385 - Improving Delivery of Breastmilk to VLBW Infants at Time of NICU Discharge Through Collaborative Quality Improvement in a Large Perinatal Care Region in Texas

Poster Number: 385
Publication Number: 385.2001

Background: The AAP supports breastmilk as the normative diet for all infants given numerous short and long-term health benefits for infants and mothers. The CDC Breastfeeding Report Card ranks Texas as #15 in “Ever breastfed” and #23 in “Breastfeeding at 12 months”. SETRAC Perinatal consists of 34 Houston area NICUs with 50000 annual deliveries, including 1200 very low birthweight infants annually. NICUs in this area reported only 26-31% of VLBW infants were discharged home on any breastmilk feeds in the years 2019 and 2020.

Objective: A multidisciplinary project team of regional physicians, nurses and lactation consultants was formed as part of the SETRAC Perinatal Committee to improve rates of NICU VLBW graduates discharged home on breastmilk. The project aimed to achieve an absolute increase of 10% in the rates of VLBW infants receiving breastmilk at discharge within 1 year of implementation.

Design/Methods: A web-based toolkit was created (https://www.setrac.org/perinatal/ Resources: Breastfeeding at Discharge) and a tiered merit system was established to incentivize hospitals to increase efforts to establish and maintain mothers’ breastmilk supply. Participation was tracked through monthly meetings, biannual survey, and quarterly RAC data submission. Hospitals tracked rates of prenatal breastmilk counseling, breast pump availability following delivery and at time of maternal discharge, and post discharge lactation follow up. Multiple PDSA cycles have since been undertaken to further improve this outcome measure with changing unit barriers.

Results: Rates of VLBW infants discharged home from SETRAC NICUs on any breastmilk increased to 53% for VLBW infants by the end of 2021 and has been sustained at 50-54% for 2022 and 2023 (n=~1200 annually). Participation in the breastmilk project improved from 53% to 80% in the first year of implementation, with 100% reporting use of the toolkit in 2023. Pump access following delivery improved from 75% to 89%, and at time of maternal discharge from 63% to 89% by 2022. Improvement has been sustained 3 years into the project, with an additional 3% absolute improvement in all weight NICU discharges on breastmilk.

Conclusion(s): Through a collaborative and incentivized initiative, SETRAC has shown how regionalized collaborative quality improvement can significantly improve health outcomes for infants and mothers. Our project demonstrates the ability of providers across multiple healthcare systems to work together towards a common goal. The use of a shared toolkit and RAC recognition of hospital units’ success helped to increase the delivery of breastmilk to high-risk infants.