2.10 Quality Improvement and Transfer

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 should not occur in isolation from a network of health services. A network contains emergency responders, paramedics, obstetricians, pediatricians, anesthesiologists, 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, the Task Force recommended a number of communication systems that can be used to enhance collaboration among all parties (10). Policies and quality improvement processes should, at minimum, delineate the following:

Quality Improvement and Policy Development (22)

  • 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 client prior to hospital discharge.

  • Documentation of the client’s perspective regarding their case during transfer.

  • A defined process to regularly review transfers that include all stakeholders with a shared goal of quality improvement and safety.

  • 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 may enhance relationship-building and work culture.