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If you want to know how Intensive Care at Home can bring down wait times in Australian emergency departments, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecareathome.com. Today, actually, I saw on LinkedIn, one of my connections, Dr. Christopher Edwards, he’s an emergency physician at Warrnambool in Victoria, Australia, but he’s also the Chief Medical Information Officer at Barwon Health in Geelong. He posted an article on LinkedIn that is on the ABC today, and the ABC headline says, “Emergency wait times blow out as hospitals struggle to discharge patients”.

Now, before I read out the article in a minute, I just want to give you some context. With Intensive Care at Home, as much as we provide a genuine alternative for a long-term intensive care stay in the community, as much as we replicate an intensive care bed in the community for predominantly long-term ventilated adults and children with tracheostomies, we also provide an emergency department bypass services

We have done that successfully for the in-touch program at the Western Sydney Local Area Health District, where we basically send our critical care nurses into the home to keep patients out of the emergency department and provide the ED service at home, saves $2,000 per ED admission that we are preventing. So, that’s the context of it because when I saw the article, I got very interested in and let me read it out.

So, the article was published today, Friday, the 17th of January 2025, let me read out the article from the ABC website.

RURAL STATE OF EMERGENCY REPORT 2024 PDF

“The number of Australians experiencing lengthy waits in hospital emergency departments for admission to a ward is about 3 times the target set by emergency medicine specialists according to a new report”, and then it links to that report from the Australasian College for Emergency Medicine, State of Emergency: Regional, Rural, and Remote 2024 Report. It’s a 40-page document and I will link towards that in the written version of this blog at intensivecareathome.com for context.

The article continues, “The Australasian College for Emergency Medicine (ACEM) said patient safety was at risk and emergency departments were filling up with vulnerable people who might not need medical attention but had nowhere else to go.

A huge proportion of these people are elderly Australians, particularly those with dementia.

“Things are deteriorating, we’re really struggling with capacity to deal with this demand”, President of the ACEM and director of Alice Springs emergency department, Dr. Stephen Gourley said.

The ACEM would like to see no more than 10% of patients who need to be admitted to hospital spend over 8 hours waiting in emergency departments, but their annual report shows in major cities, 31% are waiting longer than that. In regional areas, it’s 32%, and in remote areas, it’s 23%.

Data analyzed by the ACEM found it took 15 hours and 36 minutes before 90% of people who required admission at a metro hospital were all sent to a ward.”

That is ridiculous. I do believe the targets from memory when I was still working in public and private hospitals, as a critical care nurse, I think the target in ED was 4 hours, and here, we are talking of a complete blowout of 15 hours and 36 minutes. It’s absolutely ridiculous.

Then, there’s a table in there, a diagram in that article, “Hours taken for most (90%) people to be admitted to hospital after visiting emergency. Wait times in New South Wales and ACT, 17.54 hours. Northern Territory, 16.54 hours. Queensland, 12 hours. South Australia, 16.21 hours. Tasmania, 23.36 hours. Victoria, 16.06 hours, and WA 14.06 hours. So, on average 15 hours, it’s ridiculous.

“Dr, Gourley said patients were being put in unsafe situations.

“There’s a safe period of time to be in the emergency department and then we need to get you into the wards, and research shows the longer people wait for a bed, the higher the rates of morbidity are, and even mortality goes up.”

He said the data, which covers 293 hospitals, showed people with mental health-related presentations were spending the longest in emergency departments.

“These are people who have really serious mental health issues, and the emergency departments are noisy, the lights never go off, so being stuck in that environment for days is really not okay.” Dr. Gourley said.

I’ve got examples of people waiting 5 or 6 days in the emergency department for a bed to become available.”

That is ridiculous.

Then the next headline is, “Waiting an emergency for Brain Surgery.

Wayne Jones had to stand on crutches in the emergency department for more than 4 hours.” There’s a picture there of Wayne Jones.

“Even those with urgent medical complaints are sometimes enduring lengthy waits.

Wayne Jones presented to Perth’s Sir Charles Gairdner Hospital last year after his doctor told him he needed emergency brain surgery to have a tumor removed.

Mr. Jones had limited mobility on the right-hand side of his body due to the large tumor, but he had to stand in the emergency department waiting room for almost 5 hours with crutches he had brought from home.

“It was a disaster”, the 60-year-old said. “Chairs were absolutely scarce, and people were everywhere, and there was no offer of a wheelchair.”

He was eventually admitted, and 3 days later, his tumor was removed in a 5-hour operation. Over his 10 days in recovery, he was repeatedly moved between wards as the hospital reached capacity.

“Most mornings they would say over the loudspeaker that it was code yellow, meaning the hospital was full. People were in the halls, concertina blinds were put around them because there weren’t any rooms free.”

I just have to repeat that again, “Most mornings they said they would say over the loudspeaker that it was code yellow, meaning the hospital was full.” Now, why are some hospitals not using Intensive Care at Home to provide emergency department bypass services and to provide Intensive Care at Home? The solution is right in front of their eyes.

“Wayne Jones said the medical staff at Sir Charles Gairdner Hospital were constantly run off their feet.

He felt he would be better off at home, so self-discharged against medical advice.”

Now, that is really dangerous. People discharging against medical advice because they’re not getting the care in hospital in a timely manner. Why not provide that care at home? That is common sense, but common sense is not all that common anymore, or is it?

The article continues, “I knew hospitals were struggling, but it’s not until you’re there that you get a sniff of just how bad things are.”

Sir Charles Gairdner Hospital has been contacted for comment.”

I’ll just play an animated video from the ABC website where it says, “What causes bed block? “and that’s part of the article there and I’ll just play the audio. It’s a good video.

“Bed block happens when a hospital is full, struggling to find room for new patients.

Let’s say this hospital has this many ward beds and this many beds in the emergency department. Over here, beds are allocated for elective surgery.

When the hospital works well, someone presents to the emergency department. They receive urgent care, and if they need ongoing care or monitoring, they go to a ward before being discharged.

But complications like chronic disease and aging population, and lack of staff to manage beds can mean the system breaks down. People present to hospital sicker, they stay longer, and the ward beds that fill up.

Then, when this person presents to emergency, they have to stay there, and the emergency beds also fill up. When the next person comes, there’s no beds left. People can go to beds that might otherwise have been used for elective surgery, which eases pressure for a while. But when people’s elective surgeries are delayed, they’re more likely to turn up critically ill at emergency.

People arriving by ambulance don’t have a bed to be admitted to, so the ambulance has to continue caring for them until a bed becomes available. That ambulance isn’t free to respond to the next emergency. This is called ramping.

And the hospital, which should have a steady flow of people in and out, is bed blocked.”

Very good short animated video, but it just goes to show the dilemma in hospitals and bed blocks and bed flow. They mentioned something very critical here, staff shortages in hospitals. One of our big advantages is we can actually find staff, we have critical care nurses in the community that can provide the Intensive Care at Home and the emergency department bypass services. It’s not only that we’re keeping people out of hospital, it’s also we’re saving costs for ambulances. Ambulances are overrun as well, they’re short staffed. Let’s get the ambulances to the people that really need it and not the people that can have ED bypass services. Let us come to someone’s home so that the ambulance resources are not being used.

So, let’s continue with the article.

“Long emergency wait times are influenced by how quickly a hospital can safely discharge patients to make room for those coming in.

But when patients end up in hospital because community-based services can’t accommodate them — not because they are sick — the discharging process can be long and complicated.

Dr. Gourley said that more dementia patients were being brought into emergency departments because aged care facilities had shut high-need dementia units or didn’t have appropriately trained staff to manage, “behaviors of concerns”, which can include agitation and wandering.”

Then there’s another picture of ambulances ramping. It says, “The worst waits were in Tasmanian hospitals were 42% waited for more than 8 hours for hospital admission.”

The article continues, “Elderly people get pushed to the hospital because there’s nowhere else for them to go, and they get stuck there for a prolonged period of time, and that can be months, or in some cases, up to a year.

Right now, 20% of acute care beds are taken up by people waiting for appropriate aged care.”

Again, this is where Intensive Care at Home would come in by providing the emergency department bypass service.

The article continues, “The federal government has promised 35 specialist dementia care units around the country by 2023. So far, 16 are operational, with a further 10 to open this year.

One emergency department worker at a major Melbourne hospital who didn’t want to be named, said she’d noticed an increase in the number of National Disability Insurance Scheme (NDIS) participants presenting to ED due to funding issues.

Then there’s another, picture here, “The Australian College for Emergency Medicine said emergency departments were filling up with vulnerable people — most commonly elderly Australians.”

“I had a gentleman who was quite genuinely dumped at the emergency department by one of his support workers because his funding had run out. He was really upset as he didn’t have a medical concern but still had to be admitted.”

The health worker said she often had NDIS supported accommodation providers refusing to take back a participant after a hospital stay, which meant they were stuck in hospital.”

Once again, this is when Intensive Care at Home is coming in. If people can’t be looked after at home by support workers, and they need a registered nurse, or even a critical care registered nurse, that’s where Intensive Care at Home comes in.

“These bottlenecks at the back door mean people can’t get in the front door of the hospital”, says Andrew Partington, a health economist who works at the National Health Medical Research Council at Flinders University.

He said hospitals were commonly the “piggy in the middle”, forced to remedy failings within primary care or aged care.

“That means if you can’t get a spot in aged care, you might be looked after in an incredibly high-cost environment, which is a horribly inefficient way of picking up the slack.”

The number of patients in regional New South Wales awaiting discharged to an aged care facility nearly tripled between December 2021 and June 2022, research has shown.”

Then, there’s a picture of health economist, Andrew Partington, said “Australia is expected to have a shortfall of 110,000 aged care workers by 2030.”

A spokesperson for the Department of Health said delayed hospital discharge of older people was a complex issue, and the government was investing in a new scheme this year called the Hospital to Aged Care Dementia Support Program.

It will launch in Adelaide and Hobart soon with 11 other locations around the country to follow.”

My thoughts on the failings of the aged care system is we need an NDIS aged care system, or a similar system to the NDIS needs to be implemented for the NDIS by having more and more appropriate community nursing care to keep people out of hospital, predictably.

The article continues, “Services aplenty but staff in short supply.

Governments are attempting to tackle bed blocks with new initiatives.

Most states and territories have their own version of “hospital in the home” programs which reduce the length of hospital stay or prevent admission altogether by having medical professionals visit patients at home.

In addition, the federal government has invested in 87 urgent care clinics, meaning people can be treated for some illnesses and injuries out of hours instead of presenting to an emergency department.

There are also 45 Medicare Mental Health Centers nationwide, with extended hours where adults can seek help from mental health professionals for free, which may reduce emergency department visits.

Mr. Partington said these initiatives were helpful, but he’s worried about staffing as not only are there shortages in health, but Australia is expected to have a shortfall of 110,000 aged care workers by 2030.

“It is sad because we’ve known these pressures were coming for a long time, we’ve had good demographic modelling to tell us we should expect this”, Mr. Partington said.

Dr. Gourley said, workforce shortages were making healthcare a less appealing career.

“The pressure on the system right now is reaching the point where people can’t really work full time or stress means they leave the front lines completely.”

“In major cities, vacancies for emergency medicine specialists are at 50%, in regional and rural areas, that number increases to 75%.” That’s how the article concludes.

Now, what I want to add on to that is that what we provide with emergency department services at home, we’ve changed IDCs (indwelling catheters), SPCs (suprapubic catheters), we’ve changed nasogastric tube, PEG tubes, we’ve changed casts at home. We’ve done general nursing assessments at home to keep people out of EDs, liaising with doctors, nurses in hospitals what resources we might need to keep people out of ED and that was an incredibly successful program, incredibly successful.

Now, with all of that said, with Intensive Care at Home, we’re sending our critical care nurses into the home, 24 hours a day. Therefore, we are providing a genuine alternative to a long-term stay in intensive care for ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure)  ventilation without tracheostomy, tracheostomy without ventilation, Home TPN (Total Parenteral Nutrition, home IV potassium infusions, and home IV magnesium infusions. We’re also providing ventilation weaning at home. We’re also providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port-a-cath management for home TPN, but also for IV infusions. We’re also providing nasogastric tube management, PEG (Percutaneous Endoscopic Gastrostomy tube management at home, as well as palliative care services at home.

Like I said, we’re also sending our critical care nurses into the home for emergency department bypass services and 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 going to the emergency department

Therefore, we’re also in a position to cut the cost of an intensive care bed by around 50%. The intensive care bed costs around $5,000 to $6,000 per bed day. Our service costs between $2,500 to $3,000 per bed day, and we are freeing up the most sought-after bed in the hospital, which is the ICU bed. But most importantly, we’re improving the quality of life for patients and their families, that’s a win-win situation for all stakeholders. But as you’ve heard today, we’re also freeing up other in-demand and highly sought-after beds in hospitals, which is the ED bed.

So, 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 (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as the Department of Veteran Affairs all around Australia. Our clients and we, as a 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 in 2025. We have been achieving this level of accreditation since 2012. No other provider has achieved this high level of accreditation in the community and has created more intellectual property for Intensive Care at Home nursing than we have. That 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 and you realize that you don’t have the right level of support, I’ll give you a very tangible example here today. One of our first clients over 10 years ago was a client who was at home on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers cannot look after a client at home on a ventilator with a tracheostomy. That is like flying the airplane with a cabin crew instead of the pilot because anyone on a ventilator with the tracheostomy is at very high risk of a medical emergency or even dying if they don’t have critical care nurses looking after them 24/7.

This is evidence-based, and it’s documented in the Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com. Think about it, in intensive care in a hospital, you wouldn’t have support workers to look 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?

So eventually, this client found out about us. We were proving our concept with this client very quickly. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never ever went back into ICU ever again, and we were proving our concept there very, very fast.

We can do the same for you if you’re not safe at home, which includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business.

Same is applicable if you’re in intensive care watching this, or if you have a family member in intensive care watching this, and you need Intensive Care at Home, please reach out to us. We can take you through the right steps.

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 below the video. 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, 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 what evidence to provide, I encourage you to reach out to us as well. We can 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.

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 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, in Albury, Wodonga, in 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 to hearing from you.

I have a disclaimer because we are offering a tailor-made solution for our clients, which includes regular staff, our clients 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 availability for shifts and you’re really keen on building 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 ICU and 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’s much more cost-effective than what you pay 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, respiratory wards, please reach out to us as well. We can help you there 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 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 think about this video and what you want to see next.

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.