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Quick Tip for Families in Intensive Care: How to Stop Your Loved One on a Ventilator & Tracheostomy Go from ICU to LTAC – An Email Template!

In my last quick tip video, I talked about, “Is transferring an unstable ventilated and tracheostomy patient from ICU to LTAC medical negligence?” Today, I actually want to follow up with a letter of appeal that we have successfully used to keep patients in ICU instead of in LTAC (Long-Term Acute Care), and I will share that letter with you today, or email, I should say.

My name is Patrik Hutzel from intensivecarehotline.com and this is another quick tip for families in intensive care. So, let’s get right into it.

So, many patients in the U.S. face a transfer from ICU to LTAC once they’ve got a tracheostomy because they can’t be weaned off the ventilator. There are many things leading to that, and I’m not going into detail now. I’ve got a whole library of videos and blog posts, “How to prevent getting a tracheostomy in the first place?”, “How to wean a critically ill patient off the ventilator and the breathing tube so that a tracheostomy is being avoided?” I’ve also talked extensively about why you shouldn’t give consent to a PEG (percutaneous Endoscopic Gastrostomy) tube. Again, I’m not talking about that today.

Today, I’m talking about once your loved one does have a tracheostomy and does have a PEG tube, if you need to take some more drastic measures to stop your loved one going from ICU to LTAC.

So, let’s read out the letter of appeal.

“Objection to transfer of (put your loved one’s name in there) from ICU to LTAC without proper stabilization and also without proper infection control.

So, write “Dear (put in the doctor’s name or case manager’s name or nurse manager’s name),

I’m writing on behalf of (put in the patient’s full name and date of birth) who’s currently under your care in the intensive care unit at (put in the hospital name). I am and we are as a family, deeply concerned about the proposed transfer of (put in patient’s name) to a long-term acute care hospital at this particular point in time.

As the patient’s (put in next of kin or medical power of attorney or a spouse, daughter, maybe a proxy), I formally object to the transfer based on the following unresolved and potentially dangerous medical issues.

Number one, lack of clinical stabilization. (Put in patient’s name again) continues to exhibit unstable vital signs and clinical indicators including, briefly describe any key issues.”

Most of the time, it’s fluctuating blood pressure, oxygen, and ventilation dependency, and most importantly, the tracheostomy, because tracheostomy is an unstable airway, and an unstable airway needs to be managed 24/7 by critical care nurses. This is actually evidence-based and is shared on our website anyway.

“Next, respiratory issues. With (again, put your loved one’s name in there) being ventilator and tracheostomy dependent, it requires the skill of critical care nurses and respiratory therapists, 24 hours a day, as well as intensive care specialists. LTACs do not have that skill level. Therefore, it would be unsafe and medically negligence for my family member (put in the name) to go to an LTAC.

Next, incomplete antibiotic therapy. Active infections such as pneumonia, sepsis are often not being adequately treated or documented as resolved in an LTAC. Transferring a patient with treatment on antibiotics significantly increases the risk of treatment failure or complications. Once again, many patients on ventilation tracheostomy have ventilator-associated pneumonia (VAP) as a complication and therefore need critical care nurses once again.

Next, risk of harm due to lower monitoring standards. LTAC facilities typically lack the acute level surveillance, resources, skill levels, whether it be doctors, ICU nurses, respiratory therapist familiar with ventilation, tracheostomy to manage complex or unstable patients with unstable airways, which increases the risk of clinical deterioration, readmission to ICU or worse.”

Like I’ve said multiple times on this channel here, we have witnessed many times that patients go from ICU to LTAC only to bounce back into ICU within less than 24 to 48 hours. Keep in mind, once they’ve left the discharging ICU, they often end up going back to another ICU which leads ICU patients to go from ICU to LTAC and then to another ICU within 24 to 48 hours. That means they’re bouncing around in various facilities, whilst they’re extremely, extremely vulnerable.

Hopefully, that laid out today, that email will put a stop to that in the first place. Your loved one needs stability, needs a stable team around them and not bouncing from facility hospital to hospital. That is madness and it’s negligent.

So, conclude the letter or email with “I or we as a family respectfully insist that (put your loved one’s name in there) remain in the ICU until medically stabilized, weaned or ventilation and tracheostomy, until antibiotic and infection control plans are completed or well established and a safe coordinated transfer to a safe can be taking place.”

You can also conclude the email with, “Please document this objection in the medical records and kindly confirm receipt of this letter/email and response from the attending medical team.

I am, or we are prepared to escalate this matter to hospital administration, ethics committee, and if necessary, legal counsel to protect (put in your loved one’s name) rights and safety.”

Now, I will say I put in ethics committees here, I’ve also said on this blog that I generally try to stay clear of ethics committees. However, in this situation, you might look into using an ethics committee. But you do have to do your research, making sure that ethics committees are independent and objective, i.e., that they’re not employees of a hospital, because if they’re employees of a hospital, they’re not going to be objective. They will do whatever the hospital wants them to do.

Also, another thing that often goes hand in hand with This situation is that most specialists in ICU are also not available in an LTAC, i.e., cardiologist, neurologist, dermatologists, nephrologists, you name them. They’re not available in an LTAC and if there’s anything that is unresolved, you will not get that resolve in an LTAC.

This is where we can help you with medical record reviews, looking at all the things that are unresolved that need to be addressed while your loved one is still in ICU. But, like I said, the letter like this is often helping, has helped in the past to stop your loved one going from ICU to LTAC, which is an absolute disaster area. Do not let your loved one go from ICU to LTAC under any circumstances.

Like I said, do not give consent to a PEG tube under any circumstances. I’ve got a whole library about why you shouldn’t give consent to a PEG tube when your loved one is in ICU. There are very few exceptions to that rule when you can safely give consent to a PEG tube, but once again, I’m not going into detail here today.

The purpose of this video today is to give you guidance on how to write an email or a letter to stop your loved one from going from ICU to LTAC.

Now, I have worked in critical care nursing for 25 years in 3 different countries where I worked as a nurse manager for over 5 years in intensive care and I’ve 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 for our clients in intensive care. You can verify that by going to our testimonial section at intensivecarehotline.com or by looking at our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing. You can see on our testimonial section and on our intensivecarehotline.com podcast with our clients that I am not exaggerating in the slightest here.

You can join a growing number of members and clients that we have helped over the years, hundreds and hundreds of members and clients we have helped over the years, probably moving into the thousands now. We help them to improve their lives instantly so that they can make informed decisions, have peace of mind, control, power, and influence, making sure their loved ones get best can treatment always.

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

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.

We also have 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 e-books and 21 videos that I’ve personally written and recorded, only for our members. All of that will help you to make informed decisions, to have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment, always.

All of that, you get at [email protected]. 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. 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.