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Quick Tip for Families in Intensive Care: Can I Force LTAC (Long Term Acute Care) to Give My Dad the Antibiotics He Was Getting in ICU? -The Answer Will Surprise You! 

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, today’s tip is about a question answered from one of our members as part of our membership for families of critically ill patients in intensive care. You can find more information at intensivecarehotline.com and intensivecaresupport.org. There, 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.

Now, also before I go into today’s quick tip and question, subscribe to my YouTube channel, click the like button, click the notification bell, you will get regular updates for families in intensive care, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have so I can make a video for you as well.

So, here’s the question from our member who says, “Hi, Patrik and team. Can you please tell me if there’s a requirement for the LTAC to follow discharge instructions from the hospital?” So, this is in the context of our member’s dad being in ICU for many weeks.

She continues, “Or what can I do to force the LTAC (Long Term Acute Care) to give my dad the antibiotics he needs? As you know, my dad went into septic shock  from Candida Auris or on the 23rd of August. He experienced multiorgan failure and things were very bad. For about two weeks he was on Eraxis yet his blood cultures remained positive. The hospital added Cresemba, as a dual therapy around the 9th of September and finally, the blood cultures began coming back negative. Upon discharge on the 23rd of September, the discharge paperwork said to continue Eraxis and Cresemba for another 20 days.

The ID doctor immediately changed Eraxis to micafungin and discontinued the Cresemba. I spent so much time hunting down the doctor who never called me back, but his partner doctor so and so, finally called me back and agreed to begin the Cresemba and change the micafungin back to the Eraxis. Dad had missed one or two doses of the Cresemba at that point and one dose of Eraxis but received micafungin. I learned today that the doctor again discontinued the Cresemba and refuses to give the Eraxis more than seven days through.

I asked the patient advocate in the hospital to join me and my mom when we explained everything to the doctor and implored him to keep the antibiotics and the course at the hospital prescribed. He refused. He said there is no need to do this, and he didn’t see any documentation from the hospital as to why Cresemba was even prescribed in the first place.

Again, I explained and offered to provide any medical records that would help him understand. He refused over and over again and said we are welcome to get a second opinion from another ID doctor. ID doctor stands for infectious disease.

Meanwhile, my dad has missed two days of the Cresemba and counting. We are familiar with the other ID doctor and how they all stick together so we don’t believe getting his opinion will do anything besides solidify the other doctor’s misguided ego.

This particular doctor has a real God complex and said that he told his partner that he didn’t know that as well as he did and that Cresemba wasn’t necessary. I said in that regard, you don’t know that as well as the doctors who spent two months with him at the hospital in the ICU, one month tailoring an antibiotic regime that worked. He didn’t care. He’s a nasty man and wouldn’t listen. Very condescending.

The patient advocate said she’s going to set up a “peer-to-peer” where one doctor will speak to the hospital doctor to understand firsthand why this course of antibiotics was prescribed because clearly, he doesn’t respect me or want to hear what we have to say. Who knows when he will even have this peer-to-peer and that will go, who knows how long before getting the Cresemba restarted if ever?

Can you please provide any advice? Is there any literature about doctors needing to continue antibiotics at another facility? If you can respond at your earliest convenience, it would be appreciated so I can get back to the patient advocate with more information in the morning.”

Okay, because we’re keeping this anonymous. I won’t mention any names, of course.

“Well, thank you for your email and for sending us the updates.

In general, LTAC facilities are expected to follow the discharge instructions provided by the hospital to ensure that your dad will receive the appropriate care and treatment. These instructions are made to maintain continuity of care and address your dad’s specific medical needs.”

Now, another advice is we’ve said this for many years here, don’t go to LTAC and there’s no need to go to LTAC. We have helped so many families to stay in hospital for much longer and get the right care and treatment there. Keep in mind LTACs are designed to save money. They’re not designed for best clinical care or best clinical practice. Patients go from ICU to LTAC even though they’re ventilated and have a tracheostomy, they’re going to go from a 1 to 1 or 1 to 2 nurse-to-patient ratio to 1 to 4, 1 to 5, sometimes 1 to 10 nurse-to-patient ratio.

Many, many patients bounce back into ICU pretty quickly because (A), they’re not ready to leave ICU. How could they if they’re still ventilated or have a tracheostomy? The readmission rate back to ICU is very, very high. Also, look up the LTAC online reviews about what families say and I’ll leave that to you because you will see what family says with LTAC reviews online and it speaks volume.

Let’s continue our answer to our member, “Basically, before your dad goes to the LTAC, his prior doctors should have spoken and clearly communicated with the doctors from the receiving facility, taking note of the following: his diagnosis, medical history, allergies, medicines, treatment plan, nutritional needs, mobility, wound care, breathing support, pain relief, upcoming appointments, test results, and any infections and their treatment to have a clear understanding of your dad’s case and provide him with the needed treatment.

In terms of managing his infection, since the doctors at the previous hospital were able to tailor an effective antibiotic regime for your dad, it is reasonable to continue with the same antibiotic course given the improvement in his condition. Appropriate antibiotic treatment should not be delayed as it entails complications.

Ideally, repeating cultures on admission is a standard practice to ensure accurate diagnosis and effective treatment when a patient is transferred from one facility to another. Do you happen to know if they repeated the blood cultures or sputum cultures  for your dad? Are there any results? These are some information that would determine the appropriateness of the doctor’s plan and treatment.

You mentioned that you are willing to share the medical records with the doctors which could help them understand you. You can also share it with us along with the discharge summary and any recent medical reports so we can see and give you feedback, or answers based on the medical records provided.

Regarding your question, “Is there any literature about doctors needing to continue antibiotics at another facility? Continuing antibiotics when a patient is transferred from one healthcare facility to another is well-established and it is generally considered standard clinical and evidence-based practice.

I’ve also put a link here that gives you helpful information about the effects of switching antibiotics, mid-treatment and it’s not generally speaking a good one. So, I hope that helps.”

But I believe your biggest challenge here is to get out of the mindset of going to LTAC in the first place. You have already seen that going to LTAC is not conducive. What we haven’t focused on in this email is our member’s dad is ventilated with a tracheotomy in the ICU.

Now, the focus in this video is obviously on the infection. But keep in mind, your dad has life support needs that generally speaking can’t be met in the LTAC because they’re simply not equipped for it. So, just keep in mind in our next email, we should rather focus on how to stay in hospital and in ICU and not go to LTAC because there are proven strategies that we apply all the time so that our clients do not go to LTAC and get substandard care and bounce back into ICU.

Often what happens is patient goes from ICU to LTAC and then they bounce back into ICU and then they often bounce back to another ICU because the discharging ICU no longer has a bed available. So, that means the patient goes from ICU to back to another ICU. That is madness because patients go to three facilities or are in three facilities within no time with different teams. What patients and families need, they need consistent teams around them that get to know a patient and the family and provide holistic care.

So, that’s the question answered for today.

Now, if you have a loved one in intensive care and you want to become part of our membership for families of critically ill patients, go to intensivecaresupport.org. There, 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.

Now, I also offer one-on-one consulting and advocacy for families in intensive care over the phone, via Skype, via email. I talk to you and your families directly. I talk to doctors and nurses directly. I represent you in family meetings with intensive care teams so that you have your own intensive care team that can represent you and so that you’re not beholden just by one opinion.

I have been in hundreds of family meetings with families in intensive care, with our clients, representing them with much success so that you can make informed decisions, have peace of mind, control, power, and influence. I ask all the questions to the doctors and nurses that you haven’t even considered asking because I worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager for over 5 years in in intensive care.

Now, we also offer a medical record review in real time so that you can get a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

Now, if you’re finding value in my video, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, comment below what you want to see next, share the video with your friends and families.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.