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If you want to know what the minimum standards are when it comes to ventilation and tracheostomy for adults and children in the community, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecareathome.com. Today, I want to talk once again about minimum standards in the community when it comes to long-term ventilated adults and children with tracheostomy.

So, when you look on our website at intensivecareathome.com, we have a section where it talks about the Mechanical Home Ventilation Guidelines. Those Mechanical Home Ventilation Guidelines are evidence-based, and they are a result of over 25 years of Intensive Care at Home nursing in Germany and in Australia.

When you look at the document at the Mechanical Home Ventilation Guidelines, it clearly specifies that only critical care nurses with a minimum of 2 years critical care nursing experience can safely look after long-term ventilated adults and children with tracheostomies in the community, but that also includes patients that are not ventilated but have a tracheostomy because a tracheostomy is still an unstable airway. It also includes clients that are ventilated without a tracheostomy, they’re on BIPAP, CPAP, and they can’t manage it themselves. So that’s included there as well. So, that’s evidence-based.

All we do at Intensive Care at Home is evidence based, but today I actually want to share with you a letter that I’ve seen this week from a hospital for a ventilated child that also confirms that this child at home will not be safe without 24-hour registered nurses. So, let me just read out excerpts of the letter.

Just for more context, we do know that children that didn’t have 24-hour nursing care with critical care nurses in the past have passed away when critical care nurses were not present due to lack of funding. So, this comes from a place of a lot of information that we’ve gathered over the years because we’ve been on the coalface for the last 12 years. We know what’s happening out there in the community. We know what needs to happen from a funding perspective to keep ventilated adults and children safe because we’re bringing high standards in the community, which is really necessary for all our vulnerable clients.

So, the letter says,

“The child has an artificial airway tracheostomy through which the child receives breathing support from a machine ventilator, and supplemental oxygen. The ventilator oxygen and tracheostomy must always be monitored by a critical care nurse to ensure the child receives adequate support.

There are times when the tracheostomy may come out or may become blocked with secretions. These events are life threatening and need to be managed immediately by two skilled people, one providing breathing support, whilst the other reinserts the tracheostomy. This requires the specialized degree of skills that only critical care nurses have. This significantly increases the safety of the child as the child must be monitored, 24 hours a day, by critical care nurses, and because the tracheostomy and the ventilator also requires intervention 24 hours a day.”

And the letter continues that,

“It is essential that out of the two people, at least one of the people caring for a ventilated child is a fully trained critical care nurse who’s able to intervene immediately to manage anything that could be life-threatening events which requires high level of clinical reasoning and risk management. A fully trained critical care registered nurse would be able to direct a support worker in how to assist them in managing one of these events, which can develop rapidly and without warning.”

The letter continues,

“Because of these events, which can develop rapidly and without warning, because of this component, it is not safe or appropriate to be managed by a support worker alone and needs to always be managed by a registered nurse with critical care qualifications because then, a medical emergency can be managed by directing the registered nurse can then direct the support worker to help in a situation like that.”

So, once again, our Mechanical Home Ventilation Guidelines have been confirmed also by one of the hospitals, by a chief medical officer, by a clinical nurse consultant, and by an ICU physiotherapist. So, we’re not making it up. There are other people saying what we are saying, and unfortunately enough, adults and children have died in the community that are ventilated, tracheostomy, where the critical care nurse wasn’t present, 24 hours a day, because of lack of funding, and that needs to stop. We’re here to advocate.

I hope that illustrates once again, the level of risk that is there and how it can be safely managed.

It’s basically by replicating an intensive care bed in the community, which is what we do here at Intensive Care at Home. Keep in mind that we are actually cutting the cost of an intensive care bed by around 50%, but it’s no longer even a monetary issue. It is a safety issue, and it’s also a quality-of-life issue.

I do believe that what we do is priceless for our clients and for their families to be at home and not in an ICU where they have no quality of life, because going home with Intensive Care at Home means more quality of life, it means community access. All of our clients without exception have community access, they all can access the community and have quality of life. They’re not tied to an intensive care bed.

Now, I hope that illustrates once again how you can be safe with Intensive Care at Home.

To wrap this all up with Intensive Care at Home, we’re providing 24-hour critical care nurses at home, and we’re providing a genuine alternative to a long-term stay in intensive care for predominantly ventilated adults and children with tracheostomies, but also for Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure),  ventilation without tracheostomy, tracheostomy clients without ventilation, Home TPN (Total Parenteral Nutrition), home IV potassium infusion, and home IV magnesium infusion. We’re also providing ventilation and tracheostomy weaning at home. We’re also providing palliative care at home. We’re providing port management, 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 them going into the emergency department.

The cost savings for our emergency department bypass services are huge, let alone patients not needing to go to ED. Intensive Care at Home is also 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 around $2,500 to $3,000 per bed day, and we’re freeing up the most sought-after bed in a hospital, which is the intensive care bed. So, it’s a win-win situation all around, and more importantly, we’re improving the quality of life for our patients and their families. Once again, the cost savings are huge and it’s a win-win situation.

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’re 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), and the Department of Veteran Affairs all around the country. 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 in 2024 that has achieved third-party accreditation for Intensive Care at Home nursing. We’ve been achieving this level of accreditation since 2012, which is how long we’ve been in business for. No other provider has achieved this high level of accreditation in the community and has created this much intellectual property for 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 for our clients. No other service provider employs a higher skill level in the community than we do, which enables us to look after the highest acuity clients, adults and children, in the community. No other provider in Australia can take on a higher acuity level in the community than we can 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. One of our first clients over 10 years ago was a client who was at home on a ventilator with a tracheostomy, with the support worker model. Of course, support workers cannot keep looking after patients at home on ventilation with tracheostomy. That’s like flying the airplane with a cabin crew instead of the pilot, because this client was at high risk of dying. He was going in and out of ICU because support workers simply could not keep him at home predictably, of course not. Support workers have no skill, no experience, no knowledge how to look after a ventilator and a tracheostomy. It’s an intensive care nursing skill and an intensive care nursing skill only, period. Eventually, the client found out about us, and we were proving our concept there very fast. When we started working with a client, he never ever went back into ICU ever again, and he was safe.

We can do the same for you if you’re not safe at home. If you don’t have enough funding, let us do the advocacy, let us help you. We can help you with all of it, otherwise we wouldn’t be in business. We have always successfully advocated for our clients.

That’s 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 have put a link into the written version of this blog where I have done an interview with one of our NDIS Support Coordinators, Amanda Riches. We’re also providing TAC case management and WorkSafe case management in Victoria, our TAC case manager, Lucy McCotter.

If you’re an NDIS Support Coordinator or 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. We can help you with the right level of advocacy. We also provide NDIS specialist nursing assessments done by critical care nurses with 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 Victoria, and Geelong in Victoria, 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 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 very vulnerable and very special, that’s why we need regular staff. So, if you’re looking for agency work where you can come and go, this is not going to be the right fit for you. We are looking for consistency and our clients are looking for consistency. So please, only put your application form with us if you can give us regular and consistent availabilities for shifts and you’re really keen on building relationships with our clients and us, as an organization. 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 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’re paying in ICU or in ED for, plus you can free up a bed.

If you are 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 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 [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, comment below what you want to see next, what you think about today’s topic, and what insights you have from today’s 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.