Smooth Transitions QI Collaborative: Improving Safety and Satisfaction for Transfers of Care from Planned Community-Based Births to Hospitals

Brooke Jardine, MD, MPH, FAAP
Pediatric Hospitalist, Bellingham, WA
Melissa Denmark, LM, CPM
Audrey Levine, LM, CPM  

The Smooth TransitionsTM Quality Improvement Program is a  statewide initiative whose goal is to improve perinatal transfers from planned community-based births to hospitals.  In 2016, 3.7% of births in Washington State occurred in a freestanding birth center or in the home, with 3.2% of births attended by a licensed or other community midwife (

For a variety of reasons, a childbearing person or newborn may require transfer to a higher level of care at some point during the intrapartum or immediate postpartum period. These transfers can be challenging for both patients and providers depending on the communication, understanding of pre-hospital care, and expectations for hospital care shared between care teams. Smooth Transitions’ mission is to address the shared responsibility of community midwives, EMS services, and hospital care teams for improving transfers from planned community-based births to the hospital in order to promote greater patient safety and satisfaction. Ensuring timely and efficient transfers has the potential to reduce neonatal morbidity and mortality. Pediatricians involved with hospital-based newborn care should strongly consider engaging with their local Smooth Transitions group or starting one if it does not yet exist in their community.

The Smooth Transitions QI Program began in 2009 and is currently housed at the Foundation for Health Care Quality in Seattle ( The program provides support and training for communities to develop a multi-disciplinary Perinatal Transfer Committee that includes obstetrical staff, pediatric or neonatal staff, nursing leadership, and representatives from patient safety/risk management departments, as well as local EMS providers and community midwives who transfer to that hospital.  To date, 18 hospitals throughout Washington have participated at varying levels in this statewide QI program.

The program has the following goals:

  • Improve the safety and efficacy of the transfer process through the establishment of system-wide protocols.
  • Collect and analyze transfer outcome data for the purpose of quality improvement.
  • Build greater collaboration between community-based midwives, EMS, and hospital care teams.
  • Enhance the patient experience of care when transfers occur.

Hospitals interested in learning more about the Smooth Transitions QI Program should contact the Program Coordinator ( to set up an informational meeting with your obstetrical and pediatric/neonatal services team.  At this meeting, representatives from the Smooth Transitions Workgroup will provide an overview of community-based birth in Washington and describe the Smooth Transitions program steps. If the hospital decides to move forward with implementation, the Program Coordinator will be available to provide consultation throughout the process.