Podcast: Play in new window | Download

If you want to know more about Intensive Care at Home admission criteria, stay tuned! I’ve got news for you.

My name is Patrik Hutzel from intensivecareathome.com, and today I actually have an email from a case manager in a hospital asking whether we can take this particular patient home with Intensive Care at Home. I’m just reading out the email to answer the question here.

“Hi Patrik,

We have currently a client in ICU who is presenting with the following condition. Can you take this patient home with Intensive Care at Home? We are very interested as our ICU is very full and the family would like their family member at home.

So, the client has a tracheostomy in place and on a ventilator. They’re not in distress with the tracheostomy in place attached to the ventilator. The patient feels comfortable and has tolerated the weaning of pressure support mode ventilation. The patient remains on pressure support most of the day. Respiratory secretions and mucus were suctioned to avoid mucus plugging.

The patient receives diuretics such as Lasix twice a day. The patient also has slightly distended abdomen and hyperactive bowel sounds, pitting upper and lower extremities edema, eyes are open, patient is following commands, tracks with the eyes but having still minimal spontaneous movements.

Currently, the blood results and pathology results show abnormal levels of white blood cells, red blood cells, hemoglobin, hematocrit, platelet, blood urea nitrogen, creatinine and point-of-care glucose. The patient also had a low blood pressure reading of 104/68. That’s not really low, certainly something we can manage at home.

Close observation and monitoring of the patient is suggested.  An administration of prescribed medications, feedings and treatments with additional water flushes is allowed as well to improve the patient’s abnormal blood levels and prevent other complications such as dehydration, volume overload, electrolyte imbalances and etc.

The secretions need to be suctioned to maintain a patent airway and adequate oxygen saturations, proper positioning and mobilization as well as aggressive chest physiotherapy and lung exercises, nebulization, cough assist or hypersaline nebulization to avoid mucus plugging in the airway and promote ventilation, oxygenation, and tissue perfusion is all required. Keeping the patient comfortable and pain free at all times, always observing infection control precautions for continuous decrease in the elimination of microorganisms in the body system is also required.”

Well, on that note, home care in patients’ home, it’s a much cleaner environment. So, we practice infection control and universal precautions at home too. But it is a much cleaner environment and the risk for infection is much lower.

Now, to drill down into the numbers, white cell count is 10.7 which is pretty just about normal. Normal white cell count is between 4 to 11. Her hemoglobin is 8.4, which is a little bit low, but maybe one more blood transfusion before she’s going home is required.

So, to answer the question here, can we take this patient home? Absolutely, yes, we have done weaning at home. We’re monitoring pathology results at home. We’re taking bloods. There’s really a lot of things that we can do at home that can be done in an intensive care unit whilst we are improving the quality of life of patients’ families and whilst we’re improving the bed flow in a hospital and in an ICU in particular. We know that ICUs are screaming out for bed spaces, screaming out to free up beds to admit other patients in need of more acute critical care.

So what needs to happen here? What needs to happen here is document the care plan for when the patient is going home. Look at the setup at home. Most patients, we can take at home even in let’s just call it “suboptimal” home care environments. We know how to keep clients safe, but we can also look at the home and then recommend any modifications that potentially need to be done. It also requires OT or occupational therapy input. It also should require input from physiotherapy. That’s in a nutshell.

What else needs to be done at home? Well, the patient needs two ventilators, needs emergency backup equipment such as spare tracheostomy tubes, dilator, ambu bags, face masks, oxygen and heart rate monitor, and needs two suction machines at least, needs a special care bed, probably a wheelchair, a hoist or a lifting machine. Once that’s all in place, the patient can go home and whoever is paying for it is cutting the cost of an intensive care bed by 50%, that’s 5-0. So, that is making a lot of economic sense here taking this patient home, it’s a win-win situation.

With Intensive Care at Home, we’re providing 24-hour critical care nurses at home, and therefore we provide 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 palliative care at home. We’re also providing ventilation weaning at home, which is the case in this situation in today’s case study. There’s also organizations out there who do chest X-rays at home. We’re working with those providers as well.

It’s all about creating those win-win situations. It’s all about creating the infrastructure to keep patients and families at home safely and predictably. It’s all about creating the right teams around the patient and their family, and that’s what we’re the experts on, creating the right teams and infrastructure around a patient at home.

We’re also providing central line management, PICC (Peripherally Inserted Central Catheter) line management as well as Hickman’s line management. We’re also providing nasogastric tube management and PEG (Percutaneous Endoscopic Gastrostomy) tube management 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 a program at 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 ED. We’re also therefore in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs around $5,000 to $6,000 per bed day. Our service costs between $2,500 and $3,000 per bed day. We’re freeing up an ICU bed and we’re improving the quality of life for patients and their families. So it’s a win-win situation all around.

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 are an NDIS (National Disability Insurance Scheme) approved service provider all around the country, 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 (DVA) all around the country. Our clients and we as a provider have also received funding for 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 2024. We’ve 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 than we have, and 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 2024 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. No other provider in Australia can take on a higher acuity safely in the community than we can.

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 will give you a tangible example 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 keep a patient at home on a ventilator with a tracheostomy. That’s like flying the airplane with the cabin crew instead of the pilot, because this client was at very high risk of dying and he was going in and out of ICU because support workers simply do not have the skills, the experience or knowledge how to look after a ventilator and the tracheostomy client. This is an intensive care nursing skill and critical care nursing skill, it’s not even the skill of a general registered nurse.

Eventually, the client found out about us. We were proving our concept with this client very fast and we worked with the client and we sent him intensive care nurses, 24 hours a day. He never ever went back into ICU ever again and he was safe. We could do the same for you if you are not safe at home, which includes the advocacy that goes along with it to get the relevant funding. We have always successfully advocated for our clients, otherwise we wouldn’t be in business.

This is also why we’re 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 will put into the written version of this blog an interview that I’ve done with Amanda Riches, who’s one of our NDIS support coordinators. We’re also providing TAC case management and WorkSafe case management in Victoria.

If you’re an 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’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 advocacy. 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’re currently hiring for jobs for critical care nurses in the home 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 two years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you. I have a disclaimer though, 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 are looking for agency work where you can come and go, this is not 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, otherwise it’s not going to work.

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 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 to take the pressure off your ICU and ED beds and 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’re paying for in ICU and ED.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, respiratory wards, etc., 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.

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to info@intensivecareathome.com.

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 leave your comments below what do you want to hear next, what do you want to see next, what do you think about today’s topic and what 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.