Abstract
More recently the American Board of Pediatrics determined that physicians must work on a QI project in order to maintain their specialty and subspecialty certification. Having done considerable work with the Seton Family of Hospitals and their Perinatal Safety Initiative, a QI effort surrounding delivery and birth injury, we have come to believe several “truths” about QI: (1) Physicians do respond to outcomes data, but (2) physicians need help with QI methods, techniques, toolkits, and data collection. (3) Physicians do respond to certification and continuing medical education requirements, and (4) hospitals respond to the Joint Commission, Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention's recommendations.
The “Safe and Healthy Beginnings Resource Toolkit for Hospitals and Physicians' Offices” is one of the QI projects approved by the American Board of Pediatrics. Among the long list of QI approved projects, this is the only toolkit for breastfeeding. We need to think creatively about ways to market and disseminate this toolkit and help pediatricians and hospital personnel utilize it. And, we need to convince the Joint Commission that exclusive breastfeeding at hospital discharge remains one of the mandatory perinatal measures that birthing hospitals routinely track and report.
One example of our QI work locally at Seton Medical Center shows rates of breastfeeding at neonatal intensive care unit discharge using the PDX Clinical Data Warehouse (Fig. 1). In addition, we track our use of breastmilk feedings within the first week of life for all term and for preterm babies (Fig. 2). The University Hospital at Brackenridge is a city-county facility in Austin, TX with 2,500 deliveries per year, mostly Hispanic and indigent. Our auditing of newborn charts there has shown a persistently high rate of breastfeeding initiation but very low rates of exclusive breastfeeding at discharge. Two changes in hospital policies and routines were implemented recently: One was a policy to “take babies out to the mother” within the first hour (cesarean sections included), and the other was a requirement for a physician's order to give any supplemental formula. The resident and the nurse are required to “educate the mother” before any supplemental formula is given. Figure 3 shows increasing rates of breastfeeding in the first hour and lower rates of bottle feedings as a result. Finally, our hospital network's Maternity Practices in Infant Nutrition and Care team (we call ourselves the “Perinatal Nutrition Safety Team”) has been auditing exclusive breastfeeding at hospital discharge in late preterm and term babies cared for in the newborn nursery. Figure 4 shows increasing rates of exclusive breastfeeding over the last 4 months at (five of) our six network hospitals.
Seton Medical Center Austin breastfeeding at neonatal intensive care unit discharge for all patients by year of discharge. Source: Pediatrix Medical Group Clinical Data Warehouse (Copyright 2010 Mednax PSO, LLC.).
Breastmilk feeding within the first week of life:
University Medical Center at Brackenridge breastfeeding (BF) and formula use audit. Policy changes included #physician order required for formula and *babies “out to mother” within the first hour. DC, discharge. Source: Seton Family of Hospitals.
Exclusive breastfeeding at discharge for babies >35 weeks of gestation in the Seton Family of Hospitals. SMC-A, Seton Medical Center Austin; SMC-H, Seton Medical Center Hays; SMC-W, Seton Medical Center Williamson County; SNW, Seton Northwest; SSW, Seton Southwest; UMCB, University Medical Center at Brackenridge. Source: Seton Family of Hospitals.
Footnotes
Disclosure Statement
There are no institutional or commercial affiliations that might pose a conflict of interest regarding the publication of this article. No competing financial interests exist.