies suggest that 75% of people want to die at home instead of an institution i.e. hospital, less than 15% actually do die at home. We need to get those numbers. We need to listen to what people are telling us as health professionals and we need to act accordingly. Those studies, study like this one, just confirms that an even bigger shift is needed towards home care and not towards hospital care. We really need to listen to what patients and families want and put the relevant structures in place. Every industry works around supplying goods and services that clients want, or customers want. It should not be any different in the healthcare industry. A lot more can be done at home and people think there is, with the right skills, with the right mindset, and with the right support structure.
So, thank you for listening and I will send a link towards the study.
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 a NDIS (National Disability Insurance Scheme) approved service provider all around Australia. We are TAC (Transport Accident Commission) and WorkSafe approved in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland, and DVA (Department of Veteran Affairs) all around the country. Our clients and we as a provider have received funding through public hospitals, private health funds as well as departments of health.
We are the only service provider in Australia in 2024 that has achieved third-party accreditation for Intensive Care at Home nursing. No other provider has created this much intellectual property for Intensive Care at Home nursing than Intensive Care at Home. We are therefore employing hundreds of years of intensive care nursing experience in the community combined. Once again, no other service provider brings that level of expertise in the community than we do.
Now, if you’re at home already and you realize that you’re on a ventilator, tracheostomy, BIPAP, CPAP, home TPN, and whatever the case may be, and you realize that your current setup is not working, that your current team is not having the skills and expertise to keep you at home predictably, you feel unsafe and you’re going back to ICU all the time, or you have medical emergencies that really makes you worried where your providers might call an ambulance, that’s when you need to reach out to us because with our Intensive Care at Home nursing experience and with our critical care nursing experience, you would be safe at home and we keep our clients at home predictably.
Just want to illustrate one case study here for you, what I exactly mean. Our very first client with Intensive Care at Home over 10 years ago was a client that live at home with a C1 spinal injury, ventilation, and tracheostomy. He had a team of support workers looking after him. Team of support workers basically looking after someone on life support, that is insanity in and of itself and it’s dangerous. It’s often a death sentence. People have died because of this model of care. So, what happened was the team of support workers as well as some general RNs without ICU experience could not keep him at home. He bounced back into ICU all the time. His life was dangerous, and then eventually he got in front of us. Then, we sent a team of intensive care nurses in there and he never ever went back into ICU for any emergency admissions, that’s what I mean.
With that, if you’re at home already and you realize something’s not working, you have shifts unfilled, or the team that is looking after you, it’s simply unsafe. They don’t know what they don’t know. They don’t know what they’re doing. Bear in mind, they wouldn’t know what to do in a medical emergency. Once again, patients have died because of this. That’s when you need to come to us, and you shouldn’t be worried about the funding side of things. We’ve always been successfully involved in the advocacy for the funding.
That’s also why we’re providing Level 2 and Level 3 NDIS Support Coordination, as well as TAC case management, our NDIS support coordinator and TAC case manager, Amanda Riches in Victoria, as well as Rosie Hammer in New South Wales for wealth of knowledge in their team. I’ll put a link in the written version of this blog to an interview that I’ve done with Amanda a while ago.
If you’re a NDIS support coordinator watching this, and you’re looking for nursing care for your participants, please reach out to us as well. Or if you’re looking for funding for more nursing care for your participants and you don’t know how to go about it and what evidence to provide, I also encourage you to reach out to us. We can help you with the advocacy and we also provide NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.
If you’re a critical care nurse and you’re looking for a career change, we are currently offering jobs for critical care nurses in the home in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo in Victoria, as well as in Warragul in Victoria, and in Geelong in Victoria.
If you have worked in critical care for a minimum of two years, pediatric ICU, ED, and you have already completed a postgraduate critical care qualification, we will be delighted to hear from you.
Disclaimer, because we are offering a tailor-made solution for our clients, which includes regular staff. Our clients will have the same staff coming over and over again because they are so vulnerable and so special. It’s all about building those critical relationships with our clients, with our team members and having regular and stable teams. That means if you’re looking for agency work where you can come and go, this is probably not the right fit for you on a long-term basis because our clients want regular staff over and over again. So, it’s all about building relationships with our clients and we want to build relationships with you as well so that it remains a win-win situation.
If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We are expanding our medical team as well.
We can also help you eliminate your bed blocks in your ICU and ED for your long-term patients or for your regular readmitting patients with our critical care nurses at home. We are here to help you take the pressure off your ICU and ED beds, and in most cases, you won’t even pay for it.
If you’re a hospital executive watching this, and you have bed blocks in your ICU, ED, and respiratory wards, please reach out to us as well. We can help you.
Lastly, if you’re in the U.S. or 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.
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 info@intensivecareathome.com.
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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.