Meeting Patients Where They Are With Unified Care Team Communication

For many patients and family members, hospice is a terrifying word that is equated with giving up. Avita Home Health & Hospice is working to change that viewpoint and show that hospice care is not giving up hope, it’s simply revising hope. With the aid of healthcare technology like clinical communication and collaboration, Avita is able to meet patients where they are in their healthcare journey to answer questions and provide compassionate care.

In this episode of The Connected Care Team, Catherine Sapp, executive director at Avita Home Health & Hospice details how nurses and staff members use TigerConnect to enhance communication and coordinate care.

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Transcript

Dr. O Connor: With us today, we have Cathy Sapp, executive director at Avita Home Health and Hospice. Welcome to the show, Cathy. 

Cathy: Thank you for having me. I'm excited to be here.

Dr. O Connor: Thanks so much. Um, tell me a little bit about, Avita Home Health and your role there.

Cathy: So, Avita Home Health and Hospice is, it's a wholly owned subsidiary of a Avita Health System. So we are owned by a health system, but we are a separate organization. Uh, we're a small rural non-profit, located kind of in the center of Ohio, between Cleveland and Columbus.

We serve eight counties providing in-home, uh, home health and hospice care. We also serve hospice patients at reside in nursing homes and assisted living facilities. 

Dr. O Connor: How long have you been around? 

Cathy: So I've been with the organization for 12 years. The agency's been in existence since 1985. Um, I started as a field nurse 12 years ago and have just worked my way toward, um, executive director, which I took that role about two years ago.

Dr. O Connor: Oh, Fantastic. So that's, you've been there a while. What has, what has changed over over time? And I'd love to hear specifically about what's changed relative to how you communicate and collaborate.

Cathy: So technology of course has been the biggest changing factor over the past 12 years. I was thinking back before, uh, sitting down with you about how tech has changed since I was a field nurse 12 years ago, and I mean, goodness, GPS wasn't even a thing on our phones.

So finding patients was a challenge. Um, you know, pulling out our cell phones are so different, how we call patients, how we communicate, um, our phone lines here at the health or at the office are now integrated with the health system, which they weren't before. So to reach people within the health system is much easier.

Um, it really just has streamlined so much over the years. And I feel like because of all those advances in technology we’re able to text. We don't have to pay extra for texting anymore like we used to. So we, you know, we can text our coworkers about things and, um, we can utilize GPS on our, our cell phones now.

So it's definitely made us more efficient, more effective and, and feel more empowered to, to take care of people faster and more effectively. 

Dr. O Connor: Yeah. That, you know, that's that's certainly one of the outcomes we see when you use those types of communication. tools. What has it been like the past couple of years with COVID and how did you use those tools to keep your business going and keep that outreach to patients going?

Cathy: So, one of the nice things with all of these advances in technology is we were able to still communicate with one another very effectively, we were able to transition things to Zoom staff meetings, team huddles, patient discussions were still able to take place despite maybe not everybody being in the office all at the same time because of the nature of our work anyway. 

You know, not everybody's in the office all day long. We're out seeing patients. We're kind of used to that type of communication anyway, but we just got better at things like Zoom and those sort of platforms that helped us facilitate those types of communications better. We also, uh, learned a lot about the advancement of telehealth and we started to incorporate our services into utilizing telehealth more. 

We assisted doctors. We assisted patients who didn't have access to technology because we had it. So we were able to work with our providers and, and help their patients get seen, even if it really didn't mean that they were becoming home health patients or hospice patients. It was really just a way for us to collaborate with the health system.

Dr. O Connor: Was any of that interrupted by staffing issues? Either on the IT side or on the nursing side?

Cathy: It was, I mean, we had delays in certain things getting taken care of. Sometimes if there were hiccups in systems, we would have delays just due to staffing, both on the IT side and on our side as well. So we kind of felt like we were orienting people a lot. 

It happened, you know, frequently. And it really was because of an influx of patients. And also because of staffing and, you know, turnover is just a normal occurrence in healthcare on a good day. I felt like our agency really weathered that storm very well and that our turnover was significantly less than, than the average. However, every healthcare organization experiences it.

Dr. O Connor: Yeah, it's been a problem we've been seeing, you know, compounded uh, by COVID I think over the past couple of years, but you know, I've certainly talked to clients where their nursing turnover was 25% Um, you know, incredibly costly. So it's, it's good to hear that you've, you've done well in that regard. 

Um, what about other things that impacted you. What about how has length of stay been been impacted uh, during COVID? 

Cathy: So that was a really surprising impact that we didn't see right away. Um, so during 2020, our length of stay really stayed steady. Um, referrals increased. Which was wonderful and referrals have continued to increase since then. However, what we're finding is that the patients that are coming to us, particularly in hospice care are so much sicker than they had been before.

You were getting notified from our referral sources that you know, this patient maybe has hours two days a week at the most. And that's just not what we're used to in hospice care. We usually get a little more time with our patients and we get that referral just a little bit more, a little bit sooner. So we're getting these patients home and within hours and days they're passing away.

So it's just a whirlwind we're providing, you know, nursing care, we're providing equipment, medications and, and things like that. And we're, we're certainly not going to not take those referrals. Those individuals need that care in that time of need. But from a business perspective, it really impacts our, you know, our revenue and our reimbursement because we're providing a lot, a lot of care and not keeping them very long.

So, you know, you're not billing for a tremendous amount of service. And so it's really been impactful to the business. We've um, we've worked really hard to educate the community. We've worked really hard to educate our referral sources. So that's just our continued strategy to try to encourage people, to talk to us sooner, to kind of change the narrative about hospice care, what it is, what we do, and, uh, try to take away some of that negative connotation that goes with that word.

It's such a scary word. Most people equate it with giving up and throwing in the towel. And we're just really trying to change people's perspective in that it really isn't giving up hope, it’s just revising hope. 

Dr. O Connor: How do you combat that? Cause that is the perception, right? Cause it seems like you're right. It seems that the quicker you can get patients started with this care, the better off they are. 

Cathy: Sure. So the number one thing we hear from patients and their family is, gosh, I wish I would have called you sooner. And so. It is a hard thing to change. You know, patient testimonies are probably our number one, um, way that we can encourage people is have someone express their experience with hospice care and the services and what it really means.

And you know that no, they, it doesn't mean that we are taking away all other medical care and that they can't, they can't see their doctor or they can't, uh, you know, fix that broken hip or whatever else is happening in their, in their medical care. It's, it's so different than what people think of. I think people truly just think if they look for hospice care, that that means that their loved one or they are going to pass away today or tomorrow. And patient testimonies and, just education.

We use our social media sites a lot for that type of education. That seems to be how people, you know, obtain and gather information. So helping people realize that it's, it's not as scary as it sounds meeting with patients and their families, as well as a way that we, you know, do that. We just try to meet them where they're at and answer their questions.

Dr. O Connor: No, I've got it. I'm tracking with you now. I think meeting them where they're at is important. And certainly it sounds like you're using technology quite a bit to, you know, to do that and augment those experiences. What's your experience been like with, with TigerConnect? Talk to me a little bit about how that, that solution has impacted your operations and how you're delivering care.

Cathy: Sure. So we, uh, we actually adopted TigerConnect right in the thick of all of this in 2020. Uh, so we found that we were communicating via text message and a group message and a lot more frequently than we had been before. And we were utilizing some free platforms, um, that were not HIPAA compliant. So, you know, you'd have to text the patient's initials or things like that.

Other identifying factors so you wouldn't violate any of their privacy. So I got to looking at TigerConnect and it really you know, met our needs and it looked like something we could implement pretty easily. And that was really the game changer for us was the ease of implementation, the ease of training. We didn't want to spend a lot of time in an already stressed environment having people learn new technology, new apps, things like that. 

So we launched it in, uh, mid 2020, and, it really has been so impactful for us for a number of reasons. One, because we can, we can text about, uh, the patient, their needs and the, you know, the staff don't have to go into the EMR and think, okay, who are we talking about?

What patient is this that we're referring to? They know right away. We’ve established groups that are specific to home health, to hospice, to our nurses, to our aides, to just our office staff. So we have special, you know, threads just for that group of people. So the right people are getting the right information.

They're getting it quickly. We love the broadcast function so we can get information out to the entire staff really quickly. Um, the ease of implementation, the staff really love it for that. Um, I had a new employee just this morning, actually that I set up in TigerConnect and it took me a grand total of five minutes to get him, you know, set up with you know, a user profile and he's already texting the groups that he's involved in and had zero questions.

So that really was a game changer for us as well. And our medical director is included in our team. So that is huge for our hospice patients. So if we're with a hospice patient, um, or we get a phone call about one of our patients, we can send a message directly to her.

She can address that need quickly because she also has a practice. So, you know, we're not calling her office. Texting her office staff about a patient that they really know nothing about and asking for, for orders or changes in care. Um, when, you know, we'd have to wait for a response and that sort of thing.

So we just have direct communication with her and that's been paramount for patient care. 

Dr. O Connor: Yeah, it sounds really like it's been a paradigm shift in the way you communicate and the, and the benefits of it. Have you measured anything specific around time-savings or delays in care or things like that?

Cathy: So it's kind of a hard thing to quantify, but we did, um, we did quantify it, that we saved probably about four hours a week on just, um, saving trips back to the office to send faxes, make phone calls, uh, also saving trips to the pharmacy, to back and forth from patients' homes and things like that. We can start taking care of those things at communicating with staff and kind of work together.

Uh, so about four hours a week, we estimated that we saved by implementing TigerConnect. 

Dr. O Connor: Wow, That's impressive. I wanted to ask about staff satisfaction, with the solution. Sounds like from what you described, easy to set up, easy to use. Has there been feedback from the staff?

Cathy: Um, especially from those staff that were here, pre TigerConnect and are still here. Um, they really have a lot of positive things to say about it because they can remember a time when we didn't have it. Um, but the number one thing is ease of use. Uh, we also implemented TigerSchedule, so that's helpful with the roles.

Those of us that use that platform we can put the on-call nurses schedule in, and that will communicate with TigerConnect. Therefore, our staff don't have to ask who is on call. We used to have to shuffle around a paper on call schedule, and if it changed, you know, you're not always up to date. So knowing who to communicate with is, is huge.

So that's been a, uh, a positive, uh, bit of information that the staff have shared with us. They really enjoy that feature. And they just like being able to get ahold of our medical director. That's really important for them as well. Nothing more stressful than being in a patient's home with a patient whose condition has changed and you can't get ahold of, uh, a provider to, uh, ease those families tensions and, and that patient's discomfort.

Dr. O Connor: Yeah, That, um, what you just said, Cathy really resonated with me and I've heard other healthcare workers describe that as well, being at the bedside whether it's In the hospital or in the home and not being able to get in touch with the person that you need to take care of that patient instantly, um, is a incredible stressor as a clinician to have to deal with that.

So um, I'm glad that, uh, the technology has, has aided in that certainly better for the patients and better for the staff as well. 

Tell me a little bit more about how you're using the scheduling product to, to schedule your nurses and, and any of the feedback that you've received so far on that, because I know it's relatively new for you. 

Cathy: It is. We just recently started utilizing that. So, uh, what I love about the scheduling piece of, of TigerSchedule is that we can, uh, put the nurses that are on call in in that, and it will communicate with TigerConnect.

So then when a nurse is needing to communicate with that nurse on call, maybe pass something on for after hours in case they would get a call about a patient or an update. They don't have to think about who is on call. They can just look in TigerConnect and it, it will, it will show them who to talk to.

It also saves the messages in that role. So when that role changes hands, then the next person can kind of catch up on the communication that has happened day prior. So that's really helpful as well. I do like playing around with the scheduling feature. So I'm, I'm still learning that piece of it, but it does create a schedule for you.

So you can implement certain rules. Uh, you know, I only want a nurse on call one day a week, one weekend a month, whatever the case may be. And it will take all of your staff and plug them into various spots. So that's still a work in progress for me. I'm still learning that part, but I do like that feature thus far what I have done with it.

Dr. O Connor: Yeah. It sounds like you're getting a lot out of it. Certainly what you described around continuity of care. Being able to pass messages from one role to the next person, taking over that role allows for that and allows it to happen easily. It sounds like you're you're taking advantage of that.

Cathy: Yes.

Dr. O’Connor:  So Cathy, I’d love to finish up, just ask you plans for 2022 and beyond relative to continued improvement and how you’re collaborating.

Cathy: So for 2022, I kind of feel like this is the year where we've really gotten, I don't want to say used to COVID. I don't want to say that, but, you know, we've learned how to, to deal with, um, all of the things related to it. So now I feel like this is a great year to kind of recharge our batteries, get back to all of the things that we wanted to accomplish pre COVID.

Um, because we have a plan in place. Now it's just following that plan. Um, our biggest thing is really changing the narrative about hospice care with the community. Growing that side of our business to allow more people, the opportunity to get that care, you know, end of life care. It's not changing where, you know, it's unfortunately fewer people are not experiencing end of life needs.

Um, it's just a matter of, of utilizing our services sooner so they can get back to, um, you know, making memories and, uh, making the most of that time that they have. Um, and it's, it's really a hard concept to wrap your head around. So. That's kind of our goal for the year is just to really help change people's minds about hospice care, get them, more connected with being in charge of their care, getting them more comfortable, getting that trust back with healthcare, more comfortable with going back and seeing their doctor and, uh, communicating their needs.

Uh, I think we kind of, in the past couple of years, unfortunately, healthcare has just been so turned upside down that we kind of have to get back to getting patients comfortable with going back to their doctor and asking the right questions and starting those hard conversations, you know, do I want to continue to seek, all these treatments, these aggressive, type treatments for my illness that maybe make me feel better for a little while, but then I'm back right where I was.

Do I want to keep, if for lack of better term, spinning my wheels or do I want to think about my care differently? And that's kind of where we come in.

Dr. O Connor: It sounds like the people of Ohio are, are very lucky to, have you, um, congratulations on all your success with Avita. It certainly sounds like you're having an impact in the community and it was really fascinating to hear you talk about how the technology is impacting, how you've adapted to COVID and how you're continuing to serve your patients and provide a better experience for them as well as your staff. So thank you so much for joining us today on the show. 

Cathy: Thank you for having me. It was a pleasure.