Background: Human milk provides ideal nutrition for premature infants in the Neonatal Intensive Care Unit (NICU). Initiation of milk expression within one hour following delivery increases milk volume in mothers of very low birth weight infants. Despite these known benefits, prior analysis found 57% of NICU mothers delivering at Vanderbilt University Medical Center initiate breast-pumping within 6 hours of delivery. This quality improvement initiative aimed to evaluate our current postpartum pumping performance and decrease the median time to first breast pump in NICU mothers by 50%. Methodology: Baseline time to first breast pump was calculated for mothers who delivered between 10/01/2019 and 10/31/2019 and were seen for consultation in our Fetal Center by a single Maternal Fetal Medicine (MFM) provider (LCZ). We determined the time from delivery to first breast pump using time stamps in the electronic medical record (EMR). Intervention 1, conducted between 11/5/19 -12/17/19, consisted of counseling 3rd trimester mothers seen by LCZ in the outpatient setting on the benefits of a short interval to first pump. Intervention 2 was conducted from 12/20/19 - 12/27/19 on the inpatient antepartum service. During bedside rounds, the same physician counseled women likely to deliver neonates requiring NICU care about the importance of a short interval to first breast pump. Time to first breast pump was similarly calculated for intervention patients via time stamps in the EMR. Discussion: Nine patients were delivered during the baseline data collection period. Among this group, the median baseline time from delivery to first breast pump was 8.38 [IQR: 7.55-10.22] hours. Ten of 15 patients who received Intervention 1 commenced breast pumping after delivery, with a median time to first breast pump of 4.63 [IQR: 2.52-5.67] hours. Five patients who received Intervention 2 commenced breast pumping after delivery with a median time to first breast pump of 9.92 [IQR: 6.28-11.12] hours. Two mothers who received intervention 2 took >17 hours to initiate pumping. One did not receive her breast pump supplies in a timely manner and the other’s child was unstable and NPO, which may have contributed to delays in pumping. The overall combined intervention median was 4.92 [IQR: 2.88-8.12] hours. This represented a 41% decrease from the baseline time. Conclusion: Overall, our educational interventions reduced median time to first breast pump amongst mothers whose babies went to the NICU. Our outpatient counseling intervention proved to be strongest. Next, we plan to recruit more MFM attendings to implement the outpatient counseling, create a flier to supplement patient education, and modify the “surgical time” out protocols to include intraoperative retrieval of a breast pump for the mother’s postpartum room.

Figure 1

Run chart of process measure Percentage of patients in their third trimester who received counseling on timely initiation of breast pumping.

Figure 1

Run chart of process measure Percentage of patients in their third trimester who received counseling on timely initiation of breast pumping.

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Figure 2

Run chart of outcome measure Time from delivery to first breast pump in mothers of NICU babies who delivered vaginally or via Cesarean section.

Figure 2

Run chart of outcome measure Time from delivery to first breast pump in mothers of NICU babies who delivered vaginally or via Cesarean section.

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