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The premier resource for hospital professionals from Relias Media, the trusted source for healthcare information and continuing education.

Prevent Readmissions with ‘Sunday’ Shoes and Text Messaging

Everyone wants to prevent expensive readmissions, and recent reports indicate that it might be as simple as using dress shoes and text messages.

At Preston Memorial Hospital in Kingwood, WV, the readmission rate for heart failure patients was 22.6%. Patients were showing up at the ED with weight gain that they hadn’t recognized. The issue? Patients didn’t know they were gaining excess fluid and required diuresis. There were many reasons, including poor eyesight, cognitive decline, and poor math skills.

A simple solution was found: “Sunday” shoes. Most patients owned a pair of structured, dress shoes. Patients were given a discharge instruction sheet that asked them to try on those shoes in the morning. If they didn’t fit, they were told to notify their healthcare provider and get instructions. The Sunday Shoes Program was a success: The 30-day readmission rate for heart failure dropped to zero, two years in a row. (For more information, go to or contact Linda Flemmer, director of quality improvement.)

At Perelman School of Medicine at the University of Pennsylvania in Philadelphia, the target was postpartum women who were at risk of readmission from complications tied to preeclampsia. The problem was that there was no way to predict who would have increased blood pressure that led to preeclampsia. By the time the problem was identified, patients often had to be readmitted.

The American College of Obstetrics and Gynecology (ACOG) recommends blood pressure monitoring at routine visits within 72 hours of discharge after giving birth and then at 7-10 days after birth. As many as 70% of patients don’t follow these guidelines. The solution from Perelman? A remote blood pressure monitoring system for patients who have preeclampsia.

Adi Hirshberg, MD, a fellow in the department of Obstetrics and Gynecology at the Hospital of the University of Pennsylvania, said, “By monitoring blood pressure levels for our postpartum patients who are at home with new babies and can’t always get to office visits, we can provide a convenient and effective way of identifying those who are at risk for complications and may require follow-up care before the situation becomes critical.”

In the study, 32 patients with preeclampsia were given blood pressure cuffs when they were discharged after giving birth. For seven days, patients were texted messages that reminded them to take their blood pressure and send the results to their providers. If the readings were high, patients were asked to take another reading. The system worked: 84% did a blood pressure reading within 48 hours of discharge, and 65% reported the test results for at least five of the seven days. Two patients with high blood pressure were put on medication, but none required readmission. The results were presented at a recent ACOG meeting.

Sometimes solutions are complex, and sometimes they are not. What can you today to prevent readmissions at your hospital? (Editor’s note: Get hospital-related news as it happens on Twitter @HospitalReport.)


Joy Daughtery Dickinson is executive editor of the Hospital Group of publications at AHC Media in Atlanta and long-time editor and writer of Same-Day Surgery. She has won nine national awards from the Specialized Information Publishers Association and the Association of Business Information & Media Companies for her blogging, news writing, and editing. She makes her home in southwest Georgia.