Hospital-acquired illnesses and injuries have direct consequences on patient health and erode the trust patients place in providers and health systems. Examining within-hospital differences in Black and white adult patient safety risks is the central focus of this study. We assess racial disparities in the quality of inpatient care using 11 patient safety indicators that measure rates of adverse patient safety events of hospital-acquired illnesses or injuries. Our evidence shows that Black patients systematically experience higher rates of hospital-acquired illnesses or injuries related to surgical procedures relative to white patients treated in the same hospital. Within-hospital differences in Black-white adverse patient safety rates remain prevalent when comparing Black and white patients with similar coverage types. Our previous analysis examining differences in the quality of hospitals accessed by Black and white patients suggested that increasing the racial diversity of patients that high-quality hospitals serve or concentrating resources to improve quality of care at low-performing hospitals would narrow inequities in overall racial disparities of quality of care. Findings from this study indicate that this recommendation is a necessary but insufficient step in reducing racial disparities in the quality of health care and that racial equity in patient safety requires transforming the way care is delivered within hospitals as well.