You are invited to participate in this brief survey because you were identified as the transferring 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 receiving 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. When did the transfer occur?

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* 7. What type of transfer was it?

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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 transport?

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* 10. What was the mode of transport?

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* 11. Did you notify the hospital prior to arrival?

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* 12. Did you accompany the client to the hospital?

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* 13. Upon arrival at the hospital, did you...

  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 your scope of practice and privileges at the hospital?

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

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

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* 15. Did the hospital staff and receiving provider understand the appropriate sense of urgency for the transfer? 

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* 16. What went well during this transfer?

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

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

0 of 18 answered
 

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