Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Quick Tip for Families in ICU: Here’s an Email to an ICU How to Keep Your Loved One in ICU Instead of Going to LTAC (Long-Term Acute Care)!

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

Today, I actually want to show you what sort of letters or emails we are writing to hospital executive to get outcomes and results for families in intensive care, and you can use it by watching the video multiple times and you can adjust it to your situation.

So, this is a letter that we wrote a while ago for one of our clients who had their loved one in ICU and the ICU wanted to transfer them to LTAC.

This is obviously for a U.S. based client, and I’ll just get right into it. So, letter to hospital executive:

“I’m writing you in regards to my mother…

and I’m not going to mention any names here, of course.

…current inpatient in your ICU. First off, we have been very grateful for all the care my mother has been receiving in your ICU to date. We have been very happy with the progress she has made to date thanks to your excellent care and expertise after she was readmitted back from LTAC just as we predicted before her discharge from ICU.

Obviously, this is a client who had done enough research before coming to us realizing that going from ICU to LTAC (Long Term Acute Care) is not a good idea. And therefore, they eventually came to us because they didn’t want this to happen the second time around. I mean, we’ve been saying it so many times here on this channel that going from ICU to LTAC is sheer and utter madness, it’s almost suicidal.

The email continues,

In fact, the admittance report from ICU said she was admitted from LTAC in dwindling condition with sepsis and acute kidney injuries.

It is therefore however deeply concerning that ICU wants to discharge my mother back to an LTAC once again against our wishes and without our consultation, let alone our consent.

Obviously, even though the client speaks in the first person, we have written this email for the client.

We strongly fear that the level of care in LTAC is not appropriate for the clinical condition of my mother as we believe she still needs ICU level care.

The clinical evidence that she’s not ready for discharge to LTAC is overwhelming.

Specifically, her atrial fibrillation appears to be chronic now and in combination with the pericardial effusion which needs to be reviewed by a cardiologist before being discharged from the hospital.

Presently, she has a lung infection, Acinetobacter pneumonia, has been vomiting and is nauseated. She was just started with the course of strong antibiotics, Meropenem.

Furthermore, her hemoglobin level is still concerningly low (6.6) and we know after speaking to other ICU professionals that LTACs, generally speaking, do not have specialists available dealing with significant cardiac or hematology issues such as atrial fibrillation, pericardial effusion and low hemoglobin. Blood transfusions are generally speaking not an option at many LTACs, and the patient must be transferred to a local hospital.

A LTAC RN also said that if a patient was needing frequent blood transfusions, as is the case with my mother, they would send them back to the ICU anyway to find out what the cause of the blood loss was. This ties right in with having access to specialists such as hematology, cardiology, neurology, etc.

In the ICU, there is a frequent blood transfusion history. For example, between the 18th and the 25th of last month, she had blood transfusion, between the 13th and the 18th, she had a blood transfusion, and between the 9th and 13th, she had a blood transfusions.

Moreover, my mother is now intermittently on dialysis and she is therefore way more clinically unstable compared to her last ICU discharge in early February.

She is now hemodynamically unstable with vasopressor support on (Midodrine) to manage hemodynamic instability that inevitably often goes hand in hand with vulnerable patients on hemodialysis.

The nursing skills in LTAC don’t allow for the management of hemodynamic instability and the management of vasopressors.

Once again, when patients are in ICU, they’re often hemodynamically unstable and just because they go to LTAC doesn’t mean all of a sudden, they’re going to be hemodynamically stable, they’re often still unstable.

It is also evident that despite the rhetoric that LTACs get very poor outcomes for patients when it comes to ventilation and tracheostomy weaning.  This is evident in the online reviews of most LTACs including the LTAC that you want to send my mother back to.

Clearly, LTACs often work with lowly skilled and nonspecialist nurses that have no ICU experience, which is needed to manage ventilation and tracheostomy. Weaning off the ventilator while in ICU would open up many rehab opportunities for my mother.

On the previous LTAC admission, my mother had made no progress in terms of ventilation weaning. Also, on the previous LTAC, the nurse-to-patient ratio on LTAC as well as the lack of ventilator and tracheostomy competent nursing staff is not appropriate for someone on a ventilator with a tracheostomy.

There are no specialized doctors on site 24/7 which is not appropriate for someone on a ventilator and tracheostomy with multiple comorbidities just coming out of ICU.

Therefore, the clinical evidence that she’s not ready for discharge to LTAC is overwhelming.

We perceive discharge to an LTAC facility as medical negligence and we will not hesitate to mobilize our legal team to challenge any real or perceived medical negligence.

I have also repeatedly asked for the hospital discharge policy, and I’ve encountered nothing but excuses and have not seen such a policy.

And I just want to make a comment there that if they’re not showing you the hospital policy, you already know what it says. It says that a patient can’t be discharged without patient or family consent because otherwise they would show you the hospital policy. So, you’ve got your answer.

Please send me your hospital discharge policy today by 5 pm local time.

We strongly object to a discharge to an LTAC with poor online reviews, also, with our previous experience in LTAC.

It appears to border on insanity to send my mother to a LTAC in her extremely vulnerable condition while being at high risk of being readmitted back to ICU due to her medical complexities.

This is exactly what happened in early February just as we predicted. Surely to repeat the same happening again can’t be in the interest of my mother.

If she was to be readmitted to ICU, she would most likely be readmitted to another ICU due to the location of the LTAC.

That means she would potentially be in 4 facilities within a short period of time.

This is anything but holistic or family-friendly or patient friendly healthcare, and it completely ignores the individual and our family.

If such events would occur, we would most likely perceive it as medical negligence as well.

Patients who are as vulnerable as my mother needs stable multidisciplinary teams around them rather than being sent off to substandard LTACs where a new team has to get to know my mother from scratch.

This makes no sense whatsoever.

We request that a cardiology and hematology review is to take place as a matter of urgency, and we object a discharge to LTAC.”

So, this letter or email achieve the result. You can use as needed, but obviously the clinical details have to be correct. And obviously, with this particular client, we were getting the medical evidence through our medical record reviews. That’s where our skill comes in, the expertise comes in.

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, which is exactly what you’re up against here.

I have worked in critical care nursing for over 25 years now, in three different countries where I worked as a nurse manager for over 5 years and where I have been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy. You can verify that by looking at our testimonial section at intensivecarehotline.com or by looking at our podcast section at intensivecarehotline.com. On our podcast, you can watch the videos and podcast interviews that we’ve done with some of our clients, verifying the work that we have done for them.

We have helped hundreds of members and clients over the years in getting results for them when they have a loved one in intensive care, which is why we created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com if you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. It will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment so that you can influence decision making fast.

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly. I also represent you in family meetings with intensive care teams. When I talk to doctors and nurses directly, I ask all the questions you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. When I talk to you and your families directly, I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do 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 simply send us an email to [email protected] with your questions.

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, and 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 will get notification for the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

Thank you so much for watching.

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

Take care for now.