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Surviving ICU: The Value of Qualified, Specialist Intensive Care Nurses for INTENSIVE CARE AT HOME

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 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 clients, 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), and Home IV potassium infusions, home IV magnesium infusions, and home IV antibiotics. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheters) line management, as well as Hickman’s line management. We also provide palliative care services at home.

We’re also sending 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 with their in-touch program.

So today, I want to actually focus on a recent article from Monash University. Monash University in Melbourne, Australia says, “Surviving ICU: The value of a qualified, specialist intensive care nurse.”

Now, this article has sparked my interest, not only because one of the co-authors is Paul Ross, who is one of my former colleagues. A shout out to Paul Ross here who is an amazing ICU nurse, but also the other two co-authors, one of them I worked with, which is Professor David Pilcher, one of ICU consultant. Then there’s also Wendy Pollock, another ICU nurse who have written the article together.

Now, I’ll give you the gist of the article before I read some excerpts from it. Basically, the article highlights that specialist intensive care nurses with a postgraduate critical care qualification will make all the difference in patient outcomes in intensive care.

Now, the same is applicable to Intensive Care at Home. The article talks about that if an ICU employs over 50% to 75% of ICU nurses with the postgraduate critical care qualification, the mortality rate in ICU is going down considerably. It’s the same here with Intensive Care at Home, we would approximately employ 75% of our ICU nurses with the postgraduate critical care qualification, which is a fantastic result for us, and it also improves outcomes for our clients as well. Now, similar to ICU in hospitals, we employ hundreds of years of ICU experience combined. Most of them with the postgraduate critical care qualification.

Now, one of our KPIs is to have no non elective hospital readmissions back to hospital, and we are achieving that KPIs.

So, let’s just look at the article and I will bring it back to how it really impacts and impacts on Intensive Care at Home and that we are doing similar things here to keep our quality standards very high.

“Every year, nearly 200,000 people are admitted to an intensive care unit in Australia. An ICU is the place in a hospital where patients go when experiencing life-threatening illnesses. It is where machines provide “life support”, such as mechanical ventilation and kidney support (renal replacement therapy).” Very similar to what we do at home with Intensive Care at Home. Our clients are on machines on life support. So very similar.

The article continues, “Life sustaining drugs are also infused to keep the heart pumping and to maintain a blood pressure compatible with living. Vigilant observation is needed with continuous monitoring of the heart and oxygenation, among other things.

Australia has some of the best intensive care outcomes in the world, so good that an Australian and New Zealand specific mortality prediction tool was developed to measure and help monitor ICU care.

For patients admitted to an Australian ICU, 8% die either in ICU or while still in hospital. In the U.K., the hospital mortality for patients admitted to ICU is 18.1%, and in the U.S., the rate ranges from 10% to 29%.

What’s different about Australian ICUs?

For a developed country, we have a relatively modest number of ICU beds per capita, less than half the OECD average. Thus, there’s pressure on ICU beds”, and we help alleviate that pressure on ICU beds with Intensive Care at Home quite clearly.

“One component of Australian intensive care that’s distinctly different to many other countries is highly educated ICU nurses and how they practice.

Australian ICU nurses possess advanced knowledge and skills acquired through postgraduate qualifications, and their scope of practice is expansive and holistic.

One ICU nurse looks after one ventilated ICU patient or two non-ventilated ICU patients.” Similar with Intensive Care at Home. Our nurses have a one-to-one nurse to patient ratio on their shift. We send them to one client into one home.

“This one nurse attends to all patient care needs, including clinical assessment and monitoring of all body functions, providing all hygiene needs, delivering nutrition, attending to wounds and dressing, administering all medications, managing and titrating all machinery.” Again, very similar to what we do at the Intensive Care at Home. We just do it in someone’s home.

“For example, an ICU nurse in Australia would take a blood sample and run the test, adjust the ventilator settings according to the result, and ensure the machine-provided breathing targets are met.

They also communicate with, and support family members of the patients in their care. This is quite a different scope of practice compared to the U.S. For example, where nurses in ICU routinely get two ICU ventilated patients to care for, but there are respiratory therapists who manage the breathing machines.” Then the article continues with another heading saying,

The postgraduate qualification factor

“However, not all ICU nurses working in Australian ICUs possess a postgraduate ICU nursing qualification.

We recently conducted a study to examine whether the proportion of ICU nursing staff with a postgraduate specialty ICU nursing qualification in an ICU made a difference to patient outcomes.

Using the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and the pandemic-inspired Critical Health Resources Information System (CHRIS), we were able to link individual patient data with daily ICU nursing data in more than 16,000 patients admitted to one of 20 Victorian public and private ICUs between 1st of December 2021 and 30th of December 2022.

Patients admitted to an ICU that had 50-75% qualified ICU nurses during their admission were 21% more likely to die than patients admitted to an ICU with more than 75% qualified ICU nurses. The impact on mortality was even higher when only patients who needed a breathing machine or advanced support were examined – a 35% higher chance of dying.

The ANZICS Adult Patient Database is a high-quality registry, and these differences were observed while controlling for factors we know increased mortality such as age, frailty, emergency admissions, and severity of illness.

There was no difference in mortality for ICU patients that did not receive advanced support or need a breathing machine.”

Once again, with Intensive Care at Home, pretty much all of our clients are on breathing machines at home, whether that’s with a tracheostomy or without a tracheostomy.

“There was also no statistical difference for patients cared for in ICUs with less than 50% qualified ICU nursing staff. However, the magnitude of mortality difference was similar to the 50-75%; it just did not reach statistical significance most likely due to the small numbers of patients in this category.

Furthermore, it wasn’t just mortality that was different. Patients cared for in ICUs with more than 75% qualified ICU nurses were less likely to develop a pressure sore, experience delirium, and they had a shorter-observed ICU length of stay than what was predicted.

Clearly, a qualified ICU nurse providing care to an ICU patient makes a difference. The advanced knowledge and skills achieve better outcomes, as qualified ICU nurses are proactive in the care of their patients actively and effectively weaning life sustaining drugs and machinery, confidently advocating for changes in care as part of the ICU team and critically thinking and using clinical reasoning.

They also supervise and provide support to novices on a daily basis, thereby influencing the quality of care of other patients are receiving.

Critical shortage of qualified ICU nurses

Sadly, the COVID-19 pandemic has amplified a critical shortage of qualified ICU nurses. Burnout is at an all-time high and it’s estimated that 27% of ICU nurses intend to leave ICU. High rotations onto night duty and the need to support a growing number of inexperienced staff contribute to staff burnout.

Further, on the odd occasion when there might be a chance for a breather because there’s an empty ICU bed, an ICU nurse will be sent to another ward area to help out. This equates to sending a specialist criminal barrister to the tax law department and fails to recognize the expertise of the nurse, making them feel undervalued and just a number in the system.”

But we don’t do that here in Intensive Care at Home because our nurses will not be sent to a ward because we don’t have a ward. We only provide a genuine alternative to a long-term stay in intensive care in the community. So, we can’t send you to a ward if you work for Intensive Care at Home.

“Government policy has sought to address the ICU nursing shortage by supporting more general nurses to become specialist ICU nurses. However, the workforce gap and critical shortage relates to experienced, qualified ICU nurses.

There’s no shortage in attracting nurses to postgraduate specialty ICU nursing education. But there’s an urgent need to address retention of experienced qualified ICU nurses if the best patient outcomes we currently see in Australian ICUs are to continue.

It’s time to think of highly-educated and skilled ICU nurses as an intervention – a drug with this sort of outcome would command investment. It’s time we invested in experienced nurses so we can improve their retention and maintain our high standards of practice in ICU care.”

Well, thanks again to Paul Ross, David Pilcher, and Wendy Pollock for doing the research on this.

Like I said, we support this type of research because it just goes to show that the same is needed in the community, a highly qualified and skilled nursing workforce for ICU nurses so that we can keep the pressure off ICU beds because that’s what we do. We take the pressure off ICU beds and keep our clients at home.

So, you heard it in the article that there’s a massive shortage of ICU nurses in hospitals and therefore, ICU beds are in high demand, and we help to take the pressure off those high demand ICU beds.

In terms of quality standards, as far as I know in 2024, there is no other service in Australia that has achieved third-party accreditation for Intensive Care at Home. We are the only provider in the country that can provide this type of service in 2024, maybe it will change in the future. But for now, we are the only provider in the country that has achieved third-party accreditation for Intensive Care at Home.

Now, we also provide evidence-based care with the Mechanical Home Ventilation Guidelines. So, go and check out the Mechanical Home Ventilation Guidelines. You will see that it’s evidence-based what we do and it’s research driven.

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

Now, like I said, we are employing hundreds of years of intensive care nursing experience combined in the community. I believe that is unmatched in 2024 in Australia.

We’re also providing Level 2 and Level 3 NDIS support coordination, which is critical for most NDIS participants in a situation where they have a loved one in intensive care if you’re looking for an NDIS plan or where they have a loved one at home already with insufficient support.

If you are at home already in a similar situation, and you realize you don’t have enough support and you don’t have the ICU nurses that can take care of you or your family member properly, 24 hours a day, or your family member or yourself is going back to hospital all the time, I strongly encourage you to reach out to us as well here at intensivecareathome.com because we keep our clients at home predictably because you don’t want your family member or yourself going back to the hospital and to ICU all the time. Our success rate in keeping patients at home and our clients keeping them at home predictable is very, very high.

If you are an NDIS Support Coordinator and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for more nursing care, I also encourage you to reach out to us. We can help you with the advocacy and we also provide specialist NDIS nursing assessments.

If you are a critical care nurse and you’re looking for a career change, we are currently offering jobs for critical care nurses in the home in Melbourne, Sydney, Brisbane, and Albury Wodonga in Bendigo, in Victoria, as well as in Warragul in Victoria.

If you have worked in critical care for a minimum of two years, pediatric ICU, ED, and if you have already completed postgraduate critical care qualification, we would be delighted to hear from you.

We are offering a tailor-made solution to our clients, which includes regular staff. Our clients will have the same staff coming over and over again because our clients are very vulnerable and it’s all about building those critical relationships and having regular and stable teams.

So, if you are looking potentially for agency work where you can come and go, this may not be the right fit for you. But if you’re interested in a long-term engagement with us and a long-term engagement with our highly valued clients and their families and building those critical relationships, then this is 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.

Once again here at Intensive Care at Home, if you have bed blocks in your ICU or in your ED, we can help you eliminate some of your bed blocks for long term patients or patients that come in frequently. We can help you take the 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.

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.

All of that, you get at intensivecareathome.com. Call us on one of the numbers on top of our website or send us an email to [email protected].

If you like my videos, subscribe to my YouTube channel for regular updates for Intensive Care at Home and 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, what questions and insights you have.

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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.