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Education & Care Gaps in Tracheostomy Management: A Multi-Stakeholder Survey – Implications for Practice

“Addressing Education and Care Gaps in Tracheostomy Management: Insights from a Multi-Stakeholder Global Survey.” That’s what I’ve been talking about in the last few blogs and even in the last few weeks. This is a survey that was published on the Global Tracheostomy Collaborative website. It’s a long survey, it’s a good survey, but it lacks solutions which we have at Intensive Care at Home, and that’s what I talk about. I’ve dissected almost every single section of the survey. Today, we want to look at implications for practice and policy as part of that survey.

My name is Patrik Hutzel from intensivecareathome.com. I will also link to the survey so you can look it up for yourself.

Today, we want to look at the Implications for Practice and Policy.

These findings reveal the interconnected nature of tracheostomy care challenges, emphasizing the need for systemic changes in policy, practice, and resource allocation.

Again, I do believe we’ve got that solution already because with Intensive Care at Home, we send critical care nurses into the home that are actually tracheostomy competent. A lot of the things that came out of this survey is that people think there’s not enough staff, there’s not enough resources. It’s all a perception. There is enough staff, there’s enough resources, if you can channel it, if you can do the right advocacy. So, we actually have solutions for long-term ventilated adults and children with tracheostomies or even for long-term tracheostomy adults and children without ventilation.

So, the survey continues.

Addressing the severe gaps in workforce competency requires targeted investments in training, recruitment, and retention.

It absolutely does, which is what we’ve been doing at intensivecareathome.com since 2012 to fill those gaps. But fill those gaps with quality, not with quantity, and make it evidence-based. At no point in time is the survey referring to evidence-based.

So, when you look on our website at intensivecareathome.com, if you look at the Mechanical Home Ventilation Guidelines which I’ll link towards, you will see that it’s an evidence-based service we are providing that exclusively critically care trained nurses with a minimum of 2 years critical care nursing experience can safely look after tracheostomy adults and children at home plus minus ventilation. It’s evidence-based, comes out of over 25 years Intensive Care at Home nursing in Germany, and it comes out of over 13 years of Intensive Care at Home nursing in Australia. No other countries is advanced as Germany and Australia when it comes to Intensive Care at Home.

Similarly, improving access and affordability necessitates advocacy for equitable healthcare funding and expanded insurance coverage.

Again, I very respectfully disagree here because it all comes down to the advocacy. We cut the cost of an ICU bed by 50% and provide the same level of care at home. So, it all comes down to business models as well.

Efforts to promote teamwork and patient empowerment should focus on building dedicated tracheostomy teams, which is something we’re doing, enhancing care coordination, which is something we’re doing,  and integrating families into decision-making processes, also something we’ve been doing since 2012. Tailored interventions, informed by stakeholder input and evidence-based strategies, are essential for addressing these gaps and improving the quality of tracheostomy care globally. Something we’ve been doing with evidence-based. The survey lacks solutions. The survey lacks evidence actually. You just need to look what’s out there already and what works.

While these recommendations apply broadly, the challenges faced in low resource and rural settings for special attention.

I agree that rural settings are way more challenging than metropolitan areas, but still there are solutions for rural settings as well.

Workforce shortages, inadequate training, and limited access to care are often more pronounced in these areas where systemic barriers are compounded by logistical constraints, insufficient funding, and lack of specialized expertise.

I always hear the insufficient funding, and I argue that is incorrect because it really depends on where you start. If you start in intensive care, and you focus right from the start to get patients home, you’re already saving money by cutting the cost of an intensive care bed by 50%.

Again, the survey lacks creativity, lacks real-world solutions. It’s probably done by a lot of hospital administrators, by people who are bound by politics. We’re not bound by politics, we’re bound by real-world solutions and making it work for our clients and for our staff as well, of course, for our teams.

For instance, access to scalable educational resources, again, we’re doing that in Intensive Care at Home because we have the skills and the expertise, simulation-based training, and essential supplies is frequently restricted, I disagree there, supplies are not restricted, they weren’t even restricted during COVID, further exacerbating disparities in tracheostomy care. Well, it’s a case of closing those gaps and those disparities and advocating for your patients.

Developing tailored interventions for low-resource and rural communities is critical to ensuring equitable care delivery. There’s no question that rural and regional areas are way more challenging than metro areas, but it’s still all doable.

These challenges highlight the need for broader systemic changes in care access and affordability, including equitable resource allocation, reimbursement policies that reduce out-of-pocket costs, and incentives to distribute healthcare professionals to underserved areas. Such policy initiatives would address existing inequities while improving outcomes for marginalized populations.

I agree with all of that, but then again, we’ve been doing it for a long time, and the people of the survey haven’t even looked at what we are doing.

Future research should also explore the role of policy-level interventions in addressing barriers to health equity. For example, expanding reimbursement coverage for tracheostomy-related care and providing funding for tracheostomy education programs in underserved settings could bridge gaps identified in this study. Tracheostomy education programs need to start in hospitals in intensive care. You can’t really educate nurses and even doctors on the full spectrum of tracheostomies if you haven’t worked in intensive care. It’s as simple as that.

Ensuring affordability and accessibility for these communities is essential to fostering global improvements in tracheostomy care.

I do believe with Intensive Care at Home, we have a role model care model that people can look up to. People should also look at countries such as Germany and Australia, where Intensive Care at Home is leading the way. If someone has a better care model, we want to know about it. But I do believe that a lot of the issues that have been highlighted in this survey have been addressed with our care model.

So, 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
• 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 instead of staying 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’re a NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, and 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 currently 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 level of accreditation 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, 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’re living in an ICU, I’ll give you another tangible and real-world example today.

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 ventilated and tracheostomy client. That is dangerous and it’s negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy. It’s like flying the airplane with the 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 risk of dying if they don’t have a team of 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 a home care environment in the community?

So, this client found out about us eventually and the ICU that he went back to all the time 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 intensive care nurses, 24 hours a day. He never ever went back into ICU ever again, as long as we 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. The same is applicable for those stuck in an ICU, similar to our case study that I’ve 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 Level 2 and Level 3 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 in Victoria.

If you’re a 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’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, Bendigo, in Geelong, and 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, and 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 are 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 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. 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 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].

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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.