PC2020: Addressing Community Gaps to Breastfeeding from Hospital to First Visit - The Breastfeeding "Warm Handoff"

Purpose/Objectives: Although there is an increasing trend for more mothers to initiate breastfeeding in the US, there is a rapid decline after initiation, and racial disparities persist. A multidisciplinary team comprised of pediatricians, neonatologists, prenatal lactation support, primary care lactation experts, and members of the community partnered to address the cessation of breastfeeding before the first “Newborn” visit at our institution’s busy primary care safety net clinics, using Quality Improvement methodology.

Design/Methods: The aim of this project is to increase the number of babies still receiving some of their mother’s milk at the first visit by 5% compared to baseline rates. Key Drivers affecting early cessation were identified and interventions developed to affect change through PDSA (Plan-Do-Study-Act) cycles. Mothers identified as no longer breastfeeding at the first visit are interviewed to learn the reasons for cessation to help the team plan interventions.

Results: Baseline rates of infants born at all area hospitals still breastfeeding at the first newborn visit has remained stable at 88% from all area birth hospitals. Variation between birth hospital rates ranged from 82-92% still breastfeeding at the first visit. Differences also exist between the 3 main primary care sites, ranging from a mean of 86% to 89%. One major birthing hospital whose babies attend our 3 clinics has increased the mean “still breastfeeding” from 82% at project launch, to 88%. Mothers identified the following reasons for their discontinuation of breastfeeding: concerns about “not enough milk”, difficult latch, baby not satisfied, stress, work, and mother’s habits not safe for the baby. Systematic procedures were established, launched, and implemented to improve identification of feeding type at discharge and are now spread to all area birth hospitals for more accurate classification of feeding. Community support resource guides were created and shared with birth hospitals and the community. A one page infographic was developed to share guidance on the most common concerns of mothers during the early days and is distributed to mothers at one birth hospital. We identified lack of timely access for the first newborn visit during the early days of the COVID-19 pandemic and as a QI collaborative we were able to “sound the alarm” to health systems caring for newborns to develop mechanisms to ensure that babies receive appropriate and timely follow up care. Current work involves creation of a “Breastfeeding Warm Handoff” from hospital to first visit through identification of risk factors for breastfeeding difficulties with highlights of Red Flags pulled into the discharge summary through EPIC.

Conclusion/Discussion: A quality improvement collaborative has successfully engaged partners from across institutions and disciplines to work on improving breastfeeding continuation at the first visit with QI methodology.