Podcast: Play in new window | Download

Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home and where we also provide tailor-made solutions for hospitals and intensive care units at home whilst providing quality care for long-term ventilated adults and children with tracheostomies at home, otherwise medically complex adults and children at home, which includes Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), home tracheostomy care for adults and children that are not ventilated, Home TPN (Total Parenteral Nutrition), home IV potassium infusions, home IV magnesium infusions as well as home IV antibiotics. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management as well as Hickman’s line management, and we also provide palliative care at home.

We have also sent, and we continue to send our critical care nurses into the home for emergency department bypass services. We have done so successfully in the past for the Western Sydney Local Area Health District, their in-touch program.

Today, I want to talk about the client that we worked with recently, and we’re still working with, who has their mother in intensive care. She wanted to discharge her mother home with the tracheostomy without 24-hour nursing care. We strongly advised against that as part of our consulting and advocacy. Part of what we do is consulting and advocacy for families in intensive care and you can find more information at intensivecarehotline.com.

Now, coming back to our client who’s had her mother for months on end in ICU and rehabilitation facilities with a tracheostomy, off the ventilator later after a stroke but could not be decannulated, but the family was desperate to take her home, which is completely understandable. Nobody wants to stay in ICU or in rehabilitation facilities for months on end. There’s no quality of life in hospitals or in rehabilitation facilities, but there is quality of life at home.

You cannot send someone home with a tracheostomy without 24-hour critical care nurses, it’s just not happening and let me explain more. It’s actually evidence-based and it’s best practice-based. So, when you go to our website intensivecareathome.com, you will find a section, the Mechanical Home Ventilation Guidelines. Those guidelines are evidence-based for anyone at home on a ventilator with or without a tracheostomy, or with a tracheostomy with or without a ventilator, needs to have a critical care nurse 24 hours a day. Those critical care nurses need to have a minimum of two years critical care nursing experience.

Similar to a hospital, the workforce needs to reflect that 70-75% of that workforce to have a postgraduate critical care nursing qualification. Those are high standards and that’s a good thing. We are bringing high standards in the community, that’s the framework. Also, on top of that framework, services need to be accredited. They need to be third party accredited for Intensive Care at Home.

Where are patients in hospitals if they have a tracheostomy? They are in intensive care. The only way you can take someone out of intensive care with the tracheostomy is by bringing intensive care into a home, and that must happen with quality standards. So that leads me to that, we are the only service in Australia in 2024 that has achieved third-party accreditation for Intensive Care at Home nursing. No other service brings a higher level of skill into the community and that enables us to look after the highest acuity clients in the community.

Let’s go back to our client and let’s read out the email. It was important that you understand the framework that we’re operating in and that will put context to the email that I’m reading out to you now from our client.

“Hi Patrik,

I need to book another hour of consulting with you for your assistance. My mother was discharged to home with a tracheostomy without nurses so we couldn’t really treat my mother at home without violating her health. So, we were left alone with my mother and only for four visits from the hospice nurses for three days.

Very mad, that’s not 24 hours a day, which is what is needed for a tracheostomy client.

In addition, the doctor prescribed medication for my mother that is extremely hard to get over a holiday weekend, which resulted in her having a seizure.

So, bear in mind, this lady has a tracheostomy and seizures. You can’t do that at home without critical care nurses, 24 hours a day, people have died because of it. I’ve made countless video about that people have died at home because they didn’t have 24-hour critical nurses when they were having a tracheostomy and/or ventilation.

So, then the client continues.

I had to call an ambulance to transfer her back to ICU after the Ativan stopped the seizure completely. The ambulance laid her flat with the tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) for 40 minutes, which caused her to aspirate, and she now has an aspiration pneumonia in both lungs.

She is back on full life-support in the ICU at a local hospital as they try to work out a seizure medication in order to return her back home again.

We are to meet with the palliative care team tomorrow at 11am and I would like to you to be present so that you can give input in the care plan for my mother. I would also like the lead nurse from the ICU to be part of that conversation so that she can understand what Intensive Care at Home can provide.”

It’s another strong piece of evidence that whenever patients with a tracheostomy and/or ventilator want to go home without critical care nurses, 24 hours a day, lives are at risk. We know of at least 5 clients that have passed away in the community when critical care nurses were not present, 24 hours a day, that had a tracheostomy and/or mechanical ventilation.

So, the Mechanical Home Ventilation Guidelines plus accreditation is the gold standard in the community and we are the only provider that brings that in the community. There is no other provider who brings the same level of standards in the community. Many community services are run by non-clinical people which is scary because they don’t really understand the needs of their clients.

I’m a critical care nurse by background and I’m practicing every day whereas many other providers, they don’t have clinical people in charge and that’s quite scary. You should ask those questions when you are engaging with the provider who’s running the show, what is their clinical background? It takes years and decades of ICU nursing experience to understand what needs to happen with the tracheostomy and the ventilator. It can’t be handled by laypeople because if laypeople are handling it, people have died and will continue to die. You also need the right advocacy in a situation like that, which means you need to know what evidence to gather. You need to know who to talk to and you need to know how to advocate for the funding for critical care nurses in the community. Once again, that’s what we’ve been successfully doing for the last 12 years with Intensive Care at Home.

So, I hope that illustrates once again how dangerous it is in the community if you’re not having the right level of support. Lives are at risk, people can die, and they can die at the drop of a hat because when a tracheostomy blocks or when the ventilator stops, you have three minutes only. If within those three minutes you don’t know what you’re doing, i.e. you are not a competent critical care nurse, people are dying because you’re not getting an ambulance within three minutes.

If you do get an ambulance within three minutes, I can guarantee you, there’s absolutely no guarantee that the ambulance crew is tracheostomy and ventilator competent. Very few ambulance crews are. Therefore, critical care nurse in the community is the best life insurance, so to speak, for tracheostomy and ventilated patients at home. It still cuts the cost of an intensive care bed by around 50% and provides a much-needed win-win situation.

So, with Intensive Care at Home, we are currently operating all around Australia in all major capital cities and in all regional and rural areas. We are a NDIS (National Disability Insurance Scheme) approved service provider in Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) and the Department of Veteran Affairs (DVA) all around the country. Our clients also receive funding through public hospitals, private health funds, as well as departments of health.

We are the only provider in Australia in 2024 that’s employing hundreds of years of intensive care and critical care nursing experience combined in the community and that is unmatched in 2024. No other provider brings this high level of skill into the community and no other provider can look after a higher acuity in the community than we do safely. We’re also the only provider in Australia in 2024 that has achieved third party accreditation for Intensive Care at Home nursing. Once again, we have built substantial and significant intellectual property for our area of expertise.

Now, just like we’ve heard from our client, if you’re at home already in a similar situation or you are in ICU and you’re contemplating going home, you do need critical care nurses 24 hours a day. Anything less than that will get you back to ICU or worse, your loved one will die. We’ve seen it many times.

If you realize that whatever you’re planning going from ICU to home is not safe, or if you’re at home already and you realize it’s not safe, just like our client did here, please reach out to us. We can help you like we have helped all of our clients to obtain the right funding and obtain the right level of care for yourself or for your loved one. We can help you with the advocacy. We can help you with the funding. We’ve done so from Day 1 successfully because otherwise we would not be in business.

We’re also providing Level 2 and Level 3 NDIS Support Coordination and we can help you and your family to get on the NDIS. We’re also providing TAC case management. We help you with obtaining the right funding through the right funding scheme, that’s part of our skill set. I’ve also done an interview with our NDIS support coordinator, Amanda Riches, and I will post a link towards that interview below this video.

Now, if you’re a NDIS support coordinator watching this and you’re looking for nursing care for your participants, please reach out to us as well or if you’re looking for funding for more nursing care and you don’t know how to go about it, I also encourage you to reach out to us. We can help you with the advocacy and we also provide NDIS specialist nursing assessments done by critical care nurses.

If you are a critical care nurse looking for a career change, we’re currently offering jobs for critical care nurses in the home in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo in Victoria, as well as in Warragul in Victoria, as well as in Geelong. If you have worked in critical care for a minimum of two years pediatric ICU, ED, and you have already completed a postgraduate critical care qualification, we will be delighted to hear from you.

Because we are offering a tailor-made solution for our clients which includes regular staff, our clients want to have the same staff coming over and over again because they are very, very vulnerable. It’s all about building those critical relationships and having regular and stable teams. That also means if you’re looking for agency work where you can come and go, this may not be the right fit for you because we’re looking to engage with you on a long-term basis and our clients want to engage with you on a long-term basis. So, it’s all about building critical relationships long-term so that it remains a win-win situation for everyone.

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

We can help you to eliminate your bed blocks in ICU and ED for your long-term patients or for your frequent flyers. We’re here to help you take your pressure off your ICU and ED beds and in most cases, you won’t even pay for it.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, please reach out to us as well. We can help you.

Lastly, if you’re in the U.S. or in the U.K. and you’re watching this, and you need help, we want to hear from you as well. We can help you there privately.

Once again, contact us at intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to info@intensivecareathome.com.

If you like my videos, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care. Click the like button, click the notification bell, share this video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

I also do a weekly YouTube live where I answer your questions live on the show and you will get notification for the YouTube live if you are a subscriber to my YouTube channel, or if you are a subscriber to our email newsletter at intensivecareathome.com.

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.