What We Tried

In interviewing our readmitted patients, we determined that health care literacy was an issue for heart failure patients. We learned that patients were unable to determine for themselves when they were gaining excess fluid and required diuresis. Some patients lacked scales for daily weight monitoring. Others lacked ability to see or read the scales because of poor eye sight or inability to see over their enlarged abdomen. A number of patients were unable to recognize a weight change from monitoring serial weights because of cognitive decline or poor math skills. All of these patient challenges were resulting in potentially preventable readmissions. We then realized we had to solve a health literacy issue!

Our team brainstormed to identify triggers that would indicate weight gain prior to distress when home diuresis would still be a viable option. We decided to assess pedal edema using structured, formal shoes or “Sunday Shoes” (shoes that patients would typically wear to church on Sundays), something that virtually every patient already owned. We developed a discharge instruction sheet that told patients how to assess their pedal edema daily, beginning with the day they left the hospital when they were at a “dry” weight (patient has finished diuresing down to their ideal condition). If their shoes did not fit that morning like they did on the day they were discharged, they were to notify their family provider for instructions or an urgent visit. The Sunday Shoes Program was born and has been utilized ever since!