Program Description and Confidentiality Statement

Smooth Transitions is a statewide quality improvement initiative at 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 will be used to help improve the transfer process for others.  It takes about 6-7 minutes to complete the survey.

Thank you!

Question Title

* 1. Date of transfer

Date

Question Title

* 2. Receiving Facility and County

Question Title

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

Question Title

* 10. Did the community midwife:

  yes no
Provide a verbal report to you, including details on current health status?
Convey a sense of urgency appropriately aligned with the clinical situation?
Provide a legible copy of relevant prenatal and labor medical records?
Answer your questions about the patient and what led to the transfer?
Use a transfer form?

Question Title

* 11. Regarding the quality and accuracy of the information the midwife provided:

  high quality and very accurate average quality and accuracy low quality and inaccurate N/A
the phone request for transfer
the verbal report upon arrival
the medical record/chart

Question Title

* 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 community midwife were professional.
The communication between me and the community midwife was respectful.
The midwife and I worked well together.
The hospital staff were sensitive to the psychological/emotional needs of this patient.
The hospital staff accommodated the community midwife's presence according to the patient's wishes and/or hospital's protocols.
I participated in shared decision-making with the patient to create a care plan.

Question Title

* 13. Do you feel your interactions with the patient and/or the transferring midwife were impacted by your race/ethnicity, gender identity, or disability status?

Question Title

* 14. What went well during this transfer process?

Question Title

* 15. What could have gone better during this transfer process? 

Question Title

* 16. How would you rate this transfer overall?

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

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

T