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

So today, I have a question from Jessica, who says,

“Hi Patrik,

I would love some help or any information regarding a hospital trying to discharge my father from ICU while he’s still on a ventilator with a tracheostomy from a TBI. TBI means Traumatic Brain Injury. They want to move him to an LTAC facility, and I want to know what grounds I have to stop them. Thank you so much.” Jessica

Thank you so much for writing in and for asking this very important question.

Just recently, we’ve helped at least two clients to move their loved ones from LTAC back to ICU with our consulting and advocacy. The reason we succeeded there is simply that we looked at the medical records, we looked at the clinical situation and said, “Well, these are the reasons why this patient needs to go back to ICU. Otherwise, they are at risk of dying or risk of the more health damages, but prevention is better than cure.” Therefore, you are on the right track, Jessica, to keep your dad away from LTAC as much as possible.

So, what we’ve done over and over again is when we review medical records, once again, we’re making the clinical argument and saying, “Well, this patient is on a ventilator with a tracheostomy. They shouldn’t go to LTAC.”

Now, LTACs advertise that they are the experts in weaning patients off the ventilator with the tracheostomy. Well, unfortunately, I have to say they’re anything but, usually, when patients go from ICU to LTAC, they deteriorate fast because they don’t really have the skills, the knowledge, or the expertise to look after someone on a ventilator with a tracheostomy.

I know when you look at their websites, they will say, “Well, we are the experts.” Well, like I said, we have literally families calling us that have loved ones in LTAC and say, “Help us to get out of there. This is a nightmare.”

So, on what grounds? If your dad is on a ventilator with a tracheostomy, that in and of itself is enough not to let him go to LTAC. Often when patients are in ICU, there are many, many other things happening simultaneously. One of the reasons your dad could stay in ICU is he still needs input from neurology or neurosurgeon with the TBI. He might need input from other specialists such as a cardiologist, a hematologist, and nephrologist.

Not that you mentioned that here, but once again, when someone is in ICU, there are dozens of things happening simultaneously and dozens of things happen that need to be considered and that need to be looked at.

One of one of the many, reasons we’ve used to keep patients in ICU rather than going to LTAC is, again, specialist input, cardiology, nephrology, hepatology, gastroenterology, neurology, you name them, because you don’t get that in LTAC.

But other reasons we’ve used is patients might need blood transfusions. They might need still need inotropes or vasopressors. They might still need IV sedation or opiates.

Other things we’ve used very, very successfully is not giving consent to a PEG tube (Percutaneous Endoscopic Gastrostomy). That’s one of the easier things to do. Don’t give consent to a PEG tube for your loved one. Almost 95% doesn’t need a PEG tube. A nasogastric tube will do. But I have made other videos about that. Why? A PEG tube is not needed, and a nasogastric tube is fine. Most LTACs cannot take patients without a PEG tube.

So, other arguments you can use, Jessica, is that your dad can’t go because the hospital’s discharge policy. If you ask for the hospital’s discharge policy, they will most likely say that no patient can be discharged or transferred to another facility without patient or patient consent. Given that your dad has a TBI, he probably can’t make decisions for himself. So, you, as next of kin or power of attorney would be doing that. So therefore, you can also make those decisions based on the hospital’s discharge policy. You should ask for that, by the way.

If they can’t give it to you, they make up some nonsense because they can’t give it to you, what’s in there anyway? Because that means the hospital discharge policy will say that your loved one can’t go because the hospital needs consent.

Next, below this video, I will also send you a link to a legal document about the framework for hospital discharges. Once again, you will see that patient or family consent is needed.

So, that is my quick tip for today.

I have worked in critical care for nearly 25 years in three different countries where I worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care all over the world since 2013 here at intensivecarehotline.com.

I can say without any exaggeration that we have saved lives with our consulting and advocacy. You can verify that on our testimonial section, you can verify it on our podcast section where we have done some client interviews.

Because of that, we want to help as many families in intensive care as possible, and this video here, the email is from October last year, I’m only getting into it now. That’s how many emails we’re getting. It’s now April 2024. So, it’s nearly 6 months since I get to all emails. I do these videos almost daily, as you can probably see if you’re a subscriber of my YouTube channel, which you should be.

So, we now have a membership for families of critically ill patients in intensive care that you can become a member of, and you can get access to myself and my team, 24 hours a day, in the membership area and via email. You can get access if you go to intensivecarehotline.com, click on the membership link or go to intensivecaresupport.org directly. Once again, in the membership, you have access to me, and my team and we answer all questions intensive care related.

You also have access to 21 exclusive videos and 21 exclusive e-books, all written by me for families of critically ill patients in intensive care so that you can make informed decisions, have peace of mind, control, power, and influence, and making sure your loved one gets best care and treatment.

I also offer one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best. I talk to you and your families directly. I talk to doctors and nurses directly. When I talk to doctors and nurses directly, once again, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care, once again, so that you make informed decisions have peace of mind, control, power, and influence.

I also represent you in family meetings with intensive care teams.

We also offer 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 suspecting medical negligence.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, share the video with your friends and families, comment below what you want to see next, what questions and insights you have.

I also do a weekly YouTube live where I answer your questions live on the show and you get notification, once again, if you’re a YouTube subscriber here on my channel.

Thanks for watching.

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

Take care for now.

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Quick Tip for Families in ICU: Weaning VA-ECMO for Heart Failure, Do you Need Milrinone or Dobutamine? Quick Tip for Families in ICU: Can a Tracheostomy be Done While your Loved One is on ECMO? Quick Tip for Families in ICU: What Questions to Ask When Your Loved One is in Heart Failure in ICU! Quick Tip for Families in ICU: What are Signs that My Mom can be Weaned Off the Ventilator in ICU? Quick Tip for Families in Intensive Care: Why is My Mom Not Waking Up After Two Weeks in an Induced Coma and Paralyzing Agents After Acute Respiratory Distress Syndrome (ARDS)?