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What Needs to be Considered Before a Discharge Home from ICU for a Ventilator & Tracheostomy Patient?

Let’s move on in regards to an Intensive Care at Home that have come in during the week. Just finding the email here. There it is.

So, we’re currently talking to an ICU as well as to a family to get their loved one home from ICU after about six weeks in ICU after a car accident. Patient is ventilated, has a tracheostomy, and is unable to wean off the ventilator and the tracheostomy, but wants home care. The patient is elderly, has been in a severe high-speed motor vehicle accident and wants to go home. At the moment, she can’t be weaned off the ventilator, which is why family has reached out to us.

It looks like it’s an insurance commission case, i.e. after motor vehicle accident, the insurance should kick in for home care as well. We are looking after other home care clients, so let’s look at that. Let’s look at the questions that have come in there from the ICU actually.

By anyone watching this, if you are working in an ICU and you want to know more about our service, this is a good opportunity to answer some questions here.

So, the ICU is asking, “What about the tracheostomy and PICC (Peripherally Inserted Central Catheter) line change every 30 days? Who would facilitate this?” So we can change tracheostomy at home. When we are doing tracheostomy changes at home, whether they are elective tracheostomy changes and God forbid sometimes, they’re non-elective, but the non-elective ones happen very rarely. They still happen every now and then. So that’s how we deal with tracheostomies at home, unless of course there is a super high risk where a tracheostomy change needs to happen in a hospital environment. I’ll give you an example when a tracheostomy change does need to happen in a hospital.

There’s one client that we have worked with over the years. The tip of the tracheostomy is sitting very close to an artery and in the past, even with a tracheostomy change in a hospital, the arteries started bleeding. Obviously, that is a very high-risk and therefore a tracheostomy change for a patient like this ideally needs to happen in a hospital or in a controlled environment. Sometimes it needs to happen under bronchoscopy, but that is the exception, not the rule.

With PICC lines, no, we cannot change PICC lines at home. That would need to be done as an outpatient, but PICC lines do not need to be changed every 30 days. PICC lines can stay in for up to 12 months. We have certainly had clients at home with PICC lines staying in for up to 12 months predominantly for a home TPN (Total Parenteral Nutrition), but also sometimes for IV (Intravenous) potassium, IV magnesium infusion, but they can stay in for up to 12 months.

Next question that came in, “How does ongoing management of a patient like this look?” So first off, because it’s through a car insurance scheme, the car insurances or the motor vehicle insurance scheme, they have often their own case managers because they then usually allocate the funds to service providers in the community, whether that’s obviously to Intensive Care at Home, whether that’s to allied health such as physio, OTs (occupational therapists), but also auxiliary support such as support workers to support 24-hour critical care nurses at home. So that’s usually the process. That’s how it works with the TAC (Transport Accident Commission) in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland) in Queensland. This is obviously a different insurance scheme. I’m not going to mention names, but it’s sort of a similar process.

We obviously provide the 24/7 nursing care with critical care nurses with a minimum of two years critical care nursing experience, similar to many other clients we’re currently working with that are ventilated with tracheostomy. With all of our clients, there’s always a multidisciplinary team that needs to be created before discharge home. Once again, whether that starts with the nursing care, the medical cover, allied health, physio, OT, speech, dietitian, and so forth. And then, often, there are at least for parts of a day or a night, there are support workers as well to help with turns, help with pressure area care, but also help with household tasks sometimes as they can’t be done by the nurses because the nurses are busy with nursing the client.

The other question that came out of this is, “What’s the escalation protocol?” Well, escalation protocols, first of all, depend on the goals of care for a client. What are the goals of care for a client? Is it to wean them off the ventilator? Is it to provide palliative care at home? What are the goals of care? The escalation protocol will be tailored around that. Now, whilst we have a standard escalation protocol, that is if there are no treatment limitations, if it’s a straight forward ventilated tracheostomy client and there are no other issues.

But it’s not necessarily, well, it actually very rarely is a one-size-fits-all approach. Every client has their unique parameters really about when to escalate treatment, when to escalate care, but there is always an escalation protocol. If not, it’s our standard protocol. But a lot of it really comes down to understanding the client’s situation, the client’s condition. Like I said in the beginning, goals of care, care plans, rehabilitation plans, those discussions need to happen to then have an appropriate escalation protocol or policy.

Another question that came about is turns, pressure injury concerns. Again, like I said in the beginning of this call where one of our other clients had a question around, “Is two-hourly pressure area care something that they can expect? What if it’s not two-hourly? What if it’s over two hours and there are pressure sores and the ICU is not informing families?” Well, like I said during that segment of the call here, that’s gross nursing and medical negligence, full stop. And because it’s gross nursing and medical negligence, that’s not good enough but we do the same at home. We turn our patients two-hourly if they’re not mobilized and if they’re not out of bed. Very simple, they’re not out of bed and if they’re not mobilized.

Next, rehabilitation goals. But once again, what are the client’s rehabilitations goals? Can that be done at home? The goal is to get this lady off the ventilator, of course. Can that be achieved? I don’t know. I don’t have enough information just as yet, but these are questions that have come from the ICU directly, but we haven’t actually been given a full picture of the patient. Once we know a lot, it’s not a full picture, if we haven’t been able to look at medical records, for example, to give us an idea of what’s happened to this point. Whilst we have a good idea from the family, it’s probably not enough to talk about rehabilitation goals just as yet.

Then, the question came up about legal governance. “Who’s responsible?” Well, insurance commission in a situation like that as the funding body, once again, will allocate service providers that have their own legal governance, i.e. we have our own legal governance Intensive Care at Home. Then, allied health providers such as physio, dietitian, OT, speech therapy, and so forth, they usually have their own and legal governance because we don’t employ them. We are solely responsible for the nursing care. But the insurance commission also has a responsibility about putting the funds in place, putting the service providers in place, making sure the client gets what they need and also what they’re entitled to.

Then, next, “Who’s the doctor overseeing a case like this?” Well, that’s a great question. From our perspective  with all of our clients in Australia, it depends a little bit on the state. So for example, in Victoria, for most of our adult clients, it’s the VRSS overseeing the clients from a medical point of view. The VRSS is the Victorian Respiratory Support Service and the Victorian Respiratory Support Service is overseeing the adult clients medically. If it’s a pediatric client, ventilated client, they are overseen often by the Children’s Hospital in Victoria in Melbourne. So it depends a little bit with clinical governance.

In other states like in Queensland, New South Wales, South Australia, WA (Western Australia), there is no such thing as the VRSS. So then, the medical cover often comes through hospitals can come through respiratory physicians, through anesthetists, through pediatricians, sometimes even through GPs, but it can also come through one of our private intensive care consultants. We’re working with private intensive care consultants as well.

So those are the options, and it’s never an obstacle really. As we all know, ICUs need beds and because ICUs need beds, that’s why there is always a solution going forward to get patients home, takes goodwill from all parties of course, but that goodwill can be created, for sure.

So, I hope that helps you understand of what needs to happen in a situation like that.

So then, another Intensive Care at Home question we had coming in this week was, “Can a phosphate infusion be given at home via a central line and can Intensive Care at Home do that?” Well, that’s a great question. Well, central line, PICC line, Hickman’s line, port-a-cath, we can manage all of them at home. It’s not the issue.

Now, does a phosphate infusion always need a central line? No, it doesn’t, but most of them do. It can also be given via a big or a large peripheral vein. But the question also, is it potassium phosphate or sodium phosphate or which one of the two is it? Because potassium phosphate has a higher risk for vein irritation, and therefore it’s much better to use a central line or a PICC line or a Hickman’s line or a port-a-cath.

Keep in mind, depending on what’s going on with electrolytes, for example, if the patient needs a phosphate infusion, but then their potassium drops, for example, and they’re getting sodium phosphate, that can be given peripherally. But what if it changes? What if phosphate needs the add-on of potassium? Then, a central line would be so much better because patients that receive potassium through a peripheral line report excruciating pain, which is why it needs to be given through a central line.  So, that was a question actually from a hospital that came in last week, whether we can do that and I said, “Yes, we absolutely can. Again, we’re managing central line, PICC lines, Hickman’s line, and port-a-cath at home. That’s what we do, it’s part of our skill set.”

So, those were the questions I wanted to address today. If you have any questions, please type them into the chat pad or click on the StreamYard link here. Call and talk to me directly. Talk to me directly, this is your opportunity. This is your opportunity to talk to me. If not, you don’t have any questions and I am going to wrap this up today.

Like I said, with Intensive Care Hotline, if you need consulting and advocacy in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected]. Now, we also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, if you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in a membership area and via email, and we answer all questions intensive care related.

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly. I talk to you and your families directly. Of course, I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong.

We also do medical record reviews in real time and we also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

With Intensive Care at Home, like I said, we are providing a genuine alternative to a long-term stay in intensive care, and all around Australia at the moment, we’re sending our critical care nurses into the home 24 hours a day as a genuine alternative to a long-term stay in intensive care, predominantly for ventilated and tracheostomy clients, adults and children.

I am going to wrap this up. We’re also providing Level 2 and Level 3 NDIS Support Coordination.

We’re also currently hiring for critical care nurses in Melbourne, Sydney, Brisbane, Albury, Wodonga, Geelong, Warragul, as well as in Bendigo. If there are no other questions, I do wrap this up now.

Subscribe to my YouTube channel. Like the video, 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.

I do this weekly YouTube live. That’s every Sunday morning, 10:30am Sydney, Melbourne time, which is currently 8:30 PM Eastern Standard Time on a Saturday night, is 7:30pm on a Saturday night Central Time, North America, it’s 6:30pm Mountain Time North America, and it is 5:30pm Pacific Time, and right now it would be just 1:00am or 1:30am in the U.K. and Ireland. So, watch out for these YouTube lives they happen every week same time.

Thank you so much for watching.

I’ll see you again next week and look out for the quick tips and other videos that I’ll be sending through during the week on my channel.

Take care for now and stay safe.

So, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. That means, we are providing a genuine alternative to long-term stay in intensive care for ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy, tracheostomy without ventilation, Home TPN (Total Parenteral Nutrition), home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics. We’re also providing ventilation weaning at home. We’re also providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home. We’re also providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home as well as palliative care services at home. We also use cough assist machines for our clients for airway clearance.

We are also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of them going to the emergency department.

That also means we’re in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our services cost between $2,500 to $3,000 per day and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. But most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders. Of course, quality of life at home is much improved surrounded by families.

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

We are currently the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2025. We have been achieving this level of accreditation since 2012. No other service provider has achieved this high level of accreditation in the community and has created more intellectual property for Intensive Care at Home nursing than we have. This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do, which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this, or if you’re stuck in an ICU, or if you’re going to hospital and ED (emergency department) all the time, and you realize that you don’t have the right level of support, I’ll give you another tangible and real-world example today, very similar to the one I gave you a minute ago.

One of our first clients when we first got started over 10 years ago, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers are dangerous and negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with the cabin crew instead of the pilot because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies 24/7 or even at high risk of dying if they don’t have a team of critical care nurses looking after them 24/7. This is actually evidence-based and it’s documented in our Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

Think about it, in an intensive care unit in a hospital, you wouldn’t have support workers looking after a critical care patient on a ventilator with a tracheostomy. So, why would anyone in their right mind would do that in a home care environment in the community?

So, this client found out about us eventually and the ICU that he went back to all the time also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never, ever went back into ICU ever again and we were proving our concept there very fast.

We can do the same for you if you’re not safe at home which includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business. The same is applicable for those stuck in an ICU, similar to our case study today, or going back to ED all the time, so what you’re looking for? Reach out to us, we’ll make it happen for you as well. We can take you through the right steps including NDIS or other funding bodies, and the advocacy that needs to go along with it.

Which is also why we are providing Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS Support Coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

If you’re an NDIS Support Coordinator or a case manager from another organization watching this, and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for nursing care for your participants, and you don’t know how to go about it and what evidence to provide, I encourage you to reach out to us as well. We will help you with the right level of funding and with the right level of advocacy. We’re also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

If you are a critical care nurse and you’re looking for a career change, and you want to join a very progressive, dynamic, high-performing team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined. If you are looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I have a disclaimer, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again because they are very vulnerable and very special, and that’s why we need regular staff. So, if you’re looking for agency work where you can come and go, this will not be the right fit for you. We are looking for consistency and our clients are looking for consistency. So please, only apply with us if you can give us regular and consistent availabilities for shifts and if you’re really keen on building relationships with us and with our clients.

If you are an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well.  We can also help you eliminate your bed block in your ICU and in your ED for your long-term patients, or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it is much more cost-effective than what you’re paying for in ICU and ED, and you get the same level of care.

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

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 with one-on-one consulting and with hiring nurses privately.

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

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 the video with your friends and families, and comment below what you think about this video or what you want to see next.

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.