I enjoyed reading about your hospital based program - - I am curious as to
what you and other outpatient programs do specifically.  Do you do call
backs - how often and when - what types of situations do you cover and
handle as outpatient.  When you say you do both inpatient and outpatient -
how do you split that up?  Is there ever a problem with switching from one
area to the other?

Just read thru this post i wrote and it seems a bit long - sorry!

We have protocols for follow up, like following babies until birth weight regained (outpatient), until moms have stopped using the nipple shield are two that come to mind.  In the hospital, we see moms that are referred by nurses, doctors or the mom, sometimes.  We do not see patients routinely. We see the 'difficult' cases - no latch after 24 hours, sore nipples that the nurse can't seem to help remedy, moms with a history of breast surgery, cleft lip/palate babies, and other assorted problems.  We get given a lot of reassurance referrrals and will do those if we have time!

Outpatient, we see anyone who needs/wants to be seen.  We follow up moms who have been given nipple shields in the hospital, moms who go home pumping and other moms who the hospital LC thinks needs a FU.  We see moms who call who want to be seen, need to be seen, are sent over from their pediatrician and the moms who 'just want to make sure they are doing it right'.  It is not required that the mom have given birth at our hosptal, so we see moms from all over the San Francisco Bay Area, as we are one of only a few places like this in the area.  We get a lot of referrals from pediatricians.

As to in and out patient staffing - We have LC's that prefer working only in the hospital, yet we have all done both.  We are all pretty flexible and will fill in where needed.  We work very well together, I think. I prefer outpatient, but work in the hospital regularly.  We also have it worked out to provide coverage to the hospital LC (if she is swamped) by working a half day hospital and then going to the clinic.  Every day is different!  Today, we had 6 consults scheduled outpatient and one LC called to say her daughter was ill and would not be in.  I was alone in the clinic, with the phone ringing off the hook (it is friday) with moms that really needed to be seen so I called another LC at home who came in and helped. It is a bit frantic sometimes, but it all works out.  So, there really does not seem to be much trouble going back and forth for us.  The LC who came to help is one who works only in the hospital, but we are convincing her to 'spread her wings' and work outpatient with us!

hope that clarifies things for you.  please let me know if you still have questions.
Lanie Jewell, IBCLC
San Francisco, California, USA
Still foggy. . . 

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