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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 services for long-term, ventilated adults and children with tracheostomies. Otherwise medically complex patients at home including Home TPN (total parenteral nutrition), Home tracheostomy care for adults and children that are not ventilated, but have a tracheostomy as well as for adults and children that are not having a tracheostomy, but a BIPAP (bilevel positive airway pressure) and CPAP (continuous positive airway pressure) ventilated. And also we provide seizure management at home.
So in today’s video, I want to answer a fairly lengthy question from one of our readers and also clients. But I think it illustrates very much what a lot of families are going through in intensive care when they start to look at alternative options after they realize that intensive care can’t really give them the outcomes that they want when it comes to a long-term stay.
So let’s read out the question from Morgan who says,
Hi Patrik,
My mom has been in ICU after an emergency coronary artery bypass graft surgery at the end of August. And now we have been in hospital for over 4 1/2 months or we have been in ICU for over 4 1/2 months. And now we are being presented with the only option as being hospice because she can’t come off the ventilator and the tracheostomy.
Before all of these, she had no prior health problems other than breast cancer 15 years ago and she had chemo and radiation and she recovered from that. In August, she had complications during a cardiac catheter procedure, also known as angiogram, which resulted in a coronary artery dissection and cardiogenic shock, which is the reason for the emergency open heart surgery, also known as CABG (coronary artery bypass grafts).
She had multiple complications postoperatively including bleeding, heart failure in three days of hemofiltration, also known as CRRT, which stands for Continuous Renal Replacement Therapy. Her kidney functions are close to normal now. She was on sedation initially for 21 days before having a tracheostomy. After that, we were told she had severe sepsis and two small strokes that were discovered once the CT scan of the brain was done. She also had obviously then the tracheostomy during her stay in ICU since she was unable to come off the ventilator.
Since the open heart surgery, her ejection fraction is 40% but we are now being told she has metabolic encephalopathy since she’s not consistently responsive to commands and she has been back on sedation for the last two weeks. She has also been failing her ventilation weaning trials. I believe this has to do with the fact she has been back on sedation due to anxiety and becoming tachypneic.
The settings are SIMV (synchronized intermittent mandatory ventilation) FIO2 (fraction of inspired oxygen) of 30% and PEEP (positive end-expiratory pressure) of 5, we feel the ICU team are giving up on her because she’s costing them too much time and resources. They are making me feel guilty as if I’m making her suffer. But if there’s any hope I want to give that to her. We are hoping that she can go home with Intensive Care at Home because we are so fed up and my mother is so fed up. She has no quality of life. Can you please give any advice?
Thank you so much.
From Morgan
Hi Morgan,
Thank you so much for sharing your mother’s situation, in so much detail. You know you’re not alone out there. This is not unique to your family and to your mother to be stuck in ICU for 4 ½ months if they can’t come off the ventilator, especially after open heart surgery. Not many patients, suffer from long-term stays in ICU after open heart surgery, but I have certainly seen someone and it looks like your mom is falling into that category.
Now, going home in a situation like that won’t be a problem and if you feel like, the ICU either wants to send her to hospice to let her pass away. Well, you have a say in that assuming you are the power of attorney, it’s not up to the ICU to say she needs to go to hospice. It is up to you to make that decision. And if you want her home, you should get the ball rolling on this.
Now, in terms of costing too much, ICU bed costs 5 to $6000 per bed day and Intensive Care at Home costs about half of that.
So basically what we do is we bring you the intensive care into the home with critical care nurses 24 hours a day, which is what she has at the moment. It’s not any different with the difference that you can have this at home. Your mom will have quality of life or potentially quality of end of life, depending on how it goes with her recovery.
But they haven’t made any progress in there, clearly. They can’t give her what she needs. And the best answer they come up with is hospice. Well, the best answer to come up with, I believe in your mom’s situation is Intensive Care at Home. That’s a win-win situation. Your mom will improve her quality of life or potentially a quality of end of life. She will be in a family-friendly environment. She has the ICU coming into her home, she has critical care nurses coming into her home. You can stop “living in ICU”, you will have a life back. You can concentrate on looking after your family while we are looking after your mom at home.
Whoever is paying for the ICU bed at the moment, 5 to $6000 per bed day, we can cut that to about 50% of the cost. So again, it’s a win-win situation.
And lastly, the intensive care needs the bed, the intensive care unit needs the bed. So it’s a win-win altogether. So everybody is winning here. So, let’s continue the conversation and please reach out to us to make this happen. We can start negotiating with the health fund or maybe your mom is NDIS (National Disability Insurance Scheme), I don’t know, we need to find out the details who can be funding it, but it doesn’t really matter. Somebody will be funding it because again, there’s an economic business case here. Besides, I don’t want to reduce your mom to a business case by any means, your mom is a patient that needs to go home that needs to improve her quality of life.
Clearly, they can’t give her what she needs. But unfortunately, in situations like that, you also need to argue on an economic level, which is what we’ll help you doing. So please reach out to us here at intensivecareathome.com, send us an email to [email protected] or just call us on one of the numbers on the top of our website to take this conversation further. So we can help you going home.
Now with Intensive Care at Home, currently, we are operating all around Australia. We are an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, a TAC (Transport Accident Commission) approved service provider in Victoria, an ICare approved service provider in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as DVA (Department of Veteran Affairs) all around Australia. We also have received funding through public hospitals and through departments of health as well as private health funds.
And if you’re watching this and you’re in the U.S. or in the U.K., please reach out to us as well because we can help you with private nursing in those countries.
Now, and if you are in a similar situation where you have a loved one in intensive care and you’re in a similar situation, please reach out to us or if you’re watching this and you are a patient in ICU, you should contact us, talk to us, send us an email, and we can talk to you, we can talk to the ICU. We are very experienced in taking patients home from intensive care directly.
And furthermore, if you’re at home already and you have insufficient support, you don’t have staff, you’re going back to hospital all the time because other providers can’t keep your home because of your condition because of the complexities of your condition, we want to hear from you. Our clients do not go back to hospital, because we manage them at home, otherwise we wouldn’t be in business.
Now, if you are an NDIS support coordinator and you’re watching this and you’re wondering where to send your clients for nursing care. I especially for high complex nursing care where we are. If you need help with the advocacy. If you need help with NDIS nursing assessments, please reach out to us as well.
We also have our own Level 2 and Level 3 NDIS support coordinators. Please reach out to us if you need help there.
And if you are an intensive care nurse or a pediatric intensive care nurse or an ED nurse with a minimum of two years ICU, pediatric ICU or ED experience, and you ideally having, having a critical care postgraduate qualification, please contact us as well. We are currently hiring ICU and pediatric ICU nurses and ED nurses for clients in Melbourne Metropolitan area, Brisbane and Sydney as well as in remote areas in Victoria such as Bendigo, Warragul as well as in Albury Wodonga.
We are also currently providing an ED bypass service for the Western Sydney local area health district. If your hospital needs an ED bypass service to take pressure off your emergency department, we can do the same for you. Please reach out if you’re an emergency consultant, if you’re a hospital executive watching this and you want us to help you eliminate your bed blocks either in ICU on a respiratory ward or in Ed. We’re here to help you as well.
And if you are an intensive care doctor, ICU specialist, you have any bed blocks in your ICU, please contact us. We can help you manage your exit blocks in ICU by eliminating long-term stays in ICU and we can do that fast.
Thank you so much for watching.
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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.