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

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* 7. Urgency of transfer

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* 8. Did this client originally intend to birth in the hospital and did they come into your care because of COVID-19?

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

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

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* 11. Did you:

  yes no
Provide a verbal report to the receiving provider, including details on client's current health status?
Provide a copy of client's relevant prenatal and labor medical records?
Answer questions from the receiving provider about the client and what led to the transfer?
Use a transfer form?

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* 12. If the transfer was emergent, did the hospital staff and receiving provider respond with an appropriate sense of urgency?

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* 13. 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 receiving provider were professional.
The communication between me and the receiving provider was respectful.
The receiving staff and I worked well together.
The hospital staff were sensitive to the psychological/emotional needs of my client.
The hospital staff accommodated my presence according to my client's wishes and/or the hospital's protocols.
The receiving provider participated in shared decision-making with my client to create a care plan.
The receiving provider and I made a plan for postpartum care.

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* 14. Do you feel your interactions with the hospital staff were impacted by your race/ethnicity, gender identity, or disability status?

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* 15. What went well during this transfer process?

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

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* 17. How would you rate this transfer overall?

0 100
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?

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