How Avow Hospice Used Triage to Boost Quality, Reduce Turnover

Avow Hospice has implemented a triage system that has resulted in improved quality scores and reduced turnover.

The Florida-based provider uses an acuity system that draws data from its electronic medical record (EMR) system to help stratify patients based on their most likely immediate needs. To complement these efforts, Avow also revamped its approach to night time and weekend visits, Rebecca Gatian, COO of Avow Hospice, said at the National Hospice and Palliative Care Organization’s Virtual Interdisciplinary Conference.

“With this whole process improvement and analysis of visits at the end of life, we did really improve our [Consumer Assessment of Healthcare Providers and Systems (CAHPS)] scores related to receiving help during the evenings, weekends and holidays, and help as soon as it was needed,” Gatian said at the conference. “Some other outcomes of transforming the visit approach: Staff who have left and heard about the new model have been calling back like crazy. We have really low turnover with the staff in the department, and have higher satisfaction with the staff.”


One key element of this initiative, in addition to the technology piece, was a revamp of how the organization deploys its night shift clinicians. As Avow analyzed its systems and processes, they realized that their night shift was underutilized when it comes to home visits, and that their day shift was getting burned out with their higher caseload, Teressa Powell, clinical operations manager at Avow Hospice, said during the conference.

Generally, the organization found, their day shift was making seven to 10 visits within 12 hours, whereas the night time staff were making zero to four visits within that same time period. Consequently, the day shift clinicians often felt rushed and like they couldn’t get to all the patients they needed to see during the day. To address this, Avow began front-loading some home visits to the night shift, according to Powell.

This not only relieved some of the demands on day-time staff, but also helped Avow improve performance on quality measures like visits during the last days of life.


“At times we were missing the measures because a patient died before day shift arrived. This led us to front-load the visits at night shift,” Powell said. “This is part of why we needed to make sure that our patients were getting timely help, having more of our night shifts doing visits to increase that timely help for the patients.”

The agency also implemented a policy that if a family calls at night, they get a visit. Day-time staff could also leave “slips” for the night team that flag particular patients who would most benefit from a home visit during the evening or late hours. These protocols have reduced the number of crisis calls Avow’s staff receive during the night.

Avow also began a “daily standup” Zoom call for each of their teams early in the morning to review their patients for the day and anticipate their potential needs, based in-part on their acuity.

Staff almost immediately bought into these changes, according to Gatian. The night shift staff indicated that they felt more important and valued getting out to establish relationships with patients and families.

Moreover, former night-shift staff who had left Avow began calling with an interest in returning to the organization. One reason some of them had left was boredom due to the low number of home visits they were making, Gatian indicated.

“Through this systems approach, we have continually improved our [hospice visits during the last days of life] public measure, and internally how we’re monitoring that with our CAHPS scores,” Gatian said. “One of the measures that we did monitor was ‘getting timely help,’ and that has improved since implementing our new structure. We also looked at our staff satisfaction, not burning out the day-shift staff and making the night-shift staff feel important.”

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