4.3b Best Practice Guidelines for Transfer

Now that you have learned that conflict is rooted in ambiguity of intention, information, purpose, expectations, understanding, direction, relationship and/or role. Take a minute to think about Geeta's home birth transfer. At this point in her story there is the potential for conflict, or effective collaboration, to arise.  Review the Best Practice Guidelines for Transfer from Home to Hospital (22) with attention to when conflict could occur.

Following the 2011 Home Birth Summit, a multidisciplinary group of delegates formed a Collaboration Task Force that included leaders with expertise in obstetrics, family medicine, midwifery, nursing, health administration, public health, pediatrics, law, risk management, health policy, and ethics, as well as consumer rights and childbirth education. They developed these guidelines to reduce systems errors or conflict when care is transferred from a community setting to a hospital.  Here are excerpts from the guidelines that outline best practices for the home birth attendant and the receiving hospital staff. 

Model Practices for the Midwife During Transfers (22)

• In the prenatal period, the primary provider (midwife or physician)  provides information to the client about hospital care and procedures that may be necessary if transfer occurs.  A plan has been developed with the person for hospital transfer is documented.
• The primary provider assesses the status of the parent, fetus and newborn throughout the maternity care cycle to determine if a transfer will be necessary.
• The primary provider notifies the receiving hospital staff of the incoming transfer, reason for transfer, brief relevant clinical history, planned mode of transport and expected time of arrival.
• The primary provider continues to provide routine or urgent care en route in coordination with any emergency services personnel and address the psychosocial needs of the person during the change of birth setting.
• Upon arrival at the hospital the primary provider (midwife or physician) presents a verbal report, including details on current health status and/or need for urgent care. The provider also presents a legible copy of relevant prenatal and labor records of progress and course of care prior to admission.
• The midwife or doctor may continue in a primary role, as appropriate to their scope of practice and privileges in the hospital, and the clinical need for expertise. Otherwise, they transfer clinical responsibilities to the receiving hospital provider.
• The provider promotes good communication by ensuring that the person understands the consultant provider’s plan of care, and the hospital providers and staff understand the person’s need for information regarding care options.
• If the person chooses, the primary provider may remain to provide continuity and support even if the primary care role is transferred to the consultant.

Model Practices for the Hospital Provider and Staff During Transfers (22)

• Hospital providers and staff are sensitive to the psychosocial needs of the cleint that result from the change of birth setting.
• Hospital providers and staff communicate directly with the midwife or physician to obtain the clinical information.
• Timely access to maternity and newborn care providers may be the best accomplished by the direct admission to the labor and delivery or paediatric unit.
• Whenever possible, the parent and her newborn are kept together during transfer and after admission to the hospital.
• Hospital providers and staff participate in a shared decision making process with the person to create an ongoing plan of care that incorporates the values, beliefs and preferences of the client.
• If a person chooses, hospital personnel will accommodate the presence of the primar midwife or physician, as well as the person’s primary support person during the assessment and procedures.
• The hospital providers and the primary provider coordinate follow-up care for the parent and the newborn, and care most often reverts to the primary provider upon discharge.
• Relevant medical records, such as a discharge summary, are sent to the referring primary provider.

 Knowledge Check

Carol, the midwife, has transferred Geeta from home to hospital. What procedures, or information, are most helpful for Carol to share with the nurse, Eleanor, to participate in the coordination of clinical care?

a. Share relevant medical records

b. Convey anticipated time of arrival

c. Discuss the pre-arranged transport plan

Click here for Answer

• Answer: a.
• Explanation: Sharing records and giving a report immediately on arrival gets everyone up to speed and is helpful for the coordination of care. Generally the arrival time would be given prior to leaving the home during a transfer, or an update about time of arrival would be given enroute. The pre-arranged transport plan is discussed and revised outside of an emergency transfer as part of a quality assurance process between home birth providers and the hospital staff coordinators.