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(B) the efficiency of transportation services;

(C) the reception of the client and newborn at the hospital; and

(D) client satisfaction with the transfer, if that information is provided by the client, either verbally or in writing;

(7) problems or complications of pregnancy, labor, and postpartum care, and the appropriateness of the practitioner’s clinical judgment in obtaining consultation and addressing each problem; and

(8) an evaluation of staff ability to manage emergency situations, including client and newborn emergencies, power failures and similar emergencies, and unannounced periodic fire drills. (d) The birth center shall ensure that each review under this section includes at least 20 percent of all births, 100 percent of all transfers to a hospital of clients or newborns, and all significant outcomes required to be reported under 7 AAC 12.405(j)(9)(B), during the period covered by the review. The birth center shall document each review and any action taken as a result of the identification of issues that might affect the quality of care and services. (e) The birth center shall include in the evaluation and improvement program at least the following measures, for purposes of ensuring a safe, home-like environment:

(1) routine testing of the efficiency and effectiveness of equipment, including sphygmomanometers, Doppler fetal heart monitors, sterilizers, resuscitation equipment, transport equipment, oxygen equipment, communication equipment, heat sources for newborns, smoke alarms, and fire extinguishers;

(2) routine review of housekeeping procedures and infection control;

(3) an evaluation of maintenance policies and procedures for heat, ventilation, emergency lighting, waste disposal, water supply, and laundry and kitchen equipment. (f) The birth center shall ensure that the evaluation and improvement program monitors and promotes quality of care to clients and newborns through an effective system for collection and analysis of data, including

(1) utilization of

(A) orientation sessions;

(B) childbirth-related educational programs;

(C) postpartum home visits;

(D) follow-up postpartum office visits by the client; and

(E) follow-up office visits for the newborn;