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 the Smooth Transitions QI Program access to the Coordinated Quality Improvement Program through the WA State Department of Health. This makes it possible for community-based midwives, hospital providers and staff, and EMS personnel to engage in protected case reviews together, providing an opportunity to learn from one another and improve the quality of care. It’s a model of integration that should be replicated across the country.  

Program Steps: 

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. Form a Perinatal Transfer Committee (PTC)
      Gather a group of obstetrical and pediatric providers, nursing staff, EMS personnel, and local community midwives and form a Perinatal Transfer Committee (PTC) that meets regularly.
   4. Develop Transfer Tools and Resources
      The PTC creates a transfer protocol and other needed transfer tools such as forms, SBAR scripts, and transfer algorithms.
   5. Meet Regularly/Interaction
      The PTC meets at least ~4x/year to share updates, discuss any issues or concerns regarding transfers, and work on strategies to improve efficiency, safety, and satisfaction. This can also be an opportunity to provide/develop needed CME, skills training, and resources.
   6. Collect Data and Publish Research
      Participating hospitals and community midwives will collect data to evaluate the efficacy of the project. 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.