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 our clients, which includes Home TPN (total parenteral nutrition), Home IV potassium infusions, Home BIPAP (bilevel positive airway pressure), Home CPAP (continuous positive airway pressure), tracheostomy care, IV antibiotics, as well as port management, central line management, PICC peripherally inserted central catheter) line management and Hickman’s line management.
Now in today’s podcast, I bring on a repeat guest, Tara Thorpe in Dallas in the U.S.
Patrik: Hi Tara, how are you?
Tara: Hi, everyone. Good, thank you. How are you?
Patrik: Very good. Thank you.
Tara, thank you so much for coming on to a podcast again. I really appreciate it.
Tara, you and I have been talking on and off for the last six months and we’ve recorded a previous podcast about launching Intensive Care at Home in the US. And today we want to talk more about how we make that happen.
Tara, you are currently and you have been in Dallas in Texas for quite some time, and we now want to offer Intensive Care at Home in Dallas in Texas privately. Which means, Tara will be your go to person if you are living in Dallas in Texas or surroundings of Fort Worth, Tara is our clinic liaison nurse there. And she can help you with getting your family member home or you might be watching this or listening to this and you might have a family member at home who needs care because they’re on a ventilator or they’re on a trach or they need Home TPN, and that’s where Tara can help you.
And just for the record here, Tara has worked with us in Australia for over two years and Tara, you’ve been a great staff member. You know exactly what needs to happen in someone’s home, when someone is ventilated with a tracheostomy. You know exactly what needs to happen, also for a hospital discharge if we are transitioning someone from hospital or from ICU to home, if they have a ventilator and the tracheostomy.
Tell the people a little bit more about your experience. I know your experience very well, but tell us a little bit more what you’ve done in the past with us and how you can help our future clients in Dallas.
Tara: Yeah, so I have ICU experience. I also have experience as a trauma RN too. And so specialize with ICU ventilated patients. Patients, as Patrik said, on TPN, PICC (peripherally inserted central catheter) line management, all the clinical sides of things, human dynamic stability, but more than that I really focus on a holistic type of care too, which is I like my patients once they’re home to really experience life the way that they want to in their own autonomous way.
So not only are we focused on keeping you safe and out of hospital, we want you to have a good quality of life while you’re at home too.
And so loved working with Intensive Care at Home. Still love working with Intensive Care at Home. And it’s a company that Patrik and I have been talking and really trying to get to Texas. So we’re so excited that it’s happening now and that we can provide the service to Texans because I have so many patients in hospital that when we discharge, the family doesn’t know where the patient can go when the hospital discharges and they’re deemed medically cleared to go home. But vent dependent and they typically go to nursing homes and I’ve never been ok with that. But we don’t have any other options here typically.
Patrik: Yeah. Yeah, that’s great, Tara. And like you said, we are really excited in making this a reality now. And Tara, you and I have seen so many clients over the years, what it means for them to leave the hospital system and live a really good quality of life at home for many years to come, even though they are ventilator-dependent they have a tracheostomy but they are in the comfort of their own home.
And, our clients here, they never have any hospital readmissions, any non-elective hospital, hospital readmissions. I should say they still go back to hospital here and there for some elective stuff. But, not for anything non elective which is what people want.
I mean, you and I know there are so many families and patients in hospitals and in ICU, they’re simply depressed because they’re spending day and night in the four walls of a hospital and in LTAC (long-term acute care), you have LTAC in Dallas, I would think. And it’s just not the right place for those patients and families.
Tara: No, I second that completely.
Patrik: Yeah. Ok. So what we offer really is we offer up to 24-hour care and again, if you’re watching this or listening to this, you might be at home already and you might have insufficient support. You might bounce back into hospital all the time or you might have a family member bouncing back into hospital all the time because, you don’t have the support that you need.
This is actually how I first got started over 10 years ago. I started with a client that was at home already but had recurring ICU readmissions and we put a stop to that. So if you are watching this and you’re at home and you don’t have enough support, that would be a good starting point for you and for us to keep you home predictably. But even if you are in a hospital and you are more or less stable and you can go home, we can help you with up to 24-hour specialist nursing care.
And I also want to say, if you’re listening to this or watching this, it might sound daunting now for you to think, “Oh, how can I go home again?” That is where we are the specialists in organizing all the equipment, making sure a safe transfer can happen at home or to a home care environment. We organize all the equipment. We actually know what equipment you need to make a successful transition home.
Tara, I think what’s also important, some people, they come to us every now and then and they say, “Hey, what about the staff? Will you find me the right staff”, and you and I both know how important it is to find the right staff. You can’t just send any nurse into someone’s home. They have to have the right attitude. They have to have the skill to “read a room”. If they can’t read a room, and if they can’t read the emotion that’s going on in someone’s house they usually don’t last very long. So I also think that, we have the skill to select the right staff. Tara, when we interview, we say that more and more often we say, can you read a room? That’s part of how I interview now.
Tara: It’s funny you say that because I remember one of my dear patients in Australia, he was non-verbal but cognitively intact and we used to have conversations with facial expressions and I would be able to understand exactly what he was saying because I think I knew how to read his room.
Patrik: Exactly Tara, that is such an important skill to have. The clinical side of what we do is of course, very important, but that’s 50% of the equation. The other 50% of the equation is, can our nurses read a room?
Tara: Yeah, especially in home environment. It’s sacred. It’s someone’s space and you’re respecting their home.
Patrik: Yeah. Yeah. So, if you are concerned about, can we select the right staff for your family? I argue that we can, because that’s what we’ve been doing for the last 10 years, selecting nurses that have the clinical skills but also have the social skills to fit in your home environment. That is like you said, Tara it’s sacred. And, we are a guest in someone’s home.
So with that unique skill that Tara that you have there, I know you will be able to help families who have an interest with going home with Intensive Care at Home in the Dallas, Fort Worth Metropolitan area. And then we would hire nurses if we need more than one nurse, which we probably would, especially if it’s 24 hour nursing care.
But for example, for things such as TPN, home TPN, 24-hour care is often not needed, but sometimes it is depending on what’s exactly happening. But there are situations where 24-hour care is not needed, but especially if you’re a family member or if you want to go home on a ventilator with a tracheostomy, we strongly recommend that 24-hour nursing care is needed. Because as you know Tara, we’ve had two recent inquiries in the U.S. where families wanted to take their loved ones’ home on a tracheostomy, no ventilator. And we strongly recommended against it without 24 hour nursing care. And unfortunately, lo and behold, both family members bounced back into ICU within less than 24 hours just as we predicted at the time. So, please be aware that, we are clinicians and we have the experience when we say it’s not safe to go home. It often is because we know that the setup at home just needs to be right, and it needs to be safe before you’re making such an important decision of going home.
Tara, I also want to quickly mention in the community, what is important obviously is having access potentially to doctors if we need to escalate any medical issues. Can you quickly talk about that? How we would go about that in the Dallas Metropolitan area if we need to escalate any medical issues?
Tara: Yeah, so we would get a private physician on board to be able to, if vital signs are unstable or we were of concern that we need to go to hospital, we would be able to get patients to a safe hospital or a physician to oversee their care to keep them safe.
Patrik: Yeah. And again, this is not dissimilar to what we are doing here, Tara where if there’s a medical concern, we escalate that after hours. Home doctors or even sometimes to emergency physicians to ICU physicians, we do that here all the time and it won’t be any different here as long as you have access.
However, what I also want to stress here is because we exclusively work with critical care RNS with a minimum of two years’ critical care nursing experience, so I argue that the experience is already there, how to keep our clients or patients home predictably.
That’s what we’ve been doing for the last 10 years and we wouldn’t be in business and we wouldn’t be talking about Intensive Care at Home if we weren’t achieving that in keeping our clients home predictably, because the last thing that we want for any client is to go home and then they keep bouncing back to ICU. I mean, that can’t be in anyone’s interest.
And that’s why we sort of say why we’re saying it needs to be 24 hour nursing care for someone on a ventilator with a tracheostomy because otherwise the risk of things going wrong is real.
And unfortunately, we have seen things going very wrong if there wasn’t 24-hour nursing care with ICU nurses at home, for patients on a ventilator with the tracheostomy patients have died because they did not have the critical care nurse during certain periods of times. And that’s when things unfortunately went wrong.
So, we really want to stress that 24-hour specialist nursing care is needed at home for someone on a ventilator with a tracheostomyeven if they’re not ventilated but have a tracheostomy.
The other thing Tara that we are doing here, which might also be of interest for some clients in the Dallas area, we are now providing an emergency department bypass service for the local area health service in Sydney. Basically what we’re doing there is we’re sending our critical care nurses into people’s homes to prevent an emergency department admission.
So we unblock catheters, we change catheters.
Tara: We would be so lucky in America to have that well. We need that.
Patrik: Exactly. Exactly. If anyone and you might even be a hospital listening to this, and you might think, “Oh, that is exactly what we need because our emergency department, emergency room is overcrowded.”
Patrik: Probably is. And you might be a nursing home listening to this and you might say, “Hey, if we could keep our nursing home residents at home rather than sending them to ED”. Well, everyone is winning.
We are now going as far Tara, that we are doing nasogastric tube changes at home and we have home x-ray doing the follow up X-ray at home.
Tara: Wow. I just, how we save on resources, time. That would be..
Patrik: But Tara, it’s not only that, imagine for a nursing home resident, do they need an ambulance to go to ED? Is that what they need?
Tara: No, no, no, no. And it costs thousands. The transportation of patients.
Patrik: The stress on the patients, the stress on the nursing homes, the stress on families. The nursing home, the nurse in charge then needs to call the family and it’s just like, and emergency departments are overrun with other things and like I said, all it is really is changing a catheter, changing an IDC (indwelling catheter), changing an SPC (suprapubic catheter). Sometimes it’s changing a PEG (percutaneous endoscopic gastrostomy) tube, sometimes it’s changing a nasogastric tube. Sometimes it’s changing a tracheostomy tube.
Patrik: And sometimes it’s giving an injection for something. So, but the sky is the limit really here as long as we can mobilize nurses willing to go places.
Tara: And I believe we can.
Patrik: I think we can. We’ve shown that for the last 10 years and its location independent. It’s location independent.
What we can’t do, I think Tara, what we can’t do and for anyone listening, what we can’t do is to provide an emergency service for families who have a loved one at home on a ventilator with a tracheostomy doing sort of a call out and keeping them at home because that can’t often be done by an hour visit. That is something that really needs 24 hour nursing care which is what we’ve seen over and over and over again.
But in terms of, for someone that’s not ventilated, doesn’t have a tracheostomy, absolutely, a visit from an ED or an ICU nurse to prevent the hospital admission might be sufficient.
So Tara, we really want to keep this short today.
It’s really another announcement from our end that we are launching this now in Dallas in Texas privately. And if you think that your insurance might pay for it, that’s great, then we would obviously talk to your insurance. But, the promise that we can definitely make is to provide this service privately.
Okay, that is really great. Tara, any final words before we wrap this up?
Tara: Actually, yes. I want to say, so we say y’all in Texas, Patrik. So Intensive Care at Home is coming to Texas, y’all.
Patrik: Y’all. I’m not sure if I’m saying that the right way.
Tara: No, but we’ll work on it.
Patrik: We’ll work on it. That’s it. That’s it.
Okay, all right. Well, thank you so much Tara.
So, and you might be a critical care in Texas watching this and you might know of some patients we would love to hear from you as well. You might be a family in Dallas in Texas watching this, and you have a loved one, please reach out to us.
If you go to intensivecareathome.com, our U.S. number is on the top of the website or you can send us an email to [email protected].
You might be a hospital executive watching this. You might be an ICU doctor watching this, an ED or ER doctor watching this. Please reach out to us if you need help.
And if you are watching this and you are in Australia, please reach out to us as well. We’re operating all around Australia in all major capital cities as well as regional and rural.
We are an NDIS (National Disability Insurance Scheme) approved service provider in Australia, TAC (Transport Accident Commission) in Victoria, ICare New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as DVA (Department of Veteran Affairs) all around the country. We also offer Level 2 and Level 3 NDIS specialist support coordinations in Australia.
And Tara, thank you so much once again and I’m sure we’ll talk soon.
Tara: Okay. Sounds good.
Patrik: Thank you so much. Take care. Bye.