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Quick Tip for Families in Intensive Care: Mom’s Come Off the Ventilator in Record Time, but Still has a Tracheostomy, Should She Go to LTAC? 

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

So currently, we are working with a client who has their 80-year-old mother in ICU after a stroke, and she now has a pneumonia. And cutting a long story short, the intensive care team in the beginning was pushy towards moving this lady to hospice and palliative care saying to the family, “Well, if she does survive, she won’t have any quality of life and that it’s “in her best interest” to let nature take its course and let her die.” Now, the family obviously objected to that saying, “Well, you know that she’s a strong-willed lady and that she has clearly indicated to the family that she wants to live no matter what.”

The family then reached out to us asking whether a tracheostomy or asking what to do, and then we obviously suggested a tracheostomy might be the next step. We also then found out that she was already fairly close of having time off the ventilator, which is something the intensive care team didn’t share with the family, clearly misleading the family. And I’ll tell you why they were misleading the family in a minute once I give you the full, bigger picture.

But what it comes down to here, once again, is number one, ICU teams only tell families half of the story. Number two, the biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

So, the next step was for the family to push for tracheostomy and tracheostomy was done. Within less than seven days, this lady was off the ventilator, and we were guiding the family through it step-by-step. They were giving us the ventilator setting and we were saying, “Yep, she’s on the right track. She’s passing the spontaneous breathing trials.” And lo and behold, a week later she was off the ventilator, and she has now been off the ventilator for three days. She now still has the tracheostomy.

So, you can clearly see that ICU teams are not being transparent, which is another reason why we keep saying over and over again, you need to get access to the medical records as quickly as possible so you can come to places like us, and we can give you that second opinion. Without that second opinion, the family would’ve lost, and would’ve been lost, and would’ve potentially signed off on the death of their mother.

So, now what’s next here? ICU is still pushing, now wanting to send this lady to LTAC (long-term acute care), and they want have meetings about sending her to LTAC. And number one, ICUs can’t discharge a patient against family consent or without family consent. When you look at hospital and ICU discharge policies, it clearly says that they can’t discharge patients without their consent. Different obviously, when it comes to general hospital discharges when patients go home, if they’re well enough but we are talking about ICU here. The next step for someone from ICU is usually going to a hospital floor or to a step-down ICU, HDU (high dependency unit), hospital ward, whatever the case may be.

But the ICU is trying to push for LTAC, and I say to the family, “Well, why would you push for LTAC? She’s weaned off the ventilator in record time. Now, why can’t she wean off the tracheostomy in record time? And then there’s no need for LTAC.” LTACs in the U.S. are designed supposedly for long-term ventilated or tracheostomy patients. Well, the reality is the minute patients go into LTAC, all hell breaks loose because ICU patients can’t just go to LTACs where they employ LPNs (licensed practical nurses) or where they employ general RNs (registered nurses) without ICU experience, that have no experience in ventilation or tracheostomy weaning. There’s only one doctor on site once a day for a few hours. The nurse-to-patient ratio is one to five, often one to 10 overnight. So, it’s just an absolute disaster area.

So we advised the family, why would they meet with the hospital to talk about LTAC if the hospital should now focus on getting this lady decannulated, i.e., removal of the tracheostomy? You have to make a choice as a family whether you want to live in the ICU’s reality or whether you want to live in your reality. And I advise you to live in your reality, not in the hospital’s reality. Their reality is we want to send patients to LTAC as quickly as possible to save money, to free up a bed, to free staff. Your reality needs to be, “I want the best outcome for my mom or for my family member.” And clearly, if this particular family, our client wouldn’t have reached out to us, their mother would probably be dead by now.

So, you have to get that second opinion right from the start before it’s too late. Do not talk about LTAC, just live in your reality, push your agenda, and get that second opinion, and we can guide you through those situations in ICU step-by-step. We can almost predict what’s going to happen next, and we can arm you with those crucial strategies, so you’ll get the outcomes that you want. You can make informed decisions, get peace of mind control, power, and influence. And that’s what it’s all about.

Now, that’s my quick tip for today.

If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected] with your questions.

Also, have a look at our membership for families in intensive care at 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.

Also, if you need a medical record review for your loved one in intensive care in real time, we provide that for you and for your family, give you that second opinion. We also review medical records after intensive care, but it’s critical that you have access while loved one is in intensive care, so we can interpret the clinical data in real time, so you don’t have to believe everything the intensive care team is telling you or the information they’re withholding from you, because quite frankly, that’s what they do if you don’t ask the right questions.

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

Thanks for watching.

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

Take care.