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. Host a Smooth Transitions™ presentation.
2. Identify both a clinician champion and a community midwife liaison.
3. Establish a Perinatal Transfer Committee composed of community midwives, obstetrical providers (nurse-midwives, obstetricians, family practice physicians), pediatric providers, nursing leaders, doulas, EMS personnel, and administrative staff.
4. Draft and adopt transfer protocols and consider the use of transfer forms, SBAR scripts, and a transfer algorithm (see templates on Resources page).
5. Begin implementing transfer tools.
6. Perinatal Transfer Committee meets regularly (2 – 4 times/year) to examine trends, identify what’s working and what’s not, and edit transfer tools accordingly.  These meetings are also opportunities to build trust among providers, participate in skills training and education, and share resources.
7. Start collecting both qualitative and quantitative data by using the Smooth Transitions™ surveys and/or any other data collection tools.  This data will be reviewed at the Perinatal Transfer Committee meetings.
8. Hospitals that meet certain criteria will be able to participate in protected case review with community midwives as needed.