Improving Access to Hospital-Grade Breast Pumps for Women with Infants in the Neonatal Intensive Care Unit

To improve access to hospital-grade breast pumps for women with infants in the neonatal intensive care unit (NICU) by reducing delays in pump acquisition.

A quality improvement project using Lean Six Sigma DMAIC (Define-Measure-Analyze-Improve-Control) methodology to identify process gaps and streamline workflows.

Level IV NICU at a large academic medical center in the western United States. Women with private or employer-sponsored insurance experienced acquisition delays and out-of-pocket costs compared with women covered by public assistance programs (e.g., Medi-Cal, women, infants, and children [WIC]).

Baseline cohort included 39 NICU families (April 2023): 12 with private insurance and 27 with public assistance coverage. During the 12-month follow-up period, 200 admissions were recorded. In addition, 47 staff members participated in the study.

Baseline measures included pump ordering timelines, insurance coverage type, and out-of-pocket costs. Interventions included role clarification, durable medical equipment (DME) vendor mapping, standardized communication protocols, staff education, and patient-facing handouts. An onsite WIC pump supply was established. Outcomes were monitored for 12 months.

At baseline, 92% (11/12) of privately insured women paid out of pocket for hospital-grade pumps, with delays of up to 21 days; women with public assistance coverage obtained pumps within 1-2 business days. After implementation, out-of-pocket rates declined to less than 5%, and median acquisition time decreased to 3.5 days (range: 1-7 days) for privately insured families. Improvements were sustained at 12 months.

Lean Six Sigma-guided process redesign improved the efficiency and equity of hospital-grade breast pump access in the NICU, reducing delays and financial burden for privately insured families. Persistent payer exclusions highlight insurance-related barriers as a social determinant of lactation support.