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 otherwise medically complex Patients by improving their Quality of life and where we also provide tailor made solutions to hospitals and Intensive Care Units, reducing the cost of an ICU bed by 50%, whilst providing Quality Care!
In last weeks blog I shared another case study where we took a toddler home from PICU to provide end of life care at home.
You can check out last week’s case study here.
In this week’s blog I want to answer a question we get quite regular regarding our services and it’s simply that more and more people want to leave intensive care, even on a ventilator with tracheostomy and/or BIPAP/CPAP, non-invasive ventilation and they simply want to be in a more holistic and Patient and family friendly environment.
Therefore, people want to know,
Is it appropriate to discharge ventilated Patients from ICU/PICU to home?
With services like INTENSIVE CARE AT HOME being available, the answer to this question is a yes.
Let me explain.
Whenever Patients(adults and children) are in intensive care ventilated with a tracheostomy and whenever they end up long-term ventilated, intensive care at home is the appropriate solution.
Patients need to be medically stable, i.e. off inotropes/vasopressors and everything else can be managed at home.
How can an intensive care Patient on mechanical ventilation and tracheostomy being managed at home if the previous perception and paradigm has been that the only way they can be safely managed is in ICU/PICU?
It’s as simple as sending ICU/PICU nurses into the home 24/7 instead of having ICU/PICU nurses looking after a Patient in ICU/PICU with all the equipment that is required. Just like in ICU/PICU, the only difference is that it’s done at home.
Where is the evidence?
I’m glad you’ve asked…
Let me explain.
Intensive care at home services were first “invented” in Germany in the late 1990’s. I was part of the first service in Germany providing Intensive Care At home. We were pioneers in the day, making this a success for Patients and their families!
It was created out of necessity because people quickly realised that long-term intensive care Patients requiring ventilation with tracheostomy (also NIV ventilation such as BIPAP/CPAP) or otherwise medically complex are much better off at home in a much more holistic and patient and family friendly environment.
20 years later the concept of intensive care at home has now been proven in Australia as well, because we have been successfully implementing the concept in Australia also.
This is irrespective of the Patients clinical challenges that requires 24/7 ICU/PICU nurses in order to manage Patients at home safely.
It’s just a matter of transferring skills, expertise and experience from an ICU/PICU environment to a much more holistic as well as Patient and family friendly home care environment, by sending ICU/PICU nurses into a home care environment.
When the first Patients in Germany left ICU/PICU going home it was a huge success, improving Patients and their families’ quality of life immensely!
It has also been a huge success in Australia now since 2014, which is when we first started providing INTENSIVE CARE AT HOME services in Australia, making it a “no-brainer”!
Furthermore, the cost of the care being provided in comparison to a $5,000 per bed day ICU/PICU bed was reduced by approximately 50%, making it a “no-brainer” and making it a win-win situation that couldn’t be ignored.
Furthermore, the secondary benefit for hospitals and intensive care units was simply that they alleviated bed blocks and they created resources and beds that could be used for other Patients in need of a critical care bed!
Again, a win-win!
Furthermore, standards were created around the delivery of INTENSIVE CARE AT HOME services to make it safe taking patients home from intensive care that require the skills and expertise of intensive care nurses, because they are either ventilated or have other medical complexities that would have previously kept them in ICU/PICU.
The standards are documented in the MECHANICAL HOME VENTILATION GUIDELINES here https://intensivecareathome.com/mechanical-home-ventilation-guidelines/
Making it safe to send Patients home from Intensive Care or paediatric intensive care!
The guidelines clearly highlight that sending ventilated and tracheostomised adults and children home from intensive care is safe, as long as the same skills, expertise and experience is available for Patients, compared to ICU/PICU.
This skill and expertise can be made available with ICU/PICU nurses.
What are the outcomes?
Readmission rates to ICU/PICU are minimised and usually reduced to elective readmissions.
Some Patients can be weaned off ventilation at home, i.e. Guillan Barre syndrome.
Other Patients may be able to approach their end of life at home on ventilation with tracheostomy or on BIPAP/CPAP ventilation.
Other outcomes are things like, families spending quality time at home, rather than spending day and night in intensive care or paediatric intensive care.
Furthermore, many families when having a loved one in intensive care long-term ventilated, lose the ability to produce an income.
By having a service like INTENSIVE CARE AT HOME to take their loved one home, families can get back to more “normality” and also go back to work etc…
Other outcomes again are the reduction in cost by ~50% compared to the $5,000-$6,000 per bed day ICU/PICU bed!
Furthermore, ICU’s/PICU’s have more beds, staff and other resources available to accommodate more Patients in need of critical care/intensive care.
Also, some Patients are able to go back to work, work from home or go back to school, university etc… something they wouldn’t be able to do in the confinements of an intensive care unit!
In essence INTENSIVE CARE AT HOME is improving quality of life on all levels!
What do services look like on a day by day basis?
Services now range from managing patients at home on ventilation and tracheostomy, to non-invasive ventilated Patients on BIPAP/CPAP as well as end of life care/palliative care at home.
We also manage otherwise medically complex Patients at home that are at high risk of ICU/PICU readmission, mainly Patients with regular seizures, because of airway instability during seizures.
Other services we provide are home TPN and “one-way” extubation at home.
We also provide services to adults and children that have a tracheostomy “only” and are not ventilated.
Here is a list of our full-service provisions (click on the links below for more information)
- Quality of life nursing services for mechanically ventilated Adults with Tracheostomy as a genuine alternative to Intensive Care
- Quality of life nursing services for mechanically ventilated Children with Tracheostomy as a genuine alternative to Intensive Care
- Quality of-end-of- life nursing services for mechanically ventilated Adults and children with Tracheostomy as a genuine alternative to Intensive Care (palliative care)
- Quality of life nursing services for Adults & Children requiring Non-Invasive mask ventilation such as CPAP or BIPAP and/or High-flow Oxygen therapy.
Critical Care Nurse consultant
INTENSIVE CARE AT HOME
If you want to find out how we can help you to get your loved one out of Intensive Care including palliative care or Long-term acute care (also nursing home) or if you find that you have insufficient support for your loved one at home on a ventilator, if you want to know how to get funding for our service or if you have any questions please send me an email to [email protected] or call on one of the numbers below.
Australia/New Zealand +61 41 094 2230
USA/Canada +1 415-915-0090
UK/Ireland +44 118 324 3018
Also, check out our careers section here
We are currently hiring ICU/PICU nurses for clients in the Melbourne metropolitan area, northern suburbs, Mornington Peninsula and in South Gippsland/Victoria.
We are 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 here
We have also been part of the Royal Melbourne health accelerator program for innovative health care companies last year!
Thank you for tuning into this week’s blog.
This is Patrik Hutzel from INTENSIVE CARE AT HOME and I see you again next week in another update!