8. Is your birth facility currently participating in or has it recently participated in QI efforts with a QI organization (i.e. Perinatal Quality Collaborative, Private or Not-for-profit QI Organization) *This question is required.

• Yes
• No

9. Does the OB department have an OB provider (Physician, CNM) or a nurse leader that participates in QI projects? *This question is required.

Space Cell	Yes	No
Physician	Physician: Yes	Physician: No
Nurse-Midwife	Nurse-Midwife: Yes	Nurse-Midwife: No
Nurse-Leader	Nurse-Leader: Yes	Nurse-Leader: No

10. Does your birth facility have a multidisciplinary perinatal quality committee? *This question is required.

• Yes
• No

11. Following a challenging OB case, is there a process for 'lessons learned' to be addressed and shared with the patient, family and staff? *This question is required.

Space Cell	Yes	No
Patient and Family	Patient and Family: Yes	Patient and Family: No
Staff (OB, CNM, RN)	Staff (OB, CNM, RN): Yes	Staff (OB, CNM, RN): No

12. Does the OB Department have standardized processes (i.e. order sets, unit policies, practice protocols) for the following obstetric emergencies? Select all that apply. *This question is required.

Space Cell	Yes	No
OB Hemorrhage	OB Hemorrhage: Yes	OB Hemorrhage: No
Severe Hypertension/Preeclampsia	Severe Hypertension/Preeclampsia: Yes	Severe Hypertension/Preeclampsia: No

13. Does your birth facility Emergency Department have standardized processes (i.e. order sets, unit policies, practice protocols) for obstetric emergencies? *This question is required.

• Yes
• No
• Do not have an Emergency Department

14. How often are the obstetric emergency policies and protocols reviewed and updated?  *This question is required.

• Every year
• Every 2 years
• Every 3 years

15. How often are the obstetric emergency policies and protocols (ie. order sets) used in an obstetric emergency by staff (OB, OB Resident, CNM, Staff RN)? *This question is required.

• N/A
• 25%
• 50%
• 75%
• 100%

16. Does your birth facility have a policy for notification and response to maternal early warning signs? *This question is required.

• Yes
• No

17. Does your birth facility conduct regular multidisciplinary in situ (on site) clinical scenario simulation drills for OB emergencies? *This question is required.

• Yes
• No

18. How often does the OB department conduct clinical scenario simulation drills? *This question is required.

• N/A
• Monthly
• Quarterly
• Annually
• Other - Write In Please enter an 'other' value for this selection.

19. What obstetric emergencies do these clinical scenario simulation drills focus on? Select all that apply. *This question is required.

• N/A
• OB Hemorrhage
• Severe Hypertension/Preeclampsia
• Eclamptic Seizure
• Sepsis
• Emergent Cesarean Section
• Maternal Code
• Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

20. Which frontline providers are required to participate in the OB clinical scenario simulation drills? *This question is required.

Space Cell	Yes	No	N/A
OBs	OBs: Yes	OBs: No	OBs: N/A
OB Residents	OB Residents: Yes	OB Residents: No	OB Residents: N/A
OB Anesthesia	OB Anesthesia: Yes	OB Anesthesia: No	OB Anesthesia: N/A
Family Practitioners	Family Practitioners: Yes	Family Practitioners: No	Family Practitioners: N/A
Certified Nurse-Midwives/Certified Midwives	Certified Nurse-Midwives/Certified Midwives: Yes	Certified Nurse-Midwives/Certified Midwives: No	Certified Nurse-Midwives/Certified Midwives: N/A
Perinatal Dept. Nursing Staff	Perinatal Dept. Nursing Staff: Yes	Perinatal Dept. Nursing Staff: No	Perinatal Dept. Nursing Staff: N/A
Emergency Dept. Staff	Emergency Dept. Staff: Yes	Emergency Dept. Staff: No	Emergency Dept. Staff: N/A

21. How does the OB department obtain data to track unit-based outcomes? Select all that apply. *This question is required.

• Chart Review
• Computer generated reports
• Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

22. What type of data measures does the OB department track? Select all that apply. *This question is required.

• Process measure-frequency of performing a diagnostic test or treatment related to an outcome (i.e. rate of antibiotic prophylaxis at Cesarean birth, rate of obstetric hemorrhage risk assessment on L&D admission)
• Structure measure-identify information about policies, equipment, and staff that are relevant to the QI project and are often noted once when the task is completed (i.e. annual policy review, staff training sessions)
• Outcome measures-examines the impact on patient's health and well-being (i.e. severe maternal morbidity and mortality rates)

23. What data collection challenges exist in your birth facility? Select all that apply. *This question is required.

• Incorrect Coding
• Inadequate Documentation
• Lack of Trained Staff
• Time Burden
• None
• Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

24. Has your birth facility participated in a formal 'culture of safety' assessment within the last 2 years? *This question is required.

• Yes
• No

25. Does your OB department have a 'stop the line' policy where staff know that they have the responsibility and authority to stop a procedure when patient safety is a concern? *This question is required.

• Yes
• No