Dear Lactnet Friends,

 

There is unfortunately no recommendation available on provision of
out-patient lactation support. However, there was a good study in JHL in
2006 from Mannel and Mannel detailing one institutions' time study of
lactation support. http://jhl.sagepub.com/content/22/4/409.refs

 

From the abstract, "A retrospective review of data from a lactation
program's productivity reports at a large tertiary care teaching hospital
(4200 births per year) measured actual hours worked by international board
certified lactation consultants (IBCLCs) over a 2-year period, allocated the
hours to their respective activities, and developed ratios for optimal IBCLC
staffing for each component of service delivered. Optimal IBCLC staffing was
calculated as follows: mother/baby inpatient requires 1 full-time equivalent
(FTE) per 783 breastfeeding couplets; neonatal intensive care unit (NICU)
inpatient requires 1 FTE per 235 infant admits; mother/baby outpatient
requires 1 FTE per 1292 breastfeeding couplets discharged; NICU outpatient
requires 1 FTE per 818 breastfeeding infants discharged; telephone follow-up
requires 1 FTE per 3915 breastfeeding couplets or infants discharged;
education requires 0.1 FTE per 1000 deliveries; program
development/administration requires 0.1 FTE per 1000 deliveries; and
research requires 0.1 to 0.2 FTE total. Using the formulas provided, IBCLC
staffing can be calculated for desired services based on patient numbers.

J Hum Lact. 22(4):409-417.

 

This level of outpatient staffing, however, is not suggested to be relevant
to a true out-patient clinic. The article states, "Although some lactation
programs provide a follow-up

"breastfeeding clinic," this service is not possible with the existing level
of staffing. Outpatient consults are scheduled on an as-needed basis and
require reassigning an IBCLC from the floor to see the patient. A true
clinic would additionally be providing more than one visit for some
families."  This booklet from USLCA also outlines the documentation needed
for lactation support on pages 12 and 13
http://uslca.org/wp-content/uploads/2013/02/Containing-Health-Care-Costs-3rd
-edition-7-2014.pdf

 

As other colleagues have already responded the length of the consultation is
typically about one hour of face-to-face time. Manell's work suggested 95
minutes for out-patient consultation process.  In addition to the actual
visit, per our Code of Conduct and Documentation Guidelines we must
thoroughly document the visit record and do so in the U.S. compliant with
HIPPA guidelines. We must also send a report of the visit to the primary
care physician. Data and anectodat evidence I have collected in my practice
setting indicates most mothers will need between 1 and 3 visits to resolve
acute problems but may need additional telephone advice over the year of
breastfeeding. Complex cases such a premature babies and mothers with health
risk factors for lactation problems may need more visits. 

 

We have evidence of the incidence or breastfeeding problems in recent
research outlined in the USLCA Containing Healthcare Costs, 3rd edition
http://uslca.org/wp-content/uploads/2013/02/Containing-Health-Care-Costs-3rd
-edition-7-2014.pdf Page 6 of the document outlines some relevant studies.
The majority of women who initiate breastfeeding are not achieving their
goals and that is partly due to poor availability of breastfeeding support
for out-patient mothers and babies. Poor breastfeeding duration rates are
evidence of the need for improved access to support. 

 

Good Luck with your Clinic. 

 

Judy 

Judith L. Gutowski, BA, IBCLC, RLC

"Pray as if everything depends on God, work as if everything depends on
you."

 


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