Facilitating Transfers from Community-Based Birth to Hospital

This project addressed a specific community need for educational resources to guide the implementation of a transfer toolkit from a planned home or birth center birth to a hospital. Utah has one of the highest rates of planned home and birth center births in the nation and it is rising. Currently there is no integrated transfer process in Utah when complications arise during birth in the community. The Utah Women and Newborn's Quality Collaborative (UWNQC) has developed an evidence-based tool kit based on national guidelines that assists providers in transfer situations. The materials produced during this project are designed to augment implementation. The objectives included: 1) identifying communication and knowledge gaps in the transfer process for both community and hospital providers that could be effectively addressed with short multimedia presentations; 2) modeling appropriate communication between health providers during a transfer and use of the transfer tools using multimedia presentations; and, 3) dissemination of presentation materials. Current UWNQC survey data and expert opinion were used to determine the communication and knowledge gaps to be addressed. Use of identified educational objectives, informed the scripting and final presentation content for approval by the UWNQC subcommittee and Utah Department of Health Public Information Office. Two scripts were approved for inclusion on the UWNQC website. A third presentation was accepted by the Utah Midwives' Organization to be used as an educational resource. A poster presentation was given to the Utah Affiliate of the American College of Nurse Midwives. Community births are planned and attended births that take place outside a hospital setting either in a private residence for a home birth or a freestanding birth center. In many countries other than the United States, community births are an accepted part of the system with consultations, referrals and transfers to hospital occurring in a seamless or integrated fashion. Lack of integration in the US health care system is consistently identified as a key contributor to the apparent excess of adverse outcomes seen in many US studies. Significant systems barriers prevent full integration and seamless transfer. The UWNQC has developed a tool kit utilizing best practice guidelines and is ready to implement these practices in the community. Culturally competent materials that demonstrate and teach the use of these tools are required. Short, independently accessible, multimedia presentations addressing very specific components of the transfer process were developed in an effort to effectively address the learning needs of both community and hospital obstetric providers With the number of community births increasing, the number of women and newborns who require transfer to the hospital will also increase, resulting in more interactions between community and hospital providers. Barriers to smooth transfers can be decreased by facilitating provider competency and communication in these high-stress situations, while enhancing safety and satisfaction for women and their newborns. This project makes a necessary contribution in a pragmatic effort to improve outcomes for women and their newborns in the immediate future.