You are invited to participate in this brief survey because you were identified as the receiving provider during 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 client. 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. What was the occupation of the transferring provider?

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* 3. In which region/community did the transfer occur? 

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* 4. What was the month and year of the transfer (MM/YYYY)?

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* 5. Where was the client transferred from? 

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* 6. What type of transfer was it?

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* 7. When did the transfer occur?

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* 8. What were the reasons for the transfer? Check all that apply.

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* 9. Was this an emergent transfer/transport? 

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* 10. What was the mode of transport?

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* 11. Did the transferring provider notify the hospital prior to arrival?

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* 12. Did the transferring provider accompany the client to the hospital?

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* 13. Upon arrival at the hospital, did the transferring provider...

  Yes No Unknown
Provide a verbal report to the receiving provider? 
Provide a legible copy of the client's relevant medical history? 
Answer questions about the client's medical and labor history? 
Use a transfer form to share pertinent medical information? 
Act appropriately according to their scope of practice and privileges at the hospital? 

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

  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
I accommodated the transferring provider according to the client's wishes
I developed a plan for post-discharge care with the transferring provider

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* 15. What went well during this transfer?

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

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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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