SAFE Birth VA

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SAFE Birth VA (Standardized Approaches for Emergencies in Birth-Virginia)

Thank you for participating in the SAFE Birth VA survey. This survey is designed to gather information about Virginia hospital facilities in preparation for the launch of the SAFE Birth VA initiative. Please answer the questions to the best of your ability on behalf of your facility.

Estimated time to complete: 15-20 minutes.

Survey responses will be analyzed and reported in aggregate form to ensure complete anonymity of individual institutions. No patient data will be collected, and responses are not electronically linked to your hospital. Submission of the completed survey indicates your consent to participate.

For every 15 hospitals or birth centers that complete this survey, we will draw for one $50 Amazon gift card. (Only ONE entry per hospital or birth center is allowed.) For example, if 45 hospitals or birth centers complete the survey, we will draw for three gift cards.

Findings from the survey will be shared through the Virginia Neonatal Perinatal Collaborative (VNPC) and may be disseminated via professional meetings and publications.

This survey is part of a hospital quality improvement initiative and is not subject to Institutional Review Board (IRB) oversight.

Name of Hospital/Facility

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What is your first name?

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What is your last name?

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What is your email? (this way we can share any survey results with you)

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Please select which of the following are at your facility (select all that apply)

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Labor & Delivery

Emergency Department (ED)

Neonatal Intensive Care Unit (NICU)

Special Care Nursery (SCN)

Well-Baby Unit

Freestanding ED

Please provide a contact for your labor and delivery Unit:
First Name:
Last Name:
Email:

Approximately how many beds are in your labor and delivery unit?

Please provide a contact for your emergency department:
First Name:
Last Name:
Email:

Approximately how many beds are in your emergency department?

Please provide a contact for your NICU:
First Name:
Last Name:
Email:

Approximately how many beds are in your NICU?

Please provide a contact for your special care nursery:
First Name:
Last Name:
Email:

Approximately how many beds are in your special care nursery?

Please provide a contact for your well baby unit:
First Name:
Last Name:
Email:

Approximately how many beds are in your well baby unit?

Please provide a contact for your freestanding ED:
First Name:
Last Name:
Email:

Approximately how many beds are in your freestanding ED?

Are any of the following on your care teams? (select all that apply)

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Midwives

Doulas

Care Coordinators

Obstetricians

MFMs

Family Practice Physicians

Nurse Practitioners

Residents

Fellows

Neonatologists

Other

How much has your facility been previously enaged with the Virginia Neonatal Perinatal Collaborative (VNPC)?

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Change the slider above to set a response

You have selected an option that triggers this survey to end right now.