Smooth Transitions - Transfer Evaluation - Nursing Staff

Program Description and Confidentiality Statement

Smooth Transitions is a statewide quality improvement initiative at the Foundation for Health Care Quality with the mission to improve hospital transfers from planned community-based births to promote greater patient safety and satisfaction. The goals of Smooth Transitions are to:

1. Improve the safety and efficiency of the transfer process through the establishment of system-wide protocols.
2. Collect and analyze transfer outcome data for the purpose of quality improvement.
3. Build greater collaboration between community-based midwives, EMS, and hospital care team.
4. Enhance the patient experience of care when transfers occur.

We are eager to hear from you about your recent hospital transfer experience and appreciate your honest feedback. Your responses will be used to help improve the transfer process for others. Survey data gets de-identified, aggregated, and shared during Perinatal Transfer Committee meetings for quality improvement at hospitals participating in Smooth Transitions. In addition, selected quotes from surveys may be included in presentations to promote the program and in publications about Smooth Transitions.

It takes about 6-7 minutes to complete the survey. Thank you!

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* 1. Date of transfer

Date

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* 2. Receiving Facility and County

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* 3. Type of Transfer

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* 4. Mode of transfer

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* 5. Receiving Provider Type

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* 6. Urgency of transfer

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* 7. What was/were the indication(s) for transfer?

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* 8. Did the community midwife notify the hospital prior to arrival?

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* 9. Did the community midwife accompany the patient to the hospital?

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* 10. Did the community midwife:

	yes	no
Provide a verbal report to you, including details on current health status?	Provide a verbal report to you, including details on current health status? yes	Provide a verbal report to you, including details on current health status? no
Convey a sense of urgency appropriately aligned with the clinical situation?	Convey a sense of urgency appropriately aligned with the clinical situation? yes	Convey a sense of urgency appropriately aligned with the clinical situation? no
Provide a legible copy of relevant prenatal and labor medical records?	Provide a legible copy of relevant prenatal and labor medical records? yes	Provide a legible copy of relevant prenatal and labor medical records? no
Answer your questions about the patient and what led to the transfer?	Answer your questions about the patient and what led to the transfer? yes	Answer your questions about the patient and what led to the transfer? no
Use a transfer form?	Use a transfer form? yes	Use a transfer form? no

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* 11. Regarding the quality and accuracy of the information the midwife provided:

	high quality and very accurate	average quality and accuracy	low quality and inaccurate	N/A
the phone request for transfer	the phone request for transfer high quality and very accurate	the phone request for transfer average quality and accuracy	the phone request for transfer low quality and inaccurate	the phone request for transfer N/A
the verbal report upon arrival	the verbal report upon arrival high quality and very accurate	the verbal report upon arrival average quality and accuracy	the verbal report upon arrival low quality and inaccurate	the verbal report upon arrival N/A
the medical record/chart	the medical record/chart high quality and very accurate	the medical record/chart average quality and accuracy	the medical record/chart low quality and inaccurate	the medical record/chart N/A

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* 12. Please use the following scale in responding to the statements below:

	strongly agree	agree	undecided/neutral	disagree	strongly disagree
The interactions between me and the community midwife were professional.	The interactions between me and the community midwife were professional. strongly agree	The interactions between me and the community midwife were professional. agree	The interactions between me and the community midwife were professional. undecided/neutral	The interactions between me and the community midwife were professional. disagree	The interactions between me and the community midwife were professional. strongly disagree
The communication between me and the community midwife was respectful.	The communication between me and the community midwife was respectful. strongly agree	The communication between me and the community midwife was respectful. agree	The communication between me and the community midwife was respectful. undecided/neutral	The communication between me and the community midwife was respectful. disagree	The communication between me and the community midwife was respectful. strongly disagree
The midwife and I worked well together.	The midwife and I worked well together. strongly agree	The midwife and I worked well together. agree	The midwife and I worked well together. undecided/neutral	The midwife and I worked well together. disagree	The midwife and I worked well together. strongly disagree
The hospital staff were sensitive to the psychological/emotional needs of this patient.	The hospital staff were sensitive to the psychological/emotional needs of this patient. strongly agree	The hospital staff were sensitive to the psychological/emotional needs of this patient. agree	The hospital staff were sensitive to the psychological/emotional needs of this patient. undecided/neutral	The hospital staff were sensitive to the psychological/emotional needs of this patient. disagree	The hospital staff were sensitive to the psychological/emotional needs of this patient. strongly disagree
The hospital staff accommodated the community midwife's presence according to the patient's wishes and/or hospital's protocols.	The hospital staff accommodated the community midwife's presence according to the patient's wishes and/or hospital's protocols. strongly agree	The hospital staff accommodated the community midwife's presence according to the patient's wishes and/or hospital's protocols. agree	The hospital staff accommodated the community midwife's presence according to the patient's wishes and/or hospital's protocols. undecided/neutral	The hospital staff accommodated the community midwife's presence according to the patient's wishes and/or hospital's protocols. disagree	The hospital staff accommodated the community midwife's presence according to the patient's wishes and/or hospital's protocols. strongly disagree
I participated in shared decision-making with the patient to create a care plan.	I participated in shared decision-making with the patient to create a care plan. strongly agree	I participated in shared decision-making with the patient to create a care plan. agree	I participated in shared decision-making with the patient to create a care plan. undecided/neutral	I participated in shared decision-making with the patient to create a care plan. disagree	I participated in shared decision-making with the patient to create a care plan. strongly disagree

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* 13. A TeamBirth "huddle" is when the community midwife, hospital provider, and nurse, talk together with the patient (and their support team) about their preferences for labor, birth, and postpartum and together agree on care plans for them and their baby, and set plans for the next check-in or step.

Can you share information about your participation in these huddles? Select all that apply.

I never participated in a huddle

I was never asked to participate in huddle/s

I didn't initiate a huddle

I attempted to initiate a huddle but it didn't happen

I participated in a huddle when the patient first arrived at the hospital

The community midwife was included in huddle/s

The patient had huddles throughout their stay at the hospital

The patient only had huddles during labor and delivery

I'm not sure if the patient had huddles or not

If you participated in any huddles with this patient, please describe 1- if you thought they were helpful or not, 2-what was your experience with them, and 3-if you felt empowered to participate and speak up in them. If huddles didn't happen, what do you think were the barriers?

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* 14. Do you feel your interactions with the patient and/or the transferring midwife were impacted by your race/ethnicity, gender identity, or disability status?

Yes

If yes (please explain)

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* 15. What went well during this transfer process?

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* 16. What could have gone better during this transfer process?

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* 17. How would you rate this transfer overall?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 18. Do you have any other comments about this transfer?

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* 19. Do you participate in the Smooth Transitions Perinatal Transfer Committee Meetings with the hospital where this transfer occurred?

Yes

If you answered "No", can you please describe why not?

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* 20. How would you describe your experience level interacting with community midwives during transfers?

This is the first time I've interacted with a community midwife during a transfer.

I rarely interact with community midwives during their transfers (fewer than 5 times per year).

I interact with community midwives every couple of months or so (5-11 times per year).

I regularly interact with community midwives during their transfers (12+ times per year).