History of Smooth Transitions: 

• In 2005, the Washington State Perinatal Advisory Committee (now called the Washington State Perinatal Collaborative) convened the MD/LM Workgroup, a multi-stakeholder entity comprising obstetricians, midwives, consumers, and Department of Health staff, and charged the group with “studying and improving the process of transferring women and their babies from a planned home or birth center birth to an acute-care hospital when a higher level of care becomes necessary.”  

• In 2009, the MD/LM Workgroup launched the Smooth Transitions™ Quality Improvement Program, an initiative aimed at improving communication and enhancing collaboration between community midwives and hospital-based providers. The goals were to achieve better outcomes for mothers and babies, increase patient satisfaction with care, and decrease practitioner liability.  

• In January 2018, the Smooth Transitions QI Program moved to the Foundation for Health Care Quality (FHCQ), where it is currently housed along with several other nationally recognized QI programs.  In addition to elevating the reputation and the visibility of the program, coming under the FHCQ’s umbrella has given Smooth Transitions CQIP (Coordinated Quality Improvement Program) status through the WA State Department of Health. This will make it possible for community-based midwives, hospital providers and staff, and EMS personnel to engage in protected case reviews together.  This represents an opportunity to learn from one another to improve the quality of care. It’s a model of integration that should be replicated across the country.  

Program Steps: 

1. 1. 1. 1. 1. Host a Smooth Transitions™ Presentation
               The Smooth Transitions Program Coordinator sets up a presentation at your hospital. Beforehand, the Program Coordinator talks with hospital staff and community midwives about the current situation and issues.
            2. Identify Clinician Champions
               It is important to find clinician champions for both the hospital and the midwifery community. They will help organize meetings, communicate between the groups and with the program coordinator.
            3. Develop Transfer Protocols and Tools
               Work in small groups (facilitated by Smooth Transitions Program Coordinator and balanced between the hospital providers/nursing and community midwives) to co-create transfer protocols (gestational parent and neonatal-if applicable) and transfer tools. Drafts go out to the larger hospital and midwifery community for feedback before going live.
            4. Form a Perinatal Transfer Committee (PTC)
               Gather a group of obstetrical and pediatric providers, nursing staff, EMS personnel, doulas, and local community midwives, and form a perinatal transfer committee.
            5. Meet Regularly/Interaction
               The Perinatal Transfer Committee meets quarterly to provide updates, discuss any issues or concerns regarding transfers, and strategies about how to improve efficiency, safety, and patient experience.  This can also be an opportunity to share CME, trainings, simulations, and develop needed resources based on what topics come up in the meetings.
            6. Collect Data and Publish Research
               Participating hospital providers and staff, community midwives, EMS, doulas, and transfer patients, will submit survey data to evaluate transfers and the efficacy of the program.  Quantitative and qualitative analysis can be done for small scale improvement at the hospital level or statewide for research purposes and publication.
            7. Multidisciplinary Protected Reviews
               Hospitals that meet certain criteria will be able to participate in multidisciplinary CQIP-protected case reviews with community midwives as needed.