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 FTE’s. We have 2 FTE’s of IBCLC’s for 1,600 deliveries per year.

Proposed change: Prior to 2008, lactation consultants would see patients on the postpartum unit and made follow-up phone calls to support breastfeeding women.    The problem that continued to arise was how to get this information to either the mother or infants medical record for the continuum of care.  Patients were calling the lactation consultants more often requesting a visit as well as 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 IBCLC hours a 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 0730-1130 seven days a week and in two outpatient clinics 1200-1600 Monday through Friday.  Gundersen Lutheran is an integrated health system therefore the lactation consultants can work in both the clinic and the hospital setting.  In March of 2010 we began using the ICD9 codes and diagnoses for billing for the lactation consultant visits. The number of outpatient appointments for lactation consultants have 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 RN’s. 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 MD schedules for more appropriate patients.  We anticipate increased duration of breastfeeding due to ongoing, accessible Lactation consultant services. Data suggests that patient education and support by IBCLCs 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.

Keywords: lactation consultant, breastfeeding, revenue, continuum, ICD9 codes