Patrik Hutzel Discusses Intensive Care At Home

Presenter: Katherine
Guest: Patrik Hutzel
Guest Bio: Patrik Hutzel 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.



Transcription

Health Professional Radio

Katherine: Thanks for joining us today at Health Professional Radio. Today we have our guest again, Patrik Hutzel. He is the director of Intensive Care at Home. Welcome to our show, Patrik.

Patrik Hutzel: Thank you for having me on your show, Katherine.  It’s a pleasure to be here.

Katherine: Patrik, I thought I’d let you explain to us what Intensive Care at Home is and how this came about, you starting this business here in Australia.

Patrik: Sure.  I have actually worked in three different countries in intensive care nursing.  I originally started off in Germany as a registered nurse working in intensive care there, also working in the community in Germany and providing specialised home-care nursing for long-term ventilated patients in Germany as a genuine alternative to long-term stay in intensive care.

That was a relatively new concept then in Germany, sort of around the late 1990s, beginning of the year 2000, before I actually went overseas to continue my nursing career in the United Kingdom and then in Australia in 2005.  In those countries – in the UK as well as in Australia – I was surprised that this concept of intensive home-care nursing, it wasn’t even on people’s radar.  Long-term ventilated patients had nowhere to go to.

And as I said, I started in Australia in 2005 in intensive care.  It immediately became apparent to me that there is a lack of services for long-term ventilated patients in the community as an extension to intensive care services.  How it came about for me – that number one, there is a need; number two, patients and families are generally depressed if they have to stay in intensive care for too long; and number three, it’s usually a more cost-effective alternative to a stay in intensive care.

If I can just put that quickly in perspective, an ICU bed costs around $5,000 a day.  Plus, if there’s somebody in that bed who is long-term ventilated, that patient is generally blocking a bed that can’t be used for other more acutely unwell patients.

Katherine: Right, exactly.  With long-term patients, you touched on a few points, that it’s probably not the best environment for them to not only get well but even for their families.  Some people don’t know that some families, they don’t live that close to a hospital.  For them to visit their loved ones takes a lot of time, and maybe they can’t see them as often as they would like.  So an alternative is to bring their loved one home and have at-home care.  Can you talk us through the practicalities of what a family can do in order to get this service implemented?

Patrik: Mm-hmm.  That is a great question, Katherine, because families often … and patients as well.  And I don’t say this lightly, but I think I have to mention it.  Families are often “at the mercy of a hospital”.  Once you’re in this big machinery of a hospital, options are in fact limited.  The hospital often makes decisions that are based on the services that are available within a clinical environment.  Hospitals are not at the point where they are actively looking for home-care services, for a number of reasons.  It has to do with funding, it has to do with politics, and so forth.

Katherine: Right.

Patrik: There are hospitals now starting to look for an extension of their services, including intensive care.  So community care is growing.  Now, how can families go about it?  Now, I can tell you that just a couple of weeks ago, I have actually had a referral from an intensive care unit of a patient.  The story goes such like the patient has been in ICU for many months now.  The only thing that’s keeping the patient in ICU is the ventilator dependency.  The family knows that there must be another solution.  And the family actually asked the hospital, “Can you please start looking around and see what other options are available?”

Katherine: Right.

Patrik: That’s how they sort of came to my service and said, “Look, we’ve done a bit of research, and we found your service.  Could you have a look at this patient?  The family would like this patient at home.”  I’m not putting … all I say is it’s been many months, but it often takes the pressure from the families to look for an alternative.  The hospitals themselves, they’re not particularly looking for those services as yet.  I’m sure that will change, because I’ve seen it changing in Germany as well.  When the first services came up, nobody wanted to know about intensive care at home.  It was seen as a threat, if anything.

Katherine: Right.

Patrik: The whole health industry is very slow to change.  It’s highly political.  It’s not unlike any other industry where people put out their wallets and pay for a service.

Katherine: Yeah.

Patrik: And that leads me then probably to what the next question would be for a family: “Who’s going to pay for this service?”  Now, the way we are positioned is: the hospital ICU bed, as I mentioned before, costs $5,000 a day.  Now, a win-win situation from my perspective is the hospital continues to pay for the service but pays less, and has an empty bed.

Katherine: Yeah.

Patrik: If that makes sense.

Katherine: Yeah.  I see what you mean.  Getting to also to that point about the logistics of it – so not only the money side of it, but also what … families are thinking, “Okay, obviously, we need a ventilator and we need to make some maybe modifications to our … where our family member will stay.” What about also … you provide nurses, and these are quite qualified nurses.  Can you tell us a bit about your staff, but also – where do the taff stay?  Are they there 24/7 as well?  Or what’s the practicalities of that?

Patrik: Yup.  That’s a great question, Katherine.  Two things about … I’ll start quickly with equipment and then I’ll go on to nursing staff.

Katherine: Sure.

Patrik: With equipment, yes, you need a ventilator.  Now, our costing model is basically based on including equipment, so we provide all equipment.  That’s based in our costing model.  We have a model that includes equipment but is still more cost-effective compared to an intensive care bed.  That’s the first, hopefully takes the burden away.  If somebody wants to know more about it in terms of equipment, we take care of all the equipment.

Hospitals might actually in fact be interested in helping us out with equipment, but in general, it shouldn’t be of any concern for a family to organise a ventilator or anything else that they may need.  That’s what we do, that’s our speciality.

Katherine: Right.

Patrik: And number two, in terms of staff.  There’s a number of models.  Most patients that require long-term ventilation require 24/7 care because normally, they would be in an intensive care unit.  And in order to safely look after those people as well as providing them with the quality of life that we can give to them, that we can provide for them, they need 24/7 care.

As you’ve just mentioned, yes, we only work with intensive care nursing staff who have a minimum of 18 to 24 months clinical ICU experience, because obviously they need to know what to do with the ventilator, with the tracheostomy.  They need to know what to do in an emergency and that sort of thing.

There are, however, some families, from my experience, they say, “Look …” depending on how many people there are in the family, how much time they have, how capable they are, how much they want to be involved, they say, “Look, I think I can do some of it myself.”  They say, “Look, on a Friday, I’m happy to do that myself.  I’m happy to have nobody in my house on a Friday.”  Because having somebody around 24/7, that’s quite a challenging thing to do as well, having somebody in the house …

Katherine: It could be months.

Patrik: Sorry?

Katherine: Yeah, it could go on for months and months.

Patrik: Yes, and sometimes for years.

Katherine: Yeah.

Patrik: Even though I have seen … after a while, you’re almost part of the family. [laughs]

Katherine: Exactly.

Patrik: But there are limitations.  Sometimes people just need their space.  So I have seen both.  I have seen 24/7 care, and I have seen maybe six days a week, sometimes even five days a week.  As I said, depending on who wants to get involved from the family, depending on how much interest they have in getting personally involved in the care of their loved ones.  But some people, they just simply can’t do it for a number of reasons.

Katherine: Sure.

[crosstalk]

Patrik: Sorry, yeah.

Katherine: I was just gonna ask about the nurses.  Surely, they have lives and families of their own, so do they work shifts as well, or do they stay there 24/7?  I was just wondering about how the nurses work.

Patrik: Yeah, it is a 24/7 model.  Just like in a hospital, we offer 12-hour shifts, we offer eight-hour shifts, meaning people do 12-hour shifts, they either do a 12-hour day shift or they do a 12-hour night shift.

Katherine: I see.

Patrik: The whole model is based on clinical intensive care, which is 24/7 care.

Katherine: All right.  So the schedule is like a nurse would have at a hospital.

Patrik: Pretty much.

Katherine: Yeah.

Patrik: Pretty much.

Katherine: Okay, yeah.  Very, very interesting.  I thank you for having this service available, and also for your time today.  For those of you that would like to know more, you can visit Patrik’s website, which is intensivecareathome.com.au.  Thank you for your time.

Patrik: Not at all, Katherine.  It’s been a pleasure to talk to you and your new show.  Thank you for having me.