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How Important is ICU/Hospital Discharge Planning for INTENSIVE CARE AT HOME Clients?

Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies and where we also provide tailor-made solutions for hospitals and intensive care units whilst providing quality care for long-term ventilated adults and children with tracheostomies, and also otherwise medically complex adults and children at home, including Home BIPAP (bilevel positive airway pressure), Home CPAP (continuous positive airway pressure), home tracheostomy care when adults and children are not ventilated, also Home TPN (total parenteral nutrition). We also provide IV potassium, IV magnesium infusions at home, as well as IV antibiotic infusions at home. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as palliative care services at home, and that also includes ventilator weaning at home.

Now, today I want to answer a question that we get quite frequently from our clients, but also from hospitals as well. They ask, “How important is discharge planning for Intensive Care at Home clients or Intensive Care at Home patients?”

Well, discharge planning when going home from hospital is everything, that really sets the scene, and it really is a make-or-break point. We have done so many successful transitions from ICU to home to improve the quality of life for our clients and in some instances, improve the quality of end of life for our clients. It’s really a critical point to make it a successful transition for Intensive Care at Home clients, which includes the patient and the family, of course, but it also includes the hospitals because the goal for the hospital is to discharge patients into a safe environment, making sure they’re not coming back, that’s the whole purpose of intensive care. So, let’s look at this in more detail.

So, first of all, you have to identify the right client or the right patient that they can benefit from Intensive Care at Home, that they can improve their quality of life at home or, in some instances, quality of end of life at home. Predominantly, it’s for patients with ventilation and tracheostomy adults and children. They have been identified as having the inability to wean off the ventilator and the tracheostomy for now. That’s not to say they might not be able to do that later, but it would take long periods of time, and hospitals and ICUs, in particular, are often not the right place because they are very depressive environments with no quality of life.

One of the obstacles for patients to wean off a ventilator is simply they’re not in a patient and family friendly environment. Anyone that set a foot into an ICU knows it’s just there to help treat critical illness and save lives, and that’s fantastic. But at some point, when someone is stuck in their long term, it is no longer the right environment for them. It’s also no longer the right environment for the families because they more or less “live in ICU” and that’s not a good thing either.

Moreover, ICU beds are in short supply. Critical care beds are in short supply. Critical care beds are the most sought-after beds in a hospital. So therefore, freeing up an ICU bed and moving patients home if they can’t go to a hospital ward or hospital floor makes a lot of sense and is a win-win situation.

So, we’ve identified the right patient. In some instances, it can also be a patient that is having a tracheostomy but is not ventilated but still needs frequent suctioning, needs frequent treatment. The reality is that when you look at the evidence, a patient can’t go home when having tracheostomy or tracheostomy and ventilation without having 24-hour nursing care with ICU nurses who have a minimum of two years ICU or critical care nursing experience, only that is evidence-based and safe. I encourage you to read up our Mechanical Home Ventilation Guidelines who are evidence-based, you can have a read there what is actually safe.

Now, moving on from identifying the right patient and obviously establishing that in ICU, there is no quality of life, no quality of end of life, patients are depressed, often, families are depressed and that is not a good situation to be in. Next, we got to look at the home of a patient. We got to look whether the home is suitable for Intensive Care at Home. Most homes are, it’s probably less of an obstacle than you think it is. Some homes might need some modifications, you might need a hospital bed, and you might need a hoist, a ceiling hoist, in particular, like a lifting machine. But it’s all doable, and most homes are absolutely suitable for it. We have worked in so many environments, and we can certainly help you find out whether your home is suitable or not.

Next, we got to look at the equipment. What ventilators are needed? What size? Tracheostomies are needed. Suction machines are needed. Monitors are needed. Sometimes, the cough assist machine is needed. Tracheostomy dilators are needed. Spare tracheostomies are needed. Resuscitation bags are needed like ambu bags. You always need to have two of them. You can’t just run on one ventilator, one suction machine, what if it breaks down? We also have to probably look at, like I mentioned earlier, hospital beds, wheelchairs, emergency packs, sometimes oxygen is needed at home, but we have a checklist of what is needed. We have done so many successful transitions from intensive care to a home that we have a lot of experience making a successful transition for you as well.

Next, funding needs to be sorted, but it’s probably less of an obstacle than you think it is. Keep in mind, if you’re watching this and you are in intensive care or you have a loved one in intensive care long term, think about this: Someone is paying for the ICU bed, some insurance is paying for the ICU bed, most likely if you’re watching this. In most Western countries, U.S., Australia, the UK, an ICU bed costs around $5000 to $6000 per bed day, let that sink in, $5000 to $6000 per bed day for a 24-hour period. Intensive Care at Home is approximately 50% of that cost, a win-win situation.

So, there is not only a very compelling humanistic aspect in getting you and your loved one home, there’s also a very compelling economic and financial aspect to getting you or your family member home. Once again, it’s a win-win situation. Everyone is winning here plus you’re freeing up the ICU bed, it can’t get more win-win than that.

Next, medical governance as well as nursing governance. So, you got to look at the medical governance. Sometimes we work with GPs (general practitioner) of families, can be doctors. Sometimes, we work with respiratory physicians. Sometimes here in Melbourne, in particular, we work with the VRSS, the Victorian Respiratory Support Service who gives medical governance. Sometimes we work with children’s hospitals. We work with the children’s hospital in Melbourne, on many occasions, who provides the medical governance and thank you to those organizations. Sometimes we provide it through our own doctors in our network. So, it’s really not a one size fits all, but it is definitely doable. Once again, that is also something that needs to be looked at.

Next, if you’re watching this and you are a NDIS (National Disability Insurance Scheme) participant or you are a family member of an NDIS participant, what also makes or breaks often these situations is a good NDIS Support Coordinator. Obviously, we are currently operating all around Australia and in all major capital cities, as well as in regional and rural areas. Many of our clients are NDIS participants and a good NDIS Support Coordinator for clients with complex medical issues, with complex medical disabilities, which is what our client tell often is, need a very good NDIS Support Coordinator and we can help you with that. We have a good network. We have our own NDIS Support Coordinator. We would really like to help you as well with NDIS Support Coordination because this is absolutely critical.

But even if you’re not a NDIS participant, if you are TAC (Transport Accident Commission), iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland or any other insurance scheme or private health insurance or you’re affiliated with the Department of Health, and you need a good case manager, good advocate, one way or another. We have always been involved in successful advocacy for our clients, otherwise, we wouldn’t be doing what we are doing.

Next, team. You need the right team. So, one thing that we always say is we are not an agency. We are a unique specialist service provider in the intensive care at home space. Therefore, we have a tailor-made solution for our clients, and a tailor-made solution includes creating a team that works for you. Creating a team with the right individuals on the team with the right skills, right qualifications, but also more importantly, with the right mindset. Mindset is critical. You don’t want to repeat your experience in the hospital in an ICU. One of the reasons you got depressed there is you didn’t get what you felt like you needed there. So, at some point, going home is critical with the right team. We’ve been in business for over 10 years. We know who’s suitable for a home care environment and who isn’t. So, we are able to create the right team for you and select the staff with your input, of course.

Next, the right care plan with the right goals of care. Very important that a care plan is being documented before you or your loved one is going home. Again, this will work in combination with yourself, it’s about choice and control. It’s about working with your family. It’s about working with the hospital, but really mapping out what is it that you want and identify a care plan.

Next, when we have nurses applying for our roles or sometimes, we have doctors as well, they ask us, “So, most of your clients would have a DNR (Do Not Resuscitate) or an NFR (Not For Resuscitation), meaning they are choosing not to be resuscitated in case their heart stops.” Well, you’d be surprised. Very few of them do. Most of them want to live regardless of their perceived limitations. So, most of them, when they’re at home, live a very good quality of life but which is the whole purpose of them going home in the first place. So, discussions around NFR/DNR can take place, but you’d be surprised. At the end of the day, it’s patient and family choice and control, and very, very few patients choose a DNR or an NFR.

That says a lot about our service and it says a lot about the individuals, how they approach life and that a disability or a medical issue or concern is not holding them back to want to live life and that is very important. It’s a very important aspect of what we do. We enable our clients and their families to live life the way they want it, without any restrictions, without any judgement. This is your life, and you do what you feel is right for you.

So, I hope that sums up what is important for discharge planning when you go home with Intensive Care at Home. Just one more comment about the care plan, in particular. A care plan should really focus on maximizing your quality of life or quality of end of life at home and not go back to hospitals. That’s very important and that’s one of the major promises of our service that you don’t go back to hospital, that you stay home predictably, and it’s something you should be thinking about carefully how that can happen. Well, we know it can happen because we make it happen every day for our clients so that they don’t go to hospital.

Now, Intensive Care at Home, we are currently operating all around Australia and in all major capital cities, as well as in regional and rural areas. We are a NDIS approved service provider all around Australia. We are a TAC approved service provider in Victoria as well as WorkSafe. We are an iCare approved in New South Wales as well as a NIISQ approved service provider in Queensland. We are also a DVA (Department of Veteran Affairs) approved service provider all around Australia. We have also received funding through public hospitals, departments of health, as well as through private health funds. So, reach out to us if you need help.

If you’re at home already and you’re going back to hospital or to ICU all the time because you don’t have the right level of support, please reach out to us. We can help you with funding, we can help you with staff, and we can help you achieve your goals.

We are also providing Level 2 and Level 3 NDIS Support Coordination if you need help with that. We are also providing NDIS specialist nursing assessments if you need that for yourself or for your NDIS participants if you are a NDIS Support Coordinator.

If you are a NDIS Support Coordinator watching this and you need nursing care for your participants, please let us know. Or if you need funding for nursing care, once again, we can help you with the nursing assessment, and we can help you with the advocacy.

We are also sending intensive care nurses and critical care nurses into people’s home to avoid emergency department admissions. So, we’re also providing an emergency department bypass service.

If you are a critical care nurse and you’re looking for a career change, we want to hear from you as well. If you have worked for a minimum of two years in critical care ICU or ED or pediatric ICU, and if you ideally have completed a postgraduate critical care qualification, we currently have jobs in Sydney, Melbourne, Brisbane, in Albury, Wodonga on the New South Wales, Victorian border in Bendigo, and in Country Victoria, as well as in Warragul in Country Victoria. We want to hear from you.

We are really looking for ICU nurses or CCRNs that want to complement our team, people who are team players and people who are looking for regular work. We are a service provider with a tailor-made solution for our clients, and we are not an agency that has people coming and going. We pride ourselves on providing that tailor-made solution to our clients. So, if you’re looking for agency work and you want to come and go and pick up shifts as you want, please don’t apply, this is not for you. Only apply if you want to make a difference to our clients’ lives, and if you want regular work and that includes working with our clients on a regular basis.

If you are an intensive care specialist, we are currently expanding our medical team. We want to hear from you as well.

If you are an intensive care specialist and you have bed blocks in your ICU, which I know that you do, I encourage you to reach out to us as well. We can help you eliminate your bed blocks, but more importantly, we can improve the quality of life, and sometimes, quality of end of life for your patients and their families.

If you are a hospital executive watching this, we also want to hear from you because again, we can help you eliminate bed blocks in ICU, pediatric ICU, and ED and also on respiratory wards, please reach out if you want to have a conversation.

Our website again 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 Intensive Care at Home but also for families in intensive care. Click the like button, click the notification bell, share the 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’ll talk to you in a few days.

Take care for now.