There are many, rational, emotional and medical reasons for moving patients out of hospital ICUs and providing them with critical care at home. An ICU at home, in other words. So, who are the patients who need critical care?

There are patients who are no longer in the critical phase of their illness, but still need ICU facilities and critical care treatment. There are patients who are at the end stage of their lives and could still benefit from being sent home, where ICU services can still be provided along with home care nursing.  Long stays in the ICU potentially increases the risk of acquiring nosocomial infections, which could delay the start of rehabilitative treatments.

So, essentially, people who might need critical care are those who are recovering after a prolonged stay in the ICU, neurological patients, patients with spinal/brain injuries and/or multiple trauma, post-transplant patients, end-of-life care patients, cancer patients, patients with end-stage respiratory disorders, patients on Ventilator and/or Tracheostomy – to name a few.

The advantages: Medical and personal

Long stays in the ICU potentially increases the risk of acquiring a variety of infections that are resistance to drugs, and delaying the start of rehabilitative treatments. Delivering critical care under the aegis of home care services has several advantages.

Clinical

• Qualified, experienced staff, trained to international standards
• Minimal information gap between the care team and the treating doctor
• Following standard protocols on critical care best practice
• Structured communication between nurses, treating doctors and the family - enabled by technology, processes and proper documentation
• Utilizing the latest technologies to support the care process

Personal

• An environment with reduced noise and night-time light, assisting the return to a more physiological circadian rhythms and better sleep patterns
• More open visiting hours to allow unrestricted visits by relatives and friends
• Convenient access to personal belongings, such as books, computers, tablets, TV, music players, etc.
• Continuing intensive care services at home is also a more cost-effective and affordable alternative to the hospital ICU, as well as better managing the patients’ needs

As one client of India Home Health Care (IHHC), whose husband had been hospitalised after a major cardiac incident, puts it, “My husband came home – to a room that was a mini-recreation of the ICU at the hospital. Everything you expect to find in an ICU, all the bleeping machines, the twinkling lights on the monitors, the light humming of the ventilator machine – yes, my husband needed that as well – all the high-tech gizmos made the room an almost unreal facsimile of an ICU. Of course, all this technology was superbly supported by nursing staff who, I was told, were trained in a program that simulated real life scenarios with computerised mannequins that they practised on.”

In addition to the continuous monitoring of vitals and maintaining the highest standards of hygienic care and  administration of medication, the tasks covered by a critical care team at home include handling the following tasks, as per the treating doctor’s directive and the care plan previously decided upon, as well:

• Nursing care for mechanically ventilated patients with Tracheostomy
• Nursing care for patients on CPAP or BiPAP and/or High Flow Oxygen Therapy
• Total parenteral nutrition
• Internal feeding
• Infusion therapy
• Bowel and bladder management
• Maintaining skin integrity

The benefits to doctors

• Faster recovery of patients due to better treatment compliance
• Less chance of secondary infections
• Improved patient satisfaction due to better clinical outcomes
• Reduced length of stay thus improving efficiency and throughput for the hospital

The benefits to the patients

• Faster recovery due to the comfort of being at home
• Better compliance
• Significant cost saving as professional home health care is 60-70% less expensive than hospitals
• Smoother transition from hospital - ensures faster rehabilitation into normal life

BY THIYAGARAJAN VELAYUTHAM, FOUNDER, IHHC | 31st AUG 2018