Improving Birth Attendants' Awareness and Utilization of the Transfer Toolkit for Out-of-Hospital (OOH) Births

Background: Planned (OOH) birth is on the rise. Approximately 6.6% of those OOH births result in a transfer to a hospital setting. At the time of a transfer, there is the potential for important information to get missed and not passed on from the OOH birth attendant to the hospital receiving staff. Utah Women and Newborn's Quality Collaborative (UWNQC) developed a transfer toolkit to assist OOH birth attendants to transfer their patient to a hospital setting. It is unclear whether Utah OOH birth attendants are aware of this toolkit and if so, what parts of the toolkit are working well for them. The purpose of this DNP project was to assess and increase the awareness and knowledge, confidence in and utilization intention of UWNQC's transfer toolkit by OOH birth attendants.Methods: In this quality improvement initiative, we developed an educational presentation to increase the awareness of the transfer toolkit. OOH birth attendants throughout the state of Utah were invited to attend. Pre and post surveys were done to assess whether the information session was an effective way of distributing the information and increasing intentions to utilize the knowledge of the transfer toolkit and confidence in using it. Results: Post-intervention, there was a 18% (n=19) increase in knowledge of items to include on the transfer form, a 35% increase in knowledge of documents to bring to a transfer, and a 141% increase in knowledge of the components of the SBAR (situation, background, assessment, recommendations) communication tool. The participants reported a 74% increase in confidence using SBAR and a 45% increase in confidence using the transfer toolkit as a whole. These were all statistically significant. 100% of the attendees would recommend this form of training to their colleagues. Common barriers were noted with utilization of the transfer toolkit including not having enough time to fill out the transfer form, not having the correct paperwork on hand at the time of transfer, hospital staff not being receptive, need for transfer algorithms to be provided on the UWNQC website for more hospitals to guide them on how that specific hospital wants transfers to take place, help/support from others who have used the toolkit, and the need for additional/hands on training.Conclusion: This type of educational presentation appears to be a valuable resource to help increase the awareness and utilization of the transfer toolkit. Replication of this project is needed to determine if it could reach a broader population, and to evaluate the effectiveness of the training in different settings, or different sub-groups of OOH birth attendants.