Improving maternal safety and eliminating disparities are national patient safety priorities, yet maternal morbidity and mortality remains disproportionately experienced by persons of color in the United States.

This article describes the development and implementation of a health equity checklist within the obstetrics and gynecology department at Yale University School of Medicine. The research team developed a health equity checklist that can be incorporated into the existing safety event review process. The existing framework included a process checklist to allow for identification of areas and trends for process improvement (e.g., communication breakdowns, issues with space availability, inefficient workflows). The new health equity checklist addressed issues such as access to healthcare (e.g., immigration status, insurance, housing instability), communication (e.g., language barriers or cultural differences), psychosocial issues (e.g., substance use disorders, domestic violence) and the presence of bias and/or mistrust. Cases meeting health equity checklist criteria were referred to the departmental diversity, equity and inclusion (DEI) committee for review.

After 15 months of implementation, 12 safety event cases demonstrated evidence of having been affected by the social determinants of health and/or bias. Several affected cases were related to delays in care and diagnosis among groups historically affected by bias or racism. Additionally, three cases involved patients who did not receive evidence-based guideline-recommended treatment for postoperative venous thrombosis (VTE) and one involved inadequate pain control after surgery.