title: Improving Exclusive Breastfeeding in an Urban Academic Hospital.
abstract: OBJECTIVE
  Breastfeeding has many well-established health benefits for infants and mothers. There is greater risk reduction in health outcomes with exclusive breastfeeding (EBF). Our urban academic facility has had long-standing low EBF rates, serving a population with breastfeeding disparities. We sought to improve EBF rates through a Learning Collaborative model by participating in the Best Fed Beginnings project.
  
  
  METHODS
  Formal improvement science methods were used, including the development of a key driver diagram and plan-do-study-act cycles. Improvement activities followed the Ten Steps to Successful Breastfeeding.
  
  
  RESULTS
  We demonstrated significant improvement in the median adherence to 2 process measures, rooming in and skin-to-skin after delivery. Subsequently, the proportion of infants exclusively breastfed at hospital discharge in our facility increased from 37% to 59%. We demonstrated an increase in sustained breastfeeding in a subset of patients at a postpartum follow-up visit. These improvements led to Baby-Friendly designation at our facility.
  
  
  CONCLUSIONS
  This quality improvement initiative resulted in a higher number of infants exclusively breastfed in our patient population at "high risk not to breastfeed." Other hospitals can use these described methods and techniques to improve their EBF rates.
authors.affiliation: Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; laura.ward@cchmc.org.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Ward
authors.affiliation: Women's Health Services and.
authors.forename: Susan
authors.initials: S
authors.lastname: Williamson
authors.affiliation: Women's Health Services and.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Burke
authors.affiliation: UCMC Patient Care Services, University of Cincinnati Medical Center, Cincinnati, Ohio; and.
authors.forename: Ruby
authors.initials: R
authors.lastname: Crawford-Hemphill
authors.affiliation: Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Thompson
mesh_terms: D000046:Academic Medical Centers; D001942:Breast Feeding; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D060127:Kangaroo-Mother Care Method; D009035:Mothers; D009820:Ohio; D010349:Patient Compliance; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D012386:Rooming-in Care