1. Breastfeeding and Newborn Clinic Jennifer Dixon, Jayda Rupp, and Ann Swanson-Hill

2. Executive Summary  Expansion of services at Lawrence Memorial Hospital for new parents and families is the purpose of this proposal. Two overall program enhancements are planned. First, the expansion of services that support and promote breastfeeding. Second, a first check up program to assure that newborns are healthy following early hospital discharge.  The establishment of an advanced practice nurse- managed newborn follow-up clinic facilitates a healthier transition for newborns and their families. The ability to offset existing expenses by utilizing staff that can generate revenue as well as provide a higher level of care is a benefit to the organization and to the community.

3. Problem Definition  The American Academy of Pediatrics recommends that most newborns require follow-up within 48 hours of dismissal.  Not all physicians follow this recommendation, including some in the Lawrence area.  Many normal newborns are discharged from LMH at 24-36 hours of age putting these infants at risk for undetected health issues.  In 2006, it was identified that 1 in 6 newborns did not have a follow-up visit by 14 days of age. (Madlon-Kay and Asche, 2006)  Most at risk not to follow-up: mothers with a low education level, lack of insurance, non-white, those with 2 or more children.

4. Problem Definition  The American Academy of Pediatrics recommendation of a follow-up visit within 48 hours of dismissal is timed so newborns are examined when:  The bilirubin peaks (at 3-5 days of life)  Lactation is just being established  Congenital heart disease becomes detectable due to physiologic changes  Gastrointestinal and metabolic problems begin to manifest

5. Goals and Objectives  The ability to add services to meet these vulnerabilities that can be missed by early discharge and lack of a 48 hour follow-up is the main goal for our newborns.  The object of the ARNP managed breastfeeding clinic is to provide treatment and services that help make the transition from hospital care to home easier and safer for mothers and newborns.  This service adds to the existing maternity services provided by LMH

6. Proposal  Continue daily rounds to all new mothers conducted by ARNP with lactation certification or RN with lactation certification  Increase educational opportunities for bottle feeding parents  Monitor infants for feeding effectiveness, adequate weight gain, hyperbilirubinemia, and other physiologic changes that can impede a healthy transition

7. Proposal  Develop a billable follow-up clinic, managed by an ARNP, for all newborns, where a plan of care is created and implemented to address identified problems with transition  Reduce readmissions to the hospital for hyperbilirubinemia, dehydration, or other neonatal conditions  Close the gap that exists due to early discharge and subsequent physician follow-up at two weeks of age  Provide these services in a confidential, family-focused location

8. Proposal  Services supporting and promoting breastfeeding are directed at achieving:  Access to breastfeeding supplies that facilitate the infant’s early success when challenges occur and support continued breastfeeding  Excellence in the follow-up care provided to newborns and their families

9. Performance Criteria  Outcomes that will be measured to determine effectiveness include:  Financial- We intend for this business to eventually be profitable. With the initial costs of supplies and salaries, it may take up to a year to see a profit. We will keep financial records to determine if this business is profitable.

10. Performance Criteria  Customer Satisfaction- By enhancing the services available to new parents, we believe that customer satisfaction will be enhanced at LMH. Customer service will be measured by survey prior to and after the establishment of the clinic. This will also provide an opportunity to make changes to our program as indicated by customers.

11. Assumptions  All employees of the clinic will be either RN’s or ARNP’s that are also lactation consultants. Appropriate referrals to care providers in the community will be made as needed. Because this clinic is overseen by an ARNP, the services provided at the clinic are billable, a cost center will be established to observe our expenses and revenues.

12. Constraints  Biggest barriers to providing services:  Allocation of space  Costs  Physician competition may be a risk, we will defer follow- up appointments for those physicians not wishing their patients to utilize the follow-up clinic  Services provided as potential lost revenue

13. Milestones  Remodel/Advertisement of new services  Open House/Grand Opening  Performance of cost-benefit analysis at 6 and 12 months

14. Program Costs  ARNP Salary  Yearly raise following 1 st year (if annual goals met)  Total  $80,000.00  1% of Annual =$800/year divided over 26 pay periods=$30.77 per pay period  1 st year $80,000  2 nd year $80,800

15. Program Costs  Marketing/Advertising of new ARNP:  Information provided at OB appt  Information in monthly hospital publication  Newspaper ad per week  1 newspaper ad weekly for 1 st 6 months  Total  $0  $62.00  $1,488

16. Program Costs  Office Set up :  Billing Service  Desk/Chair  Desktop computer  Tablet computer for mobile documentation  Total  Grand Total Costs (1 st year) Utilize existing $900 $600 $1,500 $82,988.00

17. Program Revenue  Avg. monthly dyad visits  Avg. yearly visits  Approx. 80% of visits covered by private insurance monthly  Approx. visits covered yearly  Median billable amount per visit  Median billable amount reimbursed at 80%  Avg. monthly clinic reimbursement by private insurance  Total Average yearly clinic reimbursement  300  3,600  240  2,800  $100  $80  $19,200  $230,400

18. Cost Benefit Analysis  Grand Total Revenue  Grand Total Costs  Difference  $230,400.00  $82,988.00  +$147,412.00

19. Support for Hiring ARNP  By hiring an ARNP to provide billable services the clinic can continue offering services that are currently not profitable.  Based on the cost benefit analysis, hiring a Nurse Practitioner will result in a first year profit of approximately $147,412.00

20. References  Ask.com. http://www.ask.com/web?q=Advertising+Costs&qsrc=6&o=15527&l=  dis&prt=360&chn=retail&geo=US&ver=5  Campbell KP, editor. Investing in Maternal and Child Health: An Employer’s Toolkit.  Washington, DC: Center for Prevention and Health Services, National  Business Group on Health; 2007.  Gutowski JL, Walker M, Chetwynd E. “Containing Health Care Costs Help in Plain  Sight. International Board Certified Lactation Consultants: Allied Healthcare Providers Contribute to the Solution.” Morrisville, NC. United States Lactation Consultant Association, 2010.  Salary.com. http://swz.salary.com/SalaryWizard/Nurse-Practitioner-Salary-Details-66604.aspx  The Topeka Capital-Journal website. (2011). http://sales.cjonline.com/files/mediakit/rates-local-06.pdf

21. References  American Academy of Pediatrics. (2011). http://practice.aap.org/content.aspx?aid=2577  Madlon-Kay, D., & Asche, S. (2006, May-June, 2006). Factors That Influence the Receipt of Well Baby Care in the First 2 Weeks of Life. Journal of the American Board of Family Medicine, 19(3), 258-264. doi: 10.3122/jabfm.19.3.258