4.5.b Quality Improvement and Home Birth Transfer

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The safety of home birth is upheld by a network of people who collaborate to ensure timely access to care. Although planned home birth is often portrayed as “outside the system,” it does not occur outside the network of health services. The network contains emergency responders, paramedics, obstetricians, pediatricians, anesthetists, nurses, general practitioners, respiratory therapists, emergency physicians, and other midwives, physicians, or second attendants. Methods to enhance seamless collaboration among these providers can be achieved through quality improvement and policy development. At the Home Birth Summit Links to an external site., the Task Force recommended a number of communication systems that can be used to enhance collaboration among all parties (10).

Quality Improvement and Policy Development for Transfers (22)

Policies and quality improvement processes should delineate at a minimum the following:

  • Communication channels and information needed to alert the hospital to an incoming transfer.
  • Provisions for notification and rapid assembly of staff in case of emergency transfer.
  • Opportunities to debrief the case with providers and with the family prior to hospital discharge.
  • Documentation of the person’s perspective regarding their clinical care during transfer.
  • A defined process to regularly review transfers that include all stakeholders with a shared goal of quality improvement and safety. This process should be protected without the risk of discovery.
  • Opportunities for education regarding home birth practice, shared continuing medical education, and relationship building that are incorporated into medical, midwifery and nursing education programs.
  • Multi-disciplinary sessions to address system issues to enhance relationship building and work culture.