The hospital transfer packet checklist

Standing readiness by 36 weeks

• Fix the dating criteria in one written lineRecord how the due date was established, by last menstrual period or by the earliest ultrasound, with the date of that scan. Good looks like a line a stranger can read without opening a second document.
• Put the prenatal lab panel where one screen shows itBlood type and Rh, antibody screen, hemoglobin, rubella, hepatitis B, HIV, syphilis and any repeat testing, each with its date. Anything still outstanding should say pending rather than simply be absent.
• Record GBS status and the plan that follows from itCulture date, result, and what you and the client agreed to do in labor. If the status is unknown at 36 weeks, write why and write the risk based plan you will use instead.
• List medications, allergies and any RhoGAM datesInclude the antepartum RhoGAM date if it was given, current prescriptions, supplements that affect bleeding or blood pressure, and each allergy with the reaction it caused. Nothing here should need a second question.
• Write the one paragraph history a stranger can read coldGravidity and parity, previous births and their routes, any cesarean with the incision type if you know it, and relevant medical and surgical history. Keep it to a paragraph and update it when something changes.
• Confirm the receiving hospital and the route from this addressName the hospital, the realistic drive time from this client's home, and whether the plan is private vehicle or EMS. Put the address and the labor and delivery phone number in the chart, not in your head.

At the moment you decide to transfer

• Name the indication in one clinical sentenceWrite the reason as you would say it out loud: prolonged second stage, thick meconium with a non-reassuring tracing, retained placenta, maternal request for pain relief. That sentence sets the receiving team's expectations before anything else.
• Freeze the labor timeline with clock timesRupture time and fluid description, contraction pattern, last cervical exam with the time, fetal heart tone baseline and any decelerations with times. Times carry the weight here, not adjectives.
• Total the medications and fluids given at homeEvery dose administered with drug, route, amount and clock time, including any oxytocic agents, antibiotics for GBS prophylaxis and intravenous fluids. Write it into the chart rather than reciting it from memory in the ambulance bay.
• Quantify blood loss instead of estimating itWeigh what you can and record the figure in milliliters along with the method you used. A quantified number with a time stamp carries far more weight later than the word moderate ever will.
• Capture vital sign trends, not just the last setThree or four sets of maternal vitals with times, plus the fetal heart tone record, show a direction of travel. A single reading taken at the door tells the receiving team nothing about where things were heading.
• Print or generate the summary before anyone movesOne page, in your hand, before the client is in the vehicle. When it comes out of the record you already wrote, this step takes under a minute and nothing gets transcribed twice.

The call to the receiving unit

• Open with who you are and your credentialYour name, your license type, your practice name, and that you are transferring in from a planned home birth. Say it in one breath so the charge nurse can start writing immediately.
• Give gestational age, parity and indication in the first fifteen secondsSomething in the shape of: 39 and 2, second baby, prolonged second stage with reassuring heart tones. Detail follows, but the headline goes first or it never lands.
• State your arrival time and how you are travelingPrivate vehicle or EMS, and the honest drive time rather than the optimistic one. If EMS is already en route, say so and name the responding agency.
• Ask who is receiving and write the name downThe charge nurse, the attending or the midwife on the unit, plus a direct callback number. Put that name and the time of the call in your chart before you hang up.
• Say plainly what you need on arrivalA room, an operating room alert, blood availability, a pediatric team at the bedside, or nothing beyond a bed. Asking directly is far faster than hoping the message travels through three people.

After the handoff, before you sleep

• Record the arrival time and who took reportThe time you arrived, the name and role of the person who took report, and exactly what you handed over on paper. This single line answers most of the questions anyone asks later.
• Write your continuation note the same nightWhat you observed after arrival, what you were told, and the time you left. A note time stamped that night reads very differently to a reviewer than one written the following afternoon.
• Attach the summary exactly as you handed it overKeep the page the hospital received, not a tidied later version. If it was generated from the record, save the copy as printed with its time stamp attached to the chart.
• Close the loop on the outcomeWith the client's permission, request the discharge summary and the newborn record. Log the date of the request so an unanswered records request does not quietly disappear.
• Debrief with your assistant within a week and log itFifteen minutes on what happened, what worked and what you would change, written down and dated. Practices that skip this step tend to repeat the same delay.
• File whatever your state or peer review process requiresSome states require notification of a transfer within a set window, and many peer review groups want a written case summary. Check your own rule and put the deadline on the calendar the same night.