You are invited to participate in this brief survey because you were identified as emergency medical personnel who participated in a recent transfer from a planned community (home or birth center) birth. As part of the evaluation of the Alaska Birth Transfer Initiative, all transferring providers, receiving providers, registered nurses, clients, and emergency medical personnel (for emergent transports) who were involved in a transfer/transport in participating regions will be asked to complete an evaluation survey that asks about experiences with the transfer process. The Alaska Birth Transfer Initiative seeks to improve the transfer/transport process, to enhance collaboration among community and hospital-based birth providers and staff, and to improve the patient experience during transfers.
 
Your responses to this survey will remain anonymous. Your participation in this survey is entirely voluntary and you may leave the survey at any time. Please do not provide any information in the comments that could potentially identify a patient. We look forward to hearing about your recent birth transfer/transport experience and appreciate your honest feedback.
 
Please contact Katy Krings at katy.krings@alaska.gov or 907-269-3418 if you have any questions or concerns about this survey.

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* 1. What is your occupation/profession?

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* 2. In which region/community did the transport occur?

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* 3. What was the month and year of the transport (MM/YYYY)?

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* 4. What was the mode of transport? 

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* 5. What type of transport was this? 

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* 6. When did the transport occur?

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* 7. Why was the transport initiated? Check all that apply. 

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* 8. Where was the patient transported from?

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* 9. Did the report from dispatch match what you found at the facility or on scene?

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* 10. What was your estimation of time on scene? 

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* 11. What would have shortened the time on scene in your opinion? 

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* 12. Did the transferring provider...

  Yes No Unknown
Accompany the patient to the hospital?
Provide a brief report with relevant medical and labor history?

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* 13. Please respond to the following statements about your interactions with the transferring provider during this transport. 

  Strongly agree Agree Neutral Disagree Strongly disagree
The interactions with the transferring provider were respectful and professional
The transferring provider and I worked well together

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* 14. Please respond to the following statements about your interactions with the receiving provider during this transport.

  Strongly agree Agree Neutral Disagree Strongly disagree
The interactions with the receiving provider were respectful and professional
The receiving provider and I worked well together

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* 15. What went well during this transport?

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* 16. What didn't go well doing this transport?

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* 17. Please provide any additional comments for the AK Birth Transfer Initiative Advisory Committee.

0 of 17 answered
 

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