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Hi, it’s Patrik Hutzel from intensivecareathome.com. If you want to know what tests should be done before a patient is being discharged to Intensive Care at Home, stay tuned! I’ve got news for you.
My name is Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home. We 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 services at home.
We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully for the Western Sydney Local Area Health District, their in-touch program.
In essence, we’re saving 50% of the cost of an intensive care bed whilst drastically improving the quality of life for our clients and their families, and we’re saving roughly $2,000 for the cost of an ED admission by providing the ED bypass service at home. So, on top of the quality-of-life improvements for our clients and their families, massive cost savings for the healthcare system, and we’re freeing up beds in ICU and ED. All in all, it’s a win-win situation.
Today, I want to look at what tests should be done before a patient is being discharged to Intensive Care at Home. This is a question obviously that we get from one of our clients that we’re just in the process of getting home.
So, let’s look at this more closely. This is for a client who had seizures, stroke, who also has a VP (ventriculoperitoneal) shunt to manage her CSF (cerebral spinal fluid). Therefore, this client has been in ICU for months on end, so it’s way time for her to go home. She’s not ventilated, but she’s got a tracheostomy. She’s at high risk at home of airway blockage with a tracheostomy, so she does need 24-hour nursing care with critical care nurses with a minimum of two years critical care nursing experience as is evidence based.
You can look up the evidence on our website at the intensivecareathome.com. The Mechanical Home Ventilation Guidelines, once again, they are evidence based, and it says that only critical care nurses with a minimum of two years critical care nursing experience can safely provide services to ventilated plus minus tracheostomy clients at home, adults and children.
So, in a situation like that where the client had seizure and a stroke in the course of her ICU stay, she should have had an EEG (electroencephalogram). She should have had a brain CT scan and an MRI scan, and I can confirm both of that should have been done as part of the ICU admission. A 12-lead ECG (electrocardiogram) should have been done. Blood tests such as full blood count, glucose, electrolytes, calcium, renal function, liver function, urine function, and biochemistry should all be part of standard tests in ICU, especially when it comes to electrolyte discrepancies that can trigger a seizure and that need to be managed at home.
So, for example, if low magnesium, low potassium, low calcium, or the opposite, high calcium, high magnesium, high potassium could trigger a seizure, that needs to be figured out in the hospital so patients can go home with the right medication orders. Also, medications as such need to be optimized before a patient can go home even though all of that can be done at home as well. Don’t get me wrong and I’ll talk about that in a minute. All of that can be done as at home as well. There is no lengthy hospital admissions needed. But in this situation, obviously, it was a lengthy hospital admission, and we need to look at what should be done in a situation like that.
Then, on top of the full blood count, we need to look at things like white cell count. Is there still an infection lingering, hemoglobin, hematocrit, platelet count, again, coagulation such as a PTT (prothrombin time test)/INR (international normalized ratio), platelets, etc. We talked about electrolytes. Then also, in a situation like that, this particular client is on valproic acid to manage seizures, so we need valproic acid levels to be checked regularly.
Now, in ICU, she would have had regular chest X-rays and abdominal X-rays because she had some abdominal issues as well. No need for regular chest X-rays at home; however, if there are chest X-rays needed at home, they can be done at home. There are now companies out there who do home X-rays. Shout out to Michael Montalto and his team at Mobile Radiology. They are now serving Sydney, Melbourne, Brisbane, and Adelaide. They’re amazing and they’re aligned with what the clients want and what we want, which is keeping our clients home predictably. No need for ED admissions and so forth.
With chest X-rays, you need to confirm the absence of lung atelectasis, pneumothorax, pleural effusions etc., pneumonia, and all the rest of it. But once again, that can all be done at home as well, if need be. And it’s again, much more cost-effective to do it at home.
Next, a dietitian needs to look at the nutrition, how much food is needed, what type of food is needed, how much water is needed to keep an adequate fluid balance. So, that is important here as well. Also, what needs to be checked is fluid balance, is there adequate urine output? What sort of catheter does she need? Because she’s doubly incontinent. Does she need an SPC (suprapubic catheter)? Does she need an IDC (indwelling urinary catheter)? She probably needs a SPC, and I know she does have a SPC. So, it all comes down to having the right devices when it comes to urine output as well.
Furthermore, the right equipment needs to be set up. I’ve talked about equipment here in the past, that equipment needs to be set up correctly for a safe discharge. But that’s part of our expertise to make sure we’ve got spare tracheostomy tube, tracheostomy dilators, suction machines, monitors, ambu bags like Air Vivas, swivel connectors, suction catheters, everything that is needed to make a discharge home safely.
But in this situation, if the client had come to us earlier, they would have been home by now. There’s no need for months on end in ICU with the tracheostomy, absolutely not. A home care environment is so much safer, that is for sure.
So, I hope that helps, and I hope that that answers your question.
There’s one more thing. Let’s just say a client goes home on ventilation with tracheostomy, because in this situation, the client is going home with tracheostomy, not ventilation. A sleep study needs to be done so that mechanical ventilation can be optimized for home care that includes arterial blood gases, and that is very important when patients go home.
Lastly, another thing that needs to be organized is a humidifier for the client at home, especially when they have a tracheostomy so they can go on a trach mask or a trach shield, and then they also need to go on nebulizer. A nebulizer needs to be available for saline nebulizers or Ventolin or Atrovent, etc.
So, I hope that answers your question for today.
With Intensive Care at Home, we are currently operating all around Australia and all major capital cities as well as in 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, and NIISQ (National Injury Insurance Scheme) in Queensland, as well as 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 has achieved third-party accreditation for Intensive Care at Home nursing. No other provider has created policies and procedures for Intensive Care at Home and successfully implemented them in the community like we have. Nobody has built that much intellectual property in the community when it comes to Intensive Care at Home nursing than we have. We are therefore in a position to employ hundreds of years of critical care experience in the community combined.
We are also providing Level 2 and Level 3 NDIS Support Coordination, as well as TAC case management in Victoria. Our NDIS support coordinator, Amanda Riches in Victoria, has a wealth of knowledge and I’ll put a link towards a video where I did an interview with Amanda.
If you’re at home already and you’re watching this and you’re wondering, “Do I need Intensive Care at Home?” I’ll give you an example, because if you’re at home already and you realize what you have at the moment is not working or where you’re stuck in an ICU or your family member is stuck in an ICU and you’re stuck there long-term, ventilation, tracheostomy, or any other issues that keep you in ICU long-term, you absolutely should reach out to us to see whether we can continue treatment at home.
I’ll give you an example. One of our first clients over 10 years ago that was at home on a ventilator with a tracheostomy but had a team of support workers and general registered nurses. Of course, they couldn’t keep him home. He spent the majority of his time in ICU because support workers and even general registered nurses without ICU experience are not skilled to look after ventilation and tracheostomy. That is an intensive care nursing skill, full stop. When he realized that the setup wasn’t working, the insurer engaged us, and of course, we proved our model there overnight. He never ever went back to ICU ever again because that is our area of expertise. So, if you’re in a similar situation, then I encourage you to reach out to us. Or if you are working with a provider that can’t keep your roster stable for whatever reason, then I’ll encourage you to reach out to us.
Because we know there are so many vulnerable clients in the community who are at risk of dying without Intensive Care at Home. There are many clients that have died in the past because support workers could not manage medical emergencies when it comes to ventilation and tracheostomy. People have died because of this model. So, like I said, what we do is evidence based. Working with support workers is definitely not evidence based, and otherwise your life is at risk. You don’t want that, and you can reach out to us.
Once again, if you’re stuck in a hospital and you’re watching this, reach out to us as well. Please reach out to 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’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 for your participants, you don’t know how to go about it or what evidence to provide, I also encourage you to reach out to us. We can help you with the advocacy. We also provide NDIS specialist nursing assessments done by critical care nurses and legal nurse consultants.
If you are a critical care nurse and you’re looking for a career change, we’re currently offering jobs for critical care nurses in the home in Melbourne, Sydney, Brisbane, Albury, Wodonga, in Bendigo in Victoria, as well as in Warragul in Victoria and in Geelong. If you have worked in critical care for a minimum of two years pediatric ICU, ED, and you have already completed the postgraduate critical care qualification, we are delighted to hear from you.
I have a disclaimer, 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 so vulnerable and so special. It’s all about building those relationships with our clients and with our team members and having regular and stable teams. That means if you’re looking for agency work where you can come and go, working for Intensive Care at Home is probably not the right fit for you on a long-term basis because our clients want the same staff coming back over and over again. So, coming to us is all about building relationships with our clients and their families and with us, of course. We want to build a relationship with you, of course, as well so that it remains a win-win situation.
If you’re 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 blocks in ICU and ED for your long-term patients or for your regular readmitting patients, we’re here to help you to 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. We can help you there.
Lastly, if you’re in the U.S. or in the U.K. and you need help and you’re watching this, please reach out to us 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 simply send us an email to info@intensivecareathome.com.
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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.