Fitted Shoe Program Reduces Heart Failure Readmissions

The Sunday Shoes Program is an innovative solution to help heart failure patients monitor weight gain. It was developed by the Hospital Engagement Network (HEN) team at Preston Memorial Hospital, a 25-bed critical access hospital in Kingwood, WV. In 2012, the heart failure readmission rate at the hospital exceeded 22.6 percent. Despite several interventions by the team, patients were visiting the ED with considerable, unrecognized weight gain and distress. By interviewing readmitted patients, the team identified health literacy as an issue. Due to poor eyesight, cognitive decline, poor math skills or other challenges, many patients were unable to determine when they were gaining excess fluid and required diuresis. The team focused on assessing pedal edema by using structured, dress shoes— “Sunday” shoes—that nearly every patient owned. A discharge instruction sheet asks patients to assess pedal edema daily, compared to their “dry” weight when they leave the hospital. If their Sunday shoes don't fit in the morning, patients notify their provider for instructions. Following implementation of the Sunday Shoes Program, Preston Memorial Hospital's 30-day readmission rate for heart failure dropped to 0 percent in 2013 and 2014. Data for 2015 is not yet available.

For more information, contact Linda Flemmer, director of quality improvement, at lflemmer@prestonmemorial.org. Visit the Huddle for Care website at www.huddleforcare.org for a more detailed write-up of this case example plus other stories submitted by front-line staff with transitional care solutions.