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 10 minutes to complete the survey.  Thank you!

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* 1. When was the transfer?

Date

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* 2. Receiving Facility and County

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* 3. Type of Transfer

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* 4. What was/were the indication(s) for transfer?  Please select all that apply.

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* 5. Urgency of transfer

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* 6. Mode of transfer

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* 7. Receiving Provider Type

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* 8. Did the hospital staff and receiving provider respond with an appropriate sense of urgency?

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* 9. Do you know if the community midwife notified the hospital prior to arrival?

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* 10. Did the community midwife accompany the client to the hospital?

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* 11. A TeamBirth "huddle" is when the community midwife, hospital provider, and nurse talk together with your client (and their support team) about their preferences for labor, birth, and postpartum and together agree on care plans for them and their baby, and set plans for the next check-in or step. 

During your client's hospital stay, can you share information about your participation in huddles?  Select all that apply.

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* 12. 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 hospital provider/staff were professional.
The communication between me and the receiving hospital provider/staff was respectful.
The receiving hospital provider/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 hospital provider participated in shared decision-making with my client to create a care plan.

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

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

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* 15. Do you feel your client's choice to have a community birth impacted the care they received after transferring to the hospital?

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* 16. What went well during this transfer process?

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

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* 18. How would you rate this transfer overall?

0 (terrible) 100 (excedes expectations)
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 19. Do you have any other comments about this transfer?

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* 20. Do you participate in the Smooth Transitions Perinatal Transfer Committee meetings with the hospital where this transfer occurred?

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

 
 100% of survey complete.

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