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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 services for long-term ventilated adults and children with tracheostomies. 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 focus on an Australian study. In more detail, I want to focus on a study that talks about, “The latest evidence on hospital in the home programs: implementation, sustainability, and patient perspectives.”

So, I want to I’ll just read out the article and I will also link to the article so that you can see where the source of this article is coming from. So, let me read this out.

“Two companion Cochrane reviews and the new Cochrane Library editorial on Hospital at home programs were published this week. Here, Cochrane authors Dr. Jason Wallis and Professor Sasha Shepperd share their key findings.”

There’s a heading now in the picture, “Hospital in the home or also known as HITH programs have been on the rise in response to the COVID-19 Pandemic”.

“’Hospital at home or – Hospital in the home (HITH) as it’s better known here in Australia – is a service designed for people whose condition would normally need treatment in a hospital bed,’ explains Jason Wallis, researcher at Monash University’s School of Public Health. ‘Instead, with HITH, they typically receive visits from a doctor, nurse and allied health professionals at home instead – just as they would if they were in hospital.’

‘We know there’s been a significant increase in HITH programs around the globe as an alternative to hospital admission, with more services being set-up during the COVID-19 pandemic to relieve the pressure on hospital beds and increase capacity. There are two types of programs. The first is called ‘admission avoidance’ as patients are referred by emergency doctors or general practitioners for HITH, thereby avoiding admission to a hospital ward. The other type is called ‘early discharge’ and is designed to shorten the length of time patients need to stay in hospital.’

For us here at Intensive Care at Home, it’s probably the latter but we have certainly focused on admission avoidance as well because we are also sending our critical care nurses into people’s home to avoid emergency department presentations. So, we’re doing both here at Intensive Care at Home.

Let’s carry on with the article.

“’While there’s a growing evidence base on both the effectiveness and cost?effectiveness of both types of HITH programs, our review team recognized that health service managers, health professionals and policy makers need more evidence on how to actually implement and sustain these services on a wider scale. That’s why we undertook these reviews.’

So, what does the latest evidence tell us?

Jason worked with Professor Sasha Shepperd and an international team of Cochrane researchers to analyze 52 qualitative studies from 13 countries that included interviews with over 2,000 people, including patients with a variety of conditions such as stroke or pneumonia, family caregivers, health professionals delivering or referring to HITH, as well as health managers and policy makers.

The review findings highlight several key areas for healthcare leaders to consider. These include the need to:

• develop specific strategies to address specialists’ uncertainty about referrals to HITH and expand routes of referral.
• deliver more and better training to expand the roles of staff and increase the capacity for medical care in the home.
• focus on better recognizing and defining the unpaid caregivers’ role, and providing support to unpaid caregivers.”

That’s exactly what we do here at Intensive Care at Home. As much as our services for the patient and the client first and foremost, it’s also for the families. We can’t have our families live in intensive care day and night. They are often at breaking point, and that’s why it’s one of the many reasons we created Intensive Care at Home, to take the burden off patients’ families, i.e., the caregivers but also to take the burden off ICUs and hospitals in general, free up beds.

Let’s carry on in the article.

Next heading: “Financial barriers and questions around cost effectiveness.

‘A range of barriers were identified across the studies we looked at,’ Jason says. ‘One of the most critical issues was a reluctance of some hospital specialists to refer patients to the HITH services, and their difficulty with identifying eligible patients. Early engagement with hospital specialists and emergency physicians who refer the patients, and providing clear eligibility criteria for referring patients are key to addressing this problem. It’s essential to build trust and understanding so clinicians become comfortable referring patients to HITH programs.’

‘Financial barriers were also a key challenge. Though we know from previous research that it can be cheaper to treat someone at home rather than in hospital, policy makers and hospital finance teams need clear evidence of financial benefit, or at least that the program doesn’t actually cost more. Some services found it very difficult to measure the financial impact of HITH programs for their respective hospitals – particularly private hospitals that had multiple payers with different reimbursement schedules to deal with. Some overcame this by starting small with a limited number of eligible patients before expanding.’

Before I carry on in the article, clearly, that is not an issue for Intensive Care at Home, and here is clearly why. An intensive care bed costs $5,000, sometimes $6,000 per bed day. Intensive Care at Home is approximately 50% of that cost of hospital intensive care bed. So, the answer about financial sustainability is already answered.

The other question that this article so far has left out is about the freeing up of resources, the freeing up of hospital beds, which is what we’re doing here in Intensive Care at Home. We’re freeing up the most sought-after bed in a hospital, which is the intensive care bed. So, I encourage anyone that’s in the HITH program to just make sure you take the freeing up of beds into consideration as well, not only the finances, but you also need to take into consideration what it means for the families of the patient, but the article comes to that.

Carrying on in the article, “The update of the admission avoidance HITH included 20 studies, of these 12 reported cost data. In general, HITH appeared less costly than hospital, ‘but this is uncertain due to a range of different methods used to calculate cost, different unit costs and follow-up times.’

Different unit costs, and this is why Intensive Care at Home is so cost-effective, because the unit cost is an ICU bed, the cost of an ICU bed in a hospital per bed day. Here, we are slashing that by 50%. Think about that.

Carrying on in the article.

The next heading: “Other key themes: Effectiveness, safety, and patient perspectives

‘We were keen to include clinician, patient and carer perspectives in our research,’ Jason says. ‘We found that safety was the primary concern for patients considering having hospital at home. For example, many patients were concerned about being alone and not having the round the clock staff supervision that they would have in a hospital bed. On the other hand, there were also privacy concerns with patients not wanting staff in their homes.’

‘The impact of HITH on the caregiver was really interesting and quite mixed. While the impact could be positive – for example they didn’t have to travel to see their loved one in hospital – there was also this negative impact. Many carers reported feeling stressed, unsupported, unpaid, and suffering from disruptions to their sleep and usual work routines.’

‘Few studies reported on patient satisfaction and as is often the case, data on length of stay varied among trials,’ Sasha adds. ‘Overall, in terms of effectiveness, while few studies reported on adverse events, we’re moderately confident that admission avoidance hospital at home doesn’t make a difference to the number of older people who died when compared to in-hospital care. Similarly, we’re moderately confident that at six months follow-up the risk of a new admission to residential care was reduced for an older population who were allocated to hospital at home rather than admission to hospital.’

Next steps, ‘While additional large, randomized trials that include an analysis of cost-effectiveness will add to the certainty of the evidence’ Sasha concludes, ‘the lack of effective scaling?up strategies means future research should also investigate the degree to which HITH substitutes for hospital-based care and how HITH can be more widely implemented in a way that supports unpaid caregivers without creating additional work.’

As the Cochrane Library editorial published today alongside our reviews highlights, the critical need now is to identify and test strategies that can increase the adoption, uptake, and sustainability of HITH programs across different healthcare systems – including strategies for engagement of referrers, patients and caregivers, and strategies for process optimization and sustainability.’

‘This transition in research focus is critical for HITH to be a core part of every acute hospital’s care strategy and extend its impact to transform patient care on a larger scale.’”

Well, thank you so much for publishing this, and also, I can comment on the fear that some families and patients have if there’s no one around, 24 hours a day, like it is the case in a hospital, again, this is not the case with Intensive Care at Home because we are replicating an intensive care in the community. So, our nurses are there, 24 hours a day, and we are still reducing the cost of an intensive care bed by 50%. Once again, a win-win situation.

Now, I also want to highlight here, this is an Australian study. Now, as some of you know, I have done my nurse training in Germany nearly 25 years ago, and I worked with Intensive Care at Home in Germany as well. I can tell you, when I was a teenager a long time ago, even then, my grandmother had hospital in the home. So, the hospital in the home is a recent thing in Australia. In Europe, it’s been around since the 1970s. So, Australia, wake up, right? It’s time to wake up.

I can confidently talk about that because I’ve seen it, as early as the 1990s in Germany at work, in full swing, very effective. So, it’s time for Australia to catch up to the rest of the world. We are certainly doing it here at Intensive Care at Home at a fast pace. It’s time for the rest of the hospital in the home world to wake up and catch up to the rest of the world.

Now, if you have a loved one in intensive care or you’re watching this and you are in intensive care long-term, you’re ventilated, you have a tracheostomy, your loved one is ventilated, has a tracheostomy we want to hear from you. You’ve come to the right place here. We want to help you go home. You know that your quality of life at home is so much better. If you’re a family member of a patient, you know your quality of life at home is so much better. So, I encourage you to reach out at to intensivecareathome.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

Or you might be watching this, and you might be at home already and you might have insufficient support, you might have regular hospital readmissions, you don’t know how to stop them. Well, we certainly know how to stop them because that’s bread and butter for us.

Many of our clients, as a matter of fact, had insufficient support and regular hospital readmissions, ICU readmissions in particular, and we put a stop to that. Or they had support workers looking after them, and that is a high risk. Patients died because of that, not having the right level of support. Please reach out to us as well. Don’t worry about funding, we will help you with the funding, and we can help you with the advocacy to get more funding.

Because our clients don’t go back to hospital unless it’s something elective, because we can keep them out of hospital predictably, because we provide the critical care nurses at home, 24 hours a day, for adults and for children. Again, tracheostomy, ventilation, BIPAP, CPAP, Home TPN, Home IV potassium, home IV magnesium infusion, port catheter management, PICC line, central line, Hickman’s line management, palliative care at home, as well as we’re sending our CCRNs into people’s homes or residential aged care facilities to keep them out of ED (emergency department) to provide an ED bypass service.

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

We are also providing Level 2 and Level 3 NDIS specialist support coordination, if you need help with that. We’re also providing NDIS specialist nursing assessments, if you need help with that.

If you are an NDIS support coordinator and you need nursing care for your participants, we want to hear from you. Contrary to popular belief, the NDIS is funding nursing care. If you need help with the advocacy, please reach out to us. We can help you.

We have also and we are sending our registered nurses into people’s home and residential aged care facilities to provide an emergency bypass service. Please reach out to us as well.

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 and you ideally have completed a postgraduate critical care qualification. We currently have jobs in Sydney, Melbourne, Brisbane, Albury, Wodonga, as well as in Bendigo, in Country Victoria and in Warragul, Country Victoria, we want to hear from you.

We are looking for 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 and not an agency. We pride ourselves on having and providing a tailor-made solution for our clients. So, if you’re looking for agency work and you want to come and go, please don’t apply. Only apply if you want to make a difference to our client’s life and if you want regular work, build relationships with our clients, and that includes 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 if you’re an intensive care specialist and you have bed blocks in your ICU, which I know you do. After having worked in intensive care for nearly 20 years and 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, ED and also on respiratory wards. Please reach out if you need help.

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’re watching this and you’re in the U.S. or in the U.K., please reach out to us. We can help you there privately.

If you like my video, 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 and what questions and insights you have from this 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.