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Poster Session 1

Category: Obstetric Quality and Safety

Poster Session 1

(151) QAPI review of MTP utilization improves compliance and maternal outcomes

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Bryce T. Munter, MD (she/her/hers)

Maternal Fetal Medicine Fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UT Health Houston
Houston, Texas, United States

Coauthor(s)

Ghamar Bitar, MD

Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UT Health Houston
Houston, Texas, United States
Aaron W. Roberts, MD

Assistant Professor, Maternal Fetal Medicine
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Objective:
Early mobilization of resources via use of a massive postpartum hemorrhage (PPH) protocol has been shown to improve maternal morbidity and mortality. However, early mobilization can be challenging in cases of unanticipated PPH, leading to unexpectedly high blood loss and delays in resuscitation. Our objective was to identify if focused QAPI-led interventions affected 1) mobilization of resources in settings of massive hemorrhage by using MTP utilization as a marker, and 2) incidence of maternal morbidity, using hemorrhage-related ICU admission as a marker.

Study Design:
Our level IV maternal care center massive hemorrhage protocol dictates that MTP should be activated in all patients who have blood loss >1500mL AND either 1) have concern for ongoing bleeding, 2) are en route to the OR, or 3) have hemodynamic instability. Our QAPI team, a multidisciplinary collaborative group comprised of physician and nursing leadership, meets once per month to review variances and pre-specified obstetric metrics. Activation of MTP protocol was added as a review metric in 10/2024. After QAPI variance review, focused education and feedback was provided using closed-loop communication to all teams involved in patient care. Compliance rate and hemorrhage-related ICU admission rate were calculated from 10/2024 to 5/2025. Patients with known placenta accreta spectrum disorders were excluded, given our goal to focus on unanticipated massive hemorrhage.

Results:
Our QAPI team met 8 times during our study period. Since MTP utilization was added as a metric for review, 82 patients met protocol criteria and MTP was performed for 17 patients (21%). Month-by-month focused feedback and education by the QAPI team increased rate of compliance by 17% (95% CI 13.9-36.1%) over 8 months. In the same period, hemorrhage-related ICU admissions decreased by 22% (95% CI 19.4-46.2%).

Conclusion:
QAPI-led interventions increased early resuscitation efforts by 17% and decreased ICU admissions by 22% over 8 months. These findings highlight the importance of maternal quality programs as part of an overall strategy to reduce maternal morbidity.