Program Description and Confidentiality Statement

Smooth Transitions is a statewide quality improvement effort under the Foundation for Health Care Quality. The program’s mission is 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 are protected and confidential. They will be used to help improve the transfer process for others.

Thank you!

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* 1. What was the date of the emergency response to a community midwife?

Date

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* 3. Receiving Facility and County

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* 6. Why was the 911 call initiated?  Please check all that apply.

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* 7. What did you find with the patient(s) upon arrival?

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* 10. Did the community midwife's short report include:  Please check all that apply.

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* 11. Was there any information you did not receive that you felt would have been helpful/necessary for patient care?

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* 12. What was your estimation of time on the scene (in minutes)?

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

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* 15. Do you have any general comments about the interactions between the community midwife and EMS during the course of care?   (professional, respectful, helpful, clear roles, collaborative)

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* 16. What went well during this transport process?  And how can this experience help inform future tranports?

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* 18. Is there anything else you would like to share about this particular transport or with maternal/neonatal transports in general?

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* 19. How long after the transfer did you fill out this survey?

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* 20. How did you know about this survey, please explain?

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* 22. How do you feel about being given the opportunity to provide your feedback on this experience?

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* 23. Do you have any recommendations on how to improve this survey?

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