Amy Romano, MBA, MSN, CNM, FACNM
Oct 23

The Power of Partial Transfer Drills: Starting Small to Build Stronger Systems

You don't have to practice the entire transfer process to make meaningful improvements in safety, teamwork, and communication.

As participants in the 2026–27 Step Up Together Action Collaborative prepare to test their transfer processes, we're encouraging teams to start with a Partial Transfer Drill, an opportunity to practice, learn, and build confidence before tackling the complexity of a Full Transfer Drill.

A Partial Transfer Drill involves fewer moving parts and less coordination, but it can reveal important opportunities for improvement and lay the groundwork for stronger interdisciplinary collaboration.

What Is a Partial Transfer Drill?

A Partial Transfer Drill tests one portion of the community-to-hospital transfer process, rather than following a patient through the entire continuum of care.

Drill Kits in the Step Up Together Library can be used to run two types of Partial Transfer Drills:

1. Community-Initiated Partial Transfer Drill

This drill takes place in a home birth or birth center setting and focuses on recognizing and responding to a complication, stabilizing the patient, making the decision to transfer, and preparing for the transition to a higher level of care.

Teams practice emergency roles, clinical interventions, communication with the patient and family, contacting EMS or the receiving hospital, and preparing transfer documentation. The drill ends when the team has completed its preparations for transfer and simulated giving verbal report to EMS and the receiving hospital.

2. Hospital-Receiving Partial Transfer Drill

This drill begins with a simulated notification that a patient is being transferred from a community birth setting.

Hospital teams practice receiving a transfer notification, mobilizing appropriate personnel and resources, receiving a structured handoff, admitting the patient and entering emergency care orders, and providing timely care while supporting the patient's preferences and continuity of care.

This can be especially valuable for hospital staff who receive community birth transfers infrequently or have limited familiarity with out-of-hospital birth care.

Why Start with Half the Transfer?

A Full Transfer Drill—following a simulated patient from home or birth center through EMS transport and into hospital care—is a powerful learning experience. But it requires substantial coordination across organizations.

Partial Transfer Drills offer several advantages:
  • Easier to organize: Teams can conduct meaningful drills without coordinating every partner in the transfer pathway, sometimes even "on the fly."
  • Lower pressure: A smaller drill allows participants to practice skills, use unfamiliar equipment, and build confidence in a supportive environment.
  • Experience with simulation: Teams can become familiar with their Drill Kit, facilitation, observation, and structured debriefing before conducting a larger drill.
  • Actionable improvements: Even a brief drill may uncover unclear responsibilities, missing supplies, communication gaps, or opportunities to improve documentation.
  • Building momentum: An initial drill can generate enthusiasm and prepare participants for more complex interdisciplinary simulations.

Should You Invite Providers from Other Care Settings?

One important decision is whether to involve colleagues from outside the setting where your Partial Transfer Drill takes place.

For community birth teams, this might mean inviting hospital nurses, physicians, or EMS personnel to participate or observe. For hospital teams, it might mean inviting community midwives to participate in a simulated arrival and handoff.

There is no single right approach. Both options offer valuable learning opportunities.

The Benefits of Including
Interdisciplinary Partners

Inviting colleagues from other settings can begin strengthening the relationships and mutual understanding essential to effective transfers.

When hospital providers observe community midwives managing an emergency, they gain firsthand insight into their clinical skills, equipment, decision-making, and capabilities. Likewise, community birth providers participating in hospital-based drills can better understand hospital workflows, available resources, and the roles of different team members.

These experiences can challenge assumptions, clarify scopes of practice, strengthen communication, and build trust before an actual emergency occurs.

Even colleagues who participate only as observers can offer valuable perspectives during the debrief.

The Value of Practicing with
Your Own Team First

Simulation also requires vulnerability. Participants are asked to demonstrate skills, make decisions under pressure, and sometimes make mistakes in front of colleagues. This can feel particularly uncomfortable when relationships between organizations are new or trust is still developing.

Some teams may prefer to create a psychologically safe learning environment with familiar colleagues before inviting interdisciplinary partners.

A community birth team might want to practice using its Drill Kit and refining emergency roles before involving hospital or EMS colleagues. A hospital team might similarly want to test its internal notification and response processes first.

Both approaches are valid. The goal is to create the conditions for meaningful learning, not to evaluate individual performance. Starting within your own team can build confidence for more productive interdisciplinary drills later.

Making the Most of Your Partial Transfer Drill

Regardless of where your drill takes place or who participates, a few practices can maximize its impact:
  • Set clear learning goals. Identify two or three things you most want to test or improve.
  • Focus on teamwork and communication. Practice role clarity, closed-loop communication, and structured tools such as SBAR and standardized transfer forms.
  • Prioritize the debrief. Ask what went well, what was challenging, and what could work better next time. Include observers and all participating disciplines.
  • Turn learning into action. Identify concrete improvements, assign responsibility, and establish a timeline for follow-up. Use a simple QI Tracking Tool to support accountability.

A Starting Point, Not a Final Exam

Partial Transfer Drills have limitations. Because they test only one portion of the transfer process, they may not reveal challenges that arise when care crosses organizational boundaries.

A community birth team might successfully practice preparing a transfer report without discovering that the receiving hospital has difficulty accessing it. A hospital team might practice a smooth patient arrival without encountering the challenges of real-world EMS coordination.

That's why the Action Collaborative progresses from Partial to Full Transfer Drills. The Partial Transfer Drill helps teams strengthen individual components of the process; the Full Transfer Drill allows them to examine how those components work together.

As you prepare for your first drill, remember that success doesn't mean everything goes according to plan. Success means learning something that can make future transfers safer, more coordinated, and more respectful for patients and families.

Start where you are. Practice what you can. Learn together. And use those lessons to take the next step toward a stronger, more integrated system of care.
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