Guest: Patrik Hutzel
Guest Bio: Patrik Hutzel is the director of Intensive Care (ICU ) at Home. He has over 12 years’ experience internationally as a critical care nurse in places such as Germany, United Kingdom, and of course, Australia.
Health Professional Radio – ICU in Australia
Katherine: Thanks for listening to Health Professional Radio today. Today our special guest is Patrik Hutzel. He is the director of Intensive Care at Home. He has over 12 years’ experience internationally as a critical care nurse in places such as Germany, United Kingdom, and of course, Australia. Welcome to our show, Patrik.
Patrik: Hello, Katherine. Thank you very much for inviting me to this show. I’m very pleased to be your guest.
Katherine: Thanks for coming on. Firstly, to start off with, can you tell us a bit about intensive care in Australia? Most people understand what an intensive care unit is. But most people probably don’t understand that there are some patients that actually stay in intensive care for quite a while.
Patrik: Sure. Look, there are definitely some patients in intensive care currently that stay in ICU sometimes for many months. I’ve seen patients in intensive care for up to 12 months.
The concept of intensive care here in Australia currently is … there is a lot of room for improvement, from what I can see. Because what’s currently, or what’s been happening in Europe in the last 15 years already, is that most long-term ventilated patients would go home on a ventilator, and that’s not happening in Australia as yet, or not to the extent that I can see it happening. Because as is touched on, I have worked in Germany, in the UK. I have worked in Australia since 2005.
I’ve also worked in Germany in the intensive homecare niche. Basically, in Germany, there are specialised services who provide care at home for long-term ventilated patients as a genuine alternative to a long-term stay in intensive care. That basically prompted me to start a similar service here in Australia, Intensive Care at Home, because I can see such a big demand for such a service. I can also see that we can create a win-win situation for all of stakeholders involved.
Katherine: Yes. We should actually mention that you specialise in ventilated care at home for adults and children with – I hope I’m pronouncing this right – tracheostomy.
Patrik: Tracheostomy. Yes.
Katherine: Yes, can you tell us what that is?
Patrik: Yes, of course. So what happens in intensive care – if somebody is ventilated … now, most patients in intensive care are short-term ventilated, meaning they are ventilated for less than 24 to 48 hours. Now, if it goes above 48 hours and doctors and nurses can anticipate a difficult wean off the ventilator, meaning the patient can’t breathe by him- or herself, often what happens in intensive care, patients get a tracheostomy, which is basically a tube in a patient’s windpipe through the neck.
What it does is it makes ventilation much easier, and it also increases chances that if somebody does require ongoing ventilation, that they’ll be weaned of the ventilator quickly. Now again, most patients who get a tracheostomy, they will be able to be weaned off the ventilator in intensive care. For those who then don’t get off the ventilator, for whatever reason, the options at the moment are very limited. By that, I mean they then end up staying in ICU for as long as they’re ventilator-dependent, right?
It’s a relatively small number of patients, but the patients and their families who are affected by long-term ventilation in intensive care, it’s not very nice to watch. It goes hand-in-hand with lack of quality of life. It goes hand-in-hand with depression and so forth. So that hopefully answers your question and pretty much puts it in a nutshell.
Katherine: It does. I understand you have some personal experience, prior to you working in ICU. You have a personal story?
Patrik: Yes, I do. Look, my first sort of touch point with intensive care really was that my uncle died in intensive care at a very young age. He was only 51. He died from cardiomyopathy in intensive care, and it was such a traumatic experience at the time. I was only a teenager then. I still get very emotional when I talk about it today even though it’s such a long time ago. It’s still very sad because, as I said, he was very young. He was a very lovable guy.
At the time, I was in hospital myself, having had my tonsils removed, [laughs] and I couldn’t even go to the funeral. I remember my mother didn’t even tell me that he died until a few days later because she didn’t want to tell me, because I was sick and so forth. That was my sort of first touch point with hospitals and beds and dying and intensive care.
The second sort of touch point is very personal as well, where I was actually present in hospital when my grandfather died. That was, funnily enough, during my nurse training, which I did at home, very close to where I’m from. Coincidence or not, my grandfather got admitted to the hospital where I worked at, through the emergency department, and that was unexpected.
He basically died with me being present on my shift. I’m very glad that I was there because it gave me an opportunity to have a family member there while he died, but while he was unconscious. He had a great life. He was 92 at the time, and everybody was very grateful for the great life he had. But still, being there, being present, it was so overwhelming. But again, I was very grateful to be there. I believe a lot of patients, they die in isolation and don’t necessarily have family members there.
Patrik: That sort of … after my nurse training, it prompted me to go into intensive care, not being afraid of seeing people dying as I had probably two touch points already within my own family, and then I wasn’t afraid of seeing people dying. If anything, I feel very passionate about it, to be there and support patients and their families through that difficult period.
Katherine: Right. Thank you so much for sharing that story with us, that very personal story. You’re right. A lot of people don’t realise that some people do stay in intensive care, like you said, even up to 12 months or more than six months. For the family, it is very stressful because they feel maybe helpless in that situation. Plus I didn’t realise what a strain it can be on our hospital system in Australia. Our waitlists are enough without having these long-term patients and families feeling like they’re in limbo. So I wanted to ask you a bit more about your business and how you started with that as well, as an alternative to what we currently have.
Patrik: When I first started to work in Australia in 2005, in intensive care, my first realisation was that long-term ventilated patients have nowhere to go to. Even then, in 2005, it was a relatively new concept in Germany as well. It only started in Germany in the late 1990s. As far as I remember, the first services there came up in 1997, and I was working in that space for a couple of years in Germany.
So when I came to Australia in 2005, I just naturally assumed, well, if it’s available in Europe, it must be available in Australia as well. But I was surprised that there wasn’t an alternative for those patients. That prompted me to eventually start my own service because I thought, “Well, I have seen what’s possible for those patients in Germany, in the home. I know how much better the quality of life is for those patients in their families at home,” and that’s the biggest difference point.
The second biggest difference it makes as well, is obviously, ICU beds are limited in numbers. Having a long-term patient in any ICU bed blocks a bed. The ICU can’t use that bed for another, usually more acutely unwell, patient. They might end up delaying admissions; they might send them to other hospitals. As you’ve mentioned, there are waiting lists in hospitals. It’s all over the media in this day and age, and any ICU bed that’s occupied by a long-term patient can’t be used for somebody waiting for an elective surgery, for example.
Katherine: Exactly, yes.
Patrik: Because a lot of elective surgeries need an ICU bed as well, even if it’s only for a day or for two. That prompted me to … after I got to know the health system here in Australia … I was working for a good five years before I actually decided, “Okay, well, it’s time to venture out on my own and give this a shot.” And obviously also keeping an eye on what’s been happening in the space in Germany. It’s been massively successful. It’s been growing for more than a decade now. In Germany or in many European countries now, nobody even questions that the best place for a long-term ventilated patient is home.
Patrik: The biggest challenge that I’m facing here is some people within the industry, especially in intensive care who don’t know the concept, they say, “No, you can’t do ventilation at home. It’s something we can only do in intensive care.” I say, “Well, you might want to give it a second thought because it’s actually happening in other countries.”
Katherine: Very, very interesting. I would like to invite you back for another segment, which we will talk more about your business and how people can have intensive care at home. Thank you for your time, and I look forward to speaking soon.
Patrik: Thank you very much for your time, and it was a pleasure to talk to you. Thank you.