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 Quick Tip for Families in Intensive Care: Does LTAC Need to Follow Discharge Orders from ICU for My Dad?

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 for one of our members. We have a membership for families of critically ill patients in intensive care where you can get access to at intensivecarehotline.com if you click on our membership link there or go to intensivecaresupport.org directly.

So, let me read out the question from one of our members who has her father in LTAC in the U.S. We strictly recommend against LTAC but by the time this lady became a member, her dad was already in LTAC. So, we were able to advise her from there, but generally speaking, we strictly advise against LTAC, and we have proven strategies on how to avoid LTAC.

Now, let’s read out her question,

“Hi, Patrik and team,

Can you please tell me if there’s a requirement for the LTAC to follow discharge instructions from the ICU? Or what can I do to force the LTAC to give dad the antibiotics he needs?

As you know, dad went into septic shock  from Candida Auris couple of days back. He experienced multi organ 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 8th of August and finally the blood cultures began coming back negative. Upon discharge on the 23rd of August, 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 this doctor who never did call me back. But his partner, the other doctor, 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 ID doctor again discontinued through the Cresemba and refuses to give the Eraxis more than seven days (through to the 31st of August). I asked the patient advocate in the LTAC to join me and my mom when we explained everything to the doctor, and I implored him to keep the antibiotics and the course that 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.

Meanwhile, 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 doctor’s misguided ego.

This doctor has a real God complex and said that he told his partner doctor that he didn’t know dad as well as he did, and that Cresemba wasn’t necessary. I said in that regard, “You don’t know dad as well as the doctors who spent two months with him at the hospital, 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 is going to set up a “peer-to-peer” where the ID doctor will speak to the hospital doctor to understand firsthand why this antibiotic course 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 and so I can get back to the patient advocate with more information in the morning.

Thank you.”

We always get back to our members within less than 24 hours. So, if you send us an email and you are a member, we always get back to you within a few hours and answer your questions.

So, here is our answer,

“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 ICU 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.

Basically, before your dad goes to the LTAC, his prior doctors should have spoken and clearly communicated with the doctors from the receiving LTAC facility, taking note of the following: his diagnosis, medical history, allergies, medicines, treatment plan, dietary 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 ICU were able to tailor an effective antibiotic regime for your dad, it’s 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 ICU to LTAC. Do you happen to know if they repeated the blood cultures or sputum cultures for your dad? Are there any results? These are some of the 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 is generally considered standard clinical practice.

Here is a link below that can give helpful information about the effects of switching antibiotics mid-treatment.

Hope this information helps. Keep us updated.”

Now, we’ve already had the discussion with our member that going to LTAC wasn’t a good idea in the first place. So, all we can say is, generally speaking, if you’re watching this and you are in a situation where your loved one is on the brink of ICU wanting to send them to LTAC, please contact us urgently. We can help you prevent that from happening.

One of the reasons that our member here is running into so many challenges is that when patients go from ICU to LTAC, they’re going from an environment where there’s highly skilled doctors, highly skilled nurses, highly skilled RTs, they’re going to what is not even the better version of a nursing home. LTACs are really dangerous places. Just have a look online and see the reviews.

Now also, we’ve spoken to so many LTAC over the years with our consulting advocacy here. When we ask questions at the LTAC, they don’t really know what they’re talking about. So, you ask them clinical questions and they often don’t have the answer, which is why very few places are good at weaning patients off the ventilator because really that is an intensive care nursing skill.

So, that is my quick tip for today.

If you want to become part of our membership for families of critically patients in intensive care, go to intensivecarehotline.com, click on the membership link on our website and join there or go to intensivecaresupport.org directly and you can join our membership there. In the membership, you have one-to-one access to me and my team via email and in the membership area and you can ask any questions intensive care related and we answer them very quickly.

If you are a member, you can also upgrade with a 20% discount to the phone consulting advocacy options that I offer. I offer talking to you directly. I offer talking to doctors and nurses directly. I represent you in family meetings with intensive care teams. I ask all the questions you haven’t even considered asking, but you must be asking when you have a loved one in intensive care so that you get peace of mind, control, power, and influence, and so that you can make informed decisions.

We also offer medical record reviews in real time in intensive care. So, if you have a loved one in intensive care and you want the medical record review in real time so that you can make informed decisions, have peace of mind, control, power, and influence, please contact us here as well at intensivecarehotline.com. We also offer medical record reviews after intensive care if you have unanswered questions, if you are simply needing closure, or if you’re suspecting medical negligence.

Now, 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 and what questions and insights you have from this video.

Thanks for watching.

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

Take care for now.