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Hi it’s Patrik Hutzel from INTENSIVE CARE AT HOME where we provide tailor made solutions for long-term ventilated Adults & Children with Tracheostomies and where we also provide tailor made solutions for hospitals and Intensive Care Units whilst providing quality services for long-term ventilated patients and medically complex patients at home, including home TPN.
You can click on this YouTube link to watch the video for today’s blog post: https://youtu.be/WHVfRehuBc4
In last week’s blog, I talked about,
You can check out last week’s blog by clicking on the link below this video:
In today’s blog post, I want to share a podcast with Tara Thorpe, our clinical liaison nurse in the U.S. working for Intensive Care at Home.
Intensive Care at Home Now in the U.S.
Patrik: Hello and welcome to another intensivecareathome.com podcast. At Intensive Care at Home, 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. We’re providing quality services, and we also provide services for home TPN (total parenteral nutrition) clients.
In this podcast today, I have a very special guest. I’ve got Tara Thorpe here today from Dallas in the U.S.
Hi, Tara. How are you?
Tara: Hi.
Patrik: Tara, thank you so much.
Tara: Good, thank you. I’m so excited to be here.
Patrik: It’s great to have you, Tara. Thank you so much for coming onto the call. I really appreciate it.
Tara, you used to work for us for Intensive Care at Home here in Melbourne, Australia, a couple of years ago. You worked for us probably for over two years, and you’ve really embraced the work here. The clients really gave us fantastic feedback about you, and I believe you enjoyed working for us here.
Now, you’re in the U.S., and on some of my videos and podcasts, I have already shared that we are trying to set up Intensive Care at Home in the U.S., and Tara is now our clinical liaison nurse in the U.S.
Tara, tell us a little bit more about yourself. Tell us a little bit more about your nursing career and what made you interested in coming to Intensive Care at Home in the first place.
Tara: So, my name is Tara. I’ve been an RN for about four to five years now. I started actually working in LTAC (long-term acute care) as a junior nurse, and then I moved to the ICU, and then I moved to Australia and did travel there with Intensive Care at Home. Now, I’m back here in the states working for Intensive Care at Home as well as working on the trauma floor in Texas at Fort Worth.
So, what really inspired me to work at Intensive Care at Home in Melbourne was having the ability to take care of patients in the privacy of their home, but also maintaining my skills and still being challenged by the intensive care aspect as well.
Patrik: Yeah. Obviously, for some of you that follow my videos and my blogs, you would’ve heard me talking about many inquiries from the U.S. for Intensive Care at Home, but we haven’t really been able to help so far. Now, we are in the process of trying to help more clients in the U.S., and the way we’re trying to approach this at the moment is that this video, as much as it is for families and patients in intensive care, it’s also for other providers that would like to partner with us because if you can meet our quality standards, which is sending intensive care nurses into the home for predominantly long-term ventilated adults and children, we would love to work together with you, and with the families, and with the clients to improve their quality of life.
Now, Tara, talking about quality standards. You’ve worked with us here in Melbourne. You’ve seen our quality standards. You’ve gotten to know our team. You’ve gotten to know the clients. What’s your take on quality standards in the community? How important is it from what you’ve seen?
Tara: Oh, incredibly important. It’s literally the difference between life of a patient and keeping them safe. I remember we had a joke at Intensive Care at Home that we were the “Cadillac of all the nurses in the community” there. So, one of our patients, her mom was talking about how she was so impressed by the professionalism of Intensive Care at Home and how she felt so incredibly safe to sleep well at night because she knew that her daughter was in the best hands.
On top of just the safety aspect of it, I remember just the everyday living and taking care of this specific patient. We would go to school. She was 16. We would look at boys, and we would do all the fun stuff that she would do, and then when I would go home with her at night, I knew I could keep her safe when she was sleeping. If she ended up going into this medical condition that she had, I knew exactly how to treat that seizure and to protect her airway, and then we’d wake up in the morning and continue her life, just living everyday life with her, which is special.
Patrik: Absolutely. I know the client you are talking about, and I’m not sure whether you’re even aware that before you worked there, that she had a cardiac arrest. Did you know that?
Tara: Yes, yes.
Patrik: Right, and that was on shift. That was on shift with one of our critical care nurses. Now, imagine that would’ve been anything less than a critical care nurse.
Tara: Yeah.
Patrik: She ultimately survived that cardiac arrest, and to this day, still at home with our nurses. Imagine that would have been anything less than a critical care nurse.
Tara: Yeah. I mean, she recently celebrated her 18th birthday not long ago, and I remember hearing about that story. When I took care of her, it was very serious. We would have fun, but I was watching her one-to-one the entire time. Any time she went into any which way, I knew exactly how to handle it, and I was confident with that, with being able to take care of her.
Also, another patient that we had when the electrician turned off the electricity in the entire house and his ventilator turned off, and I had to literally instruct the electrician while I’m Ambu-bagging, giving him oxygen, telling him, “It’s okay”, to grab the ventilator, walk through the safety checks, and then I had to switch it over, and then he was okay. Then, we got the electricity and the house turned on. These events, you have to really know how to protect someone’s airway, how to manage the ventilator, how to do the safety checks.
Patrik: I remember that, too. Unlike in an ICU, you don’t have 20 people to call on.
Tara: You don’t. You don’t have that code button. You have your knowledge, your skills.
Patrik: You have to think on your feet literally to keep the clients safe. Now, I think those are very good examples, Tara, to highlight the quality aspect, which from our end is also underpinned by an accreditation process here in Australia. We are third party-accredited to provide Intensive Care at Home. We have policies, procedures, and again, whoever is watching this, we would expect a similar quality standard if you wanted to partner with us.
From our perspective, we have two KPIs, key performance indicators. One KPI is to have zero readmissions, zero non-elective readmissions, I should say that. Zero non-elective readmissions back to ICU or to hospitals because otherwise, we wouldn’t be in business, and we couldn’t deliver on our promise. That’s one KPI. Another KPI that we strive towards is having all available shifts filled because we can’t have our clients without staff. So, these are really quality aspects we’re looking for anyone that wants to partner with us, and you can see, for anyone watching this, that’s a family that we have rigorous quality standards to make sure we can make a successful transition from an ICU or in the U.S., from LTAC to going home.
Tara: Yeah.
Patrik: So, the other thing, Tara. You’ve worked in LTAC because we have a lot of inquiries in the U.S. from patients that are either on the verge of going from ICU to LTAC, and they often contact us at that inflexion point, or they are already in LTAC, and they are, for lack of a better term, desperate to get out of LTAC. Saying to us things like, “Get me out of here. This is horrible. They’re not doing anything for my family member.” Can you talk about the LTAC aspect in the U.S. in particular and how you think it compares to Intensive Care at Home?
Tara: Yeah. So, LTAC. LTAC is typically is a facility, long-term care. They typically have two nurses covering. When I was there, there were 50 patients that had tracheostomies, awful. Also, the nurses, they typically have… They’re not registered nurses. It’s typically enrolled nurses, which is a different certificate. It’s not a degree in that sense. Comparing that type of care going to an ICU when patients are trached, ventilated, pegged, it’s a one-to-one, one-to-two at most.
Working in the hospital presently, currently too, when we discharge a patient to LTAC, we know that they’ll be back in three to five days. The patients that I’ve been talking to, the families who’ve been coming to me working with Intensive Care at Home currently right now, they’re on their third readmission back to the ICU. They’re going back to LTAC, back to ICU. It’s heartbreaking in so many ways. You know that they’re going to be back with more problems. They’re going to be septic. There’s a pressure injury, and it’s infection, and it’s these problems that are compounding with each discharge and readmission. We get them, we stabilize them, we get them safe in the hospital, we discharge them to LTAC, they’re back with more problems. It’s awful. It’s awful.
Patrik: Sorry. Go on.
Tara: So, the alternative to Intensive Care at Home is, I mean, you working there at bedside with Intensive Care at Home that was zero… That would never happen. Those are our two mottos, our gold standard of quality staff, quality care, no readmissions back to hospital.
Patrik: You would think that an LTAC would take a similar approach where they say, “Okay. If someone goes to LTAC, they should be ready, and if the LTAC is doing all the right things, there should be no readmissions back to ICU.” You would think that they would have a similar approach, wouldn’t you?
Tara: That would be one of their core concepts, and it’s entirely not because it’s their core concepts of knowing that that’s going to happen. We know it on the floor that when we say “Bye” to the patient, we hope to not see them again, but we know if they come back, they’ll either be back with us or into another ICU step-down unit being taken care of with more issues.
Patrik: That’s crazy. Tara, you have glanced into some of the work that we’re doing with our sister company at intensivecarehotline.com, and we often get inquiries again at the inflexion point where patients go from or are supposed to go from ICU to LTAC, and then we often look at medical records or we talk to ICUs directly, and we go like, “This is going to be a disaster waiting to happen if you sent this patient from ICU now to LTAC.” You can already see it.
Tara: Yeah.
Patrik: From what I’ve learned there, I argue the system is broken, and patients are almost deliberately being put at harm’s way by sending them to LTAC, and the next thing you hear, like you described, three days later, they’re back in ICU potentially back in a different ICU because the previous ICU does no longer have any beds. And then vulnerable patients are within three locations within a few days. That’s madness in my mind.
Tara: It is, and then there’s a distress that’s created from patient to nurses. I’ve had patients that are not being taken care of properly at an LTAC, and they come back, and they don’t trust the staff because they’ve been just hauled around to different. It’s a failure of the system and we’ve got to do something different in America where we’re able to take care of patients safely in the comfort of their home where they have autonomy to make decisions over their life, where they have that ability like we do in Australia, how we give patients back that autonomy over their life, and to have a greater quality of life, and where it’s not at a facility, in and out of facility. We’ve got to do something different.
Patrik: Absolutely, absolutely. It has to be a different approach. What’s your experience in LTAC about success rates for ventilation weaning? Can you comment on that? Have you seen any success stories, or what’s your experience there?
Tara: I know it’s more so stories about pneumonia, patients getting pneumonia pretty often because they’re not positioned properly. They’re not getting their treatments. I can’t talk about the success rate. I can’t. It’s the opposite.
Patrik: Yeah. The first thing that comes to mind is pneumonia.
Tara: Pneumonia. Yeah, entirely.
Patrik: That’s terrible. That’s terrible. Okay, but that really also illustrates the quality standards that need to be taken with home care, with Intensive Care at Home in particular because that’s when we believe we can carry on almost seamlessly from an ICU, assuming that ventilation weaning is not possible. I’m not suggesting to take any patient home from ICU. No, we are really focusing on patients that have the inability to come off the ventilator in the short and medium term.
So we’re talking about when I look at our client or patient cohort here in Australia, it’s anyone with neuromuscular diseases, spinal injuries, but there could also be patients with COPD (chronic obstructive pulmonary disease), asthma that, for whatever reason, ended up in ICU, ventilated, and now can’t be weaned off the ventilator. That’s a patient group I believe we could look after as well, including Guillain-Barré syndrome, we’ve done that. I remember we have looked after Guillain-Barré when I did this side of work in Germany, 25 years ago. We looked after Guillain-Barré at home and successfully weaned someone there. So, there’s a number of patients.
I also need to make a quick disclaimer here, about what we can’t do. Sometimes we do get inquiries, “Can we take people home on a breathing tube, on an endotracheal tube?” We don’t because it’s too risky taking someone home with an endotracheal tube because we can’t re-intubate at home. The only thing that we have done on a couple of occasions is a one-way extubation at home for palliative care. So, that is the exception to the rule with the breathing tube. But generally speaking, we have sometimes family coming to us, “Oh, my mom, my dad, my spouse has been in ICU now for one or two weeks. They’re on a breathing tube. Can we take them home and continue treatment at home?” The answer to that question is no. It’s too risky.
Tara: Okay.
Patrik: So, that was just my quick disclaimer. So, in terms of I want to address this video again back to other providers. We can also help other providers with implementing policies and procedures that we are using here in Australia that we believe are applicable in the U.S. as well. Again, we are happy to share the approaches with you so that we can maintain high-quality standards and manage those KPIs.
Another thing that I wanted to mention quickly is as much as we want to partner with providers that are open to talk to us, we’re also in the process of looking at our home care, our own home care licenses in a couple of states where we think we can set it up independently. But again, we are very open to talk to other providers.
Tara, you’ve also worked in the community in the U.S. previously, have you?
Tara: No, not in the U.S.
Patrik: Oh, I thought you have also worked in home care. Okay. Maybe I misunderstood that. Okay.
Tara: Talking about what a day, a normal day would be like with Intensive Care at Home, it’s one-to-one. So, you’re with that patient, and you’re taking care of that patient for a 12-hour shift a day, and you’re looking after them.
Also, I wanted to talk about too, for nurses as well, the difference between working in hospital and community too, and the benefits of it because it’s such a beautiful experience on the nursing side to be able to do that one-to-one care in community with these patients because it’s very intimate, and you get to go through all day taking care of them without all of the pressures that the hospital side gives you and with administration. We know about the nurse burnout and all that that we’re all going through right now. It’s a need for nurses, too. Yeah, entirely.
Patrik: I agree with you, Tara. Unfortunately, and we see it here as well, the nurses are leaving the hospital system. Like you said, they’re burnt out, they’ve had enough, and they see this as an avenue to continue their nursing career by using their skills in a different environment.
Tara: Yeah, entirely.
Patrik: The other thing, if nurses listen to this, the other thing that I will say, and what we do, sometimes people come to us, and they think, “Oh, I’ve done 20 years in ICU, and I’m looking for something easier,” and I will say, “Well, what we do is not easy,”.
Tara: It’s not easy, but it’s entirely rewarding in so many ways, and it’s a lot of things. It’s not easy, but it’s beautiful, truly. I mean, you’re making a difference in your patients’ lives. You’re making a difference to improve healthcare for families, for yourself because you’re not going to be burnt out like in the hospital, but it’s very holistic almost I think in every way.
Patrik: It is.
Tara: Entirely.
Patrik: Yeah, yeah. Another thing that I would like to mention because somebody watching might also be wondering about the medical cover and clinical governance in general. So, let me talk about that for a moment.
So, here in Australia, our medical governance is usually coming from the discharging hospital, but it can also come from what we’re doing in the meantime, virtual health organizations. We’re doing telehealth all the time. Not all the time, but when needed. Also, sometimes it can even come from a GP. I don’t know what’s a GP in the U.S. A GP here is a family doctor, a general practitioner. It’s the same.
Tara: A primary care physician.
Patrik: Primary care physician, okay. So, even clinical governance can come from a primary care physician as well. So, there’s numerous aspects of how we could manage clinical governance on a medical level. Again, maybe someone is watching this that has an interest in providing medical governance to some of our clients. We would, again, very much welcome you to reach out to us because you might say, “Yep, I’m a doctor. I can see there’s a need for this, and it makes sense to do some work with clients or with Intensive Care at Home. Again, we would love to hear from you.
Since you’ve gone back to the U.S., Tara, we’re doing a lot of telehealth now, way more than before even. There’s an organization here now that is, “My emergency doctor”, shout out to them. We get an emergency physician on call, 24 hours a day, if we need to, and we’ve avoided so many hospital readmissions just by using them. They’re fantastic.
Tara: Yeah, and lately, that’s great because our emergency room has been saturated. I mean, that’s great. There’s a need for that as well.
Patrik: There’s a need for that as well, and not that I’ve researched it, but I’m certain that if you can get an emergency consultant on the phone here, there would be organizations in the U.S. that don’t do a similar approach. Potentially, even you get an ICU consultant on the phone. That’s the next step here. I’m waiting for that, for someone. There is a company that’s trying to set that up here, and I would think, again, even where the whole healthcare system is moving more and more towards healthcare, as much as there is an ICU emergency doctor on call, there needs to be an ICU doctor on call as well.
Tara: Yeah.
Patrik: There has to be.
Tara: I love it. It’s like a time of we need to move towards what needs to change, and we have the ability to do it, to impact.
Patrik: Absolutely, absolutely. So, for any providers or families watching this, please reach out to us at intensivecareathome.com. You will find phone numbers on the top of our website at intensivecareathome.com. You can also email us at [email protected].
Tara, do you have any final thoughts?
Tara: I don’t think so.
Patrik: I think we touched on everything that’s important. We touched on everything that’s important. It’s really taking those next steps to help what I believe is already a big audience in the U.S. that’s probably watching the videos, is resonating with the whole concept, with the whole idea of Intensive Care at Home, taking those next steps, and again, whether it’s patients, families, whether it’s providers, we are open to talking to you, taking those next steps, and taking those next steps with you.
Now, we’ve got Tara who really understands Intensive Care at Home inside-out and unlike me, knows much more about the U.S. market than I do who is going to be a really great conduit to taking those next steps.
Tara: Yeah. Yep.
Patrik: Tara, thank you so much for taking the time to get on camera with me.
Tara: Pleasure. Yeah.
Patrik: I’m sure we’ll do a follow-up episode at some point when we have more news, or maybe there’s people coming forward with questions, and maybe our next step maybe is addressing any questions on another podcast. That might be the easiest way to get the message out there. We’ll see how it goes.
Tara: Okay.
Patrik: Now, thank you for watching.
Now, subscribe to my YouTube channel, share the video with your friends and families, anyone that could benefit from this video, click the like button, click the notification bell, and comment below this video what questions you have, or what insights you have, or any other video you want us to make about this topic, and we will talk to you very soon.
Thank you so much again, Tara. Thank you.
Tara: Bye. Thank you.
Now, if you have a loved one in intensive care and you want to go home with our service intensive care at home and if you want to find out how to get funding for our service and how it all works, please contact us on one of the numbers on the top of our website, or send me an email to [email protected]. That’s Patrik, just with a K at the end.
Please also have a look at our case studies because there we highlight more about what we can do for clients, how clients can live at home with ventilation and tracheostomies and you can look at our case studies as well at our service section.
Intensive care at home Case studies
And if you are at home already and you need support for your critically ill loved one at home, and you have insufficient support or insufficient funding, please contact us as well. We can help you with all of that.
And if you are an intensive care nurse or a pediatric intensive care nurse with a minimum of two years, ICU or pediatric ICU experience, and you ideally have a critical care certificate, please contact us as well. Check out our career section on our website. We are currently hiring ICU and pediatric ICU nurses for clients in the Melbourne metropolitan area, Northern suburbs, Sunbury, Bendigo, Mornington Peninsula, Bittern, Patterson Lakes, Frankston area, South Gippsland, Drouin, Warragul, Trida, Trafalgar and Moe as well as Wollongong in New South Wales.
www.intensivecareathome.com/careers
So we are also an NDIS, TAC (Victoria) and DVA (Department of Veteran Affairs) approved community service provider in Australia. Also have a look at our range of full service provisions.
Thank you for watching this video and thank you for tuning into this week’s blog.
This is Patrik from Intensive Care at Home, and I’ll see you again next week in another update.