Implementing Lactation Services Support from Hospital to Clinic
Version of Record online: 14 JUN 2012
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2012 Convention Proceedings
Volume 41, Issue s1, pages S68–S67, June 2012
How to Cite
Susdorf, S. and Curtis, K. (2012), Implementing Lactation Services Support from Hospital to Clinic. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S68–S67. doi: 10.1111/j.1552-6909.2012.01361_17.x
- Issue online: 14 JUN 2012
- Version of Record online: 14 JUN 2012
- lactation consultant;
- ICD9 codes
Purpose for the Program
Our goal was to expand our inpatient lactation consultant services to our two outpatient clinics where mothers with complex breastfeeding problems could schedule appointments with a lactation consultant. We needed to accomplish this without increasing full-time equivalents. We have two full-time equivalent international board certified lactation consultants for 1,600 deliveries per year.
Prior to 2008, lactation consultants would see patients on the postpartum unit and make follow-up phone calls to support breastfeeding women. The problem that continued to arise was how to get this information to either the mother's or infant's medical record for the continuum of care. Patients were calling the lactation consultants more often requesting visits, and the medical staff were requesting the lactation consultants to see their patients for complex breastfeeding issues.
Implementation, Outcomes, and Evaluation
Beginning in 2008, we shifted 16 international board certified lactation consultant hours per week to the two outpatient pediatric clinics. This provided lactation services two afternoons per week in each clinic. These visits were considered a nurse-only visit. By 2009, we expanded to three afternoons per week in each clinic. The need to open more lactation clinic hours became obvious as the number of patient appointments increased. Today, lactation consultants are in the hospital from 7:30 a.m. to 11:30 a.m. seven days a week and in two outpatient clinics from 12:00 p.m. to 4:00 p.m. Monday through Friday. Gundersen Lutheran is an integrated health system and, therefore, the lactation consultants can work in both the clinic and the hospital setting. In March of 2010, we began using the International Classification of Diseases-Ninth Clinical Modification codes and diagnoses for billing for the lactation consultant visits. The number of outpatient appointments for lactation consultants increased from 444 in 2008 to 756 in 2010. Between March and December of 2010 there was almost $30,000 billed for lactation consultation visits.
Implications for Nursing Practice
All of our lactation consultants are registered nurses. The visits are billed under a physician order. Physicians are present in the clinics for consultation. Seeing a lactation consultant for complex breastfeeding problems has opened up the physicians’ schedules for more appropriate patients. We anticipate increased duration of breastfeeding due to ongoing, accessible lactation consultant services. Data suggest that patient education and support by international board certified lactation consultants promotes a longer duration of breastfeeding when utilized in a primary care setting. With the implementation of Epic for our electronic medical record in August 2011, we will now be able to begin tracking more precise data for duration of breastfeeding.