Evaluating Use of the Utah Women and Newborn Quality Collaborative Transfer Toolkit in an Out-of-hospital Freestanding Birth Center

Out-of-hospital (OOH) births increased by 12% (n=5,996) in 2021. In Utah, OOH births comprise more than 4% of all births annually. These births are attended by community midwives with varying levels of education, certification, and licensing. After determining a need for a more consistent transfer process between transferring and receiving providers, the Utah Women and Children Quality Collaborative (UWNQC) created a transfer toolkit for midwives needing to transfer patients to the hospital during the intrapartum period. The UWNQC toolkit intends to improve communication during the transfer for better maternal and fetal outcomes. As OOH births continue to increase, it is recommended that community midwives have a protocol in place to address the transfer of their patients to an inpatient obstetrical (OB) setting when the need arises. Local Problem: In Utah, the number of OOH births is four times the national average. Although the UWNQC transfer toolkit exists, community midwives are not utilizing it. Members of UWNQC were interested in understanding this phenomenon. A willing midwifery practice was contacted and agreed to participate in this project. Methods: For this quality improvement project, a needs assessment using a SWOT analysis was conducted to understand reasons and motivations for why community midwives do not routinely use the UWNQC toolkit. This project's methods used group discussions, personal interviews of member midwives, obstetric data collected by the State of Utah, and audits of the practice patient's records to conduct the needs assessment. Intervention: Midwives of Wasatch Midwifery and Wellness (WMW) were engaged to participate in the project. Public health obstetric data were obtained to gain perspective of the problem. Midwives were interviewed individually and participated in group discussions directed by scripted prompts developed by the project lead. Patient chart audits were used to determine intrapartum transfer rates and reasons for the transfers. Data were analyzed and synthesized to compose an executive summary, which was shared with the practice members. Results: Utah State data revealed that OOH birth rates increased annually from 2017 to 2022. A retrospective chart audit revealed that 9% (n=12) of WMW patients required transfer to an inpatient setting from January 2023 to December 2023. On average, transfers occurred 30 minutes after the need for transfer was discussed with the patient, and most transfers occurred due to maternal requests for pain relief. The SWOT analysis revealed that WMW staff did not utilize the transfer toolkit and were unsure if it was beneficial; their primary concerns were about the length of the UWNQC toolkit form and the time needed to complete it. Conclusion: With OOH birth rates increasing, midwives of WMW need to use a consistent, systematic plan for patient transfers. Presentation of the project findings helped WMW better understand the utility and conciseness of the toolkit form and the brief amount of time required to complete it. Members acknowledged the benefits of using the toolkit for their practice and patients and verbalized intent to use it moving forward.