Podcast: Play in new window | Download

“Addressing Education and Care Gaps in Tracheostomy Management: Insights from a Multi-Stakeholder Global Survey ” that the Global Tracheostomy Collaborative has published on their website in recent months. It’s a long survey, it’s a good survey overall, and I’ve been breaking this survey down one section at the time because it is very closely related to our day to day work with Intensive Care at Home, where we provide intensive care nurses in the home for ventilation  and tracheostomy.

My name is Patrik Hutzel from intensivecareathome.com.

So, in this survey, healthcare professionals have been interviewed about challenges with tracheostomies either in hospitals or when it comes to discharging tracheostomy patients in the community, and a lot of gaps have obviously been identified, but the survey lacks solutions, which we have here at Intensive Care at Home.

It’s been a multi-part series here, so you can go back to other parts that I’m breaking down in this survey and where I highlight the issues and offer solutions, because that’s what we do here at Intensive Care at Home. We actually have real world solutions. I will also link to the survey here in the written version of this blog. You can actually look at the survey.

Today, I want to break down this section in the survey addressing suctioning-related tracheostomy concerns.

So the survey says,

One area where the lack of workforce competency and standardization was particularly evident was suctioning-related tracheostomy care.

Again, I’ve mentioned it in my other videos about this survey. We don’t have a lack of workforce competency because our workforce is critically care trained, i.e. looking after tracheostomies and ventilation is bread and butter.

The survey continues,

Suctioning is a critical component of tracheostomy management, essential for maintaining a clear airway, preventing respiratory complications, and ensuring patient comfort. However, inadequate suctioning practices may lead to serious complications such as aspiration, infection, or even respiratory distress.

Once again, that can almost always be avoided if you have a critical care trained nursing workforce, who knows what they’re doing. There’s too many corner cutters, so to speak, in the community that are trying to send support workers, RNs without ICU experience, or even family members who just simply are not trained and can never be trained unless you’ve worked in ICU for a minimum of two years. This is actually evidence-based, by the way, if you look on our website at intensivecareathome.com, we have a section there, the Mechanical Home Ventilation Guidelines that are evidence-based. The evidence-based Mechanical Home Ventilation Guidelines clearly say that only critical care nurses with a minimum of 2 years critical care nursing experience can safely look after ventilation plus minus tracheostomy clients at home, adults and children.

So survey continues,

While a prior study mentioned issues with stoma placement, our study revealed specific concerns around suctioning practices, including technique variation, patient discomfort, and inconsistent training across disciplines. These gaps highlight the broader issue of inadequate training resources and the absence of standardized education, which further compound challenges in care delivery.

Again, I disagree there that absence of standardized education also leads to absence of standardized care delivery. Again, that’s what we do here at Intensive Care at Home. I argue we are the only organization in the community that brings in standards. Everybody else is just doing whatever they want, and people have died because of that.

Addressing these concerns requires the implementation of standardized suctioning competencies for all healthcare practitioners, including nurses, respiratory therapists, physicians, and speech-language pathologists, as well as for patients and care partners.

Again, it is standardized, however, what the survey also is missing here, many patients in the community, adults and children, want to have specific suction techniques that differ greatly actually from patients in hospitals. So again, I do believe if people have not worked in the community, they also lack insights here in terms of how do clients want to be suctioned in the community. It’s very unique to and specific to the clients.

These competencies should be incorporated into onboarding programs, evaluated regularly through simulations, and integrated into discharge protocols. Standardizing suctioning techniques is not only vital for improving patient safety but also represents a critical step in reducing variability and enhancing the overall quality of tracheostomy care.

Again, I disagree there, and I respectfully disagree here, that once you go into the community and patients had tracheostomies for years, and sometimes decades, they do want the specific suction techniques that hospitals often miss because they do the one size fits all. In the community, it’s all about the care delivery, as the patients or the clients want it.

Structured pathways and evidence-based care protocols, as recommended by respondents, could further streamline care delivery, improving both efficiency and coordination across multidisciplinary teams.

Once again, we have evidence-based care protocols already by exclusively working with critically care trained nurses and that does streamline care delivery. I argue no other service provider currently can match what we are delivering in the community, and that is actually improving both efficiency and coordination across the multidisciplinary teams.

So next week, we’ll continue with the next section addressing lack of standardization in tracheostomy care.

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].

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.