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Review
. 2025 Mar 13;6(1):e553.
doi: 10.1097/AS9.0000000000000553. eCollection 2025 Mar.

Safety Net Hospitals and the Quality of Surgical Care

Shyamin Mehra  1   2 , Ashley Yang  1 , Maya Dornbrand-Lo  1 , Saikiran Beesam  1 , Alessandra Mele  3   4 , Ravi J Chokshi  1   2 , Kathie-Ann Joseph  5 , Cherisse D Berry  1   2 , Susan E Pories  1   2
Affiliations
Review

Safety Net Hospitals and the Quality of Surgical Care

Shyamin Mehra et al. Ann Surg Open. .

Abstract

Objective: To investigate the number of safety net hospitals (SNHs) that have American College of Surgeons (ACS) accreditation for surgical programs.

Background: SNHs provide healthcare to a substantial proportion of uninsured and underserved patient populations and rely heavily on public funding to sustain their operations. ACS accreditation emphasizes evidence-based care and standardization to improve patient outcomes. However, SNHs face financial and administrative barriers to ACS accreditation.

Methods: We investigated the number of SNHs with ACS accreditation for specific programs by utilizing the publicly available listing of ACS-accredited programs and the listing of SNHs from the America's Essential Hospitals membership. We then performed a descriptive analysis of the number and geographic distribution of SNHs within the United States and the number of SNHs with ACS-accredited programs.

Results: SNHs vary by regional disparities and demographic characteristics of respective states. Almost 20% of states are without access to SNHs. Most SNHs do not pursue ACS accreditation. Of 322 SNHs, 36% were accredited for cancer care (Commission on Cancer), 31% for trauma (Trauma Quality Improvement Program), 21% for bariatrics (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program), 13% for breast care (National Accreditation Program for Breast Centers), and 5% for rectal cancer (National Accreditation Program for Rectal Cancer).

Conclusions: ACS accreditation can benefit SNHs in improving guideline-concordant care for medically underserved patients and SNHs should be encouraged to attain ACS accreditation to improve access to and quality of care for vulnerable patient populations.

Keywords: accreditation; quality; safety net hospitals; surgery.

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Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
Number of safety net hospitals with ACS accreditations. Of 322 safety net hospitals, 36% have CoC accreditation, 31% TQIP, 21% MBSAQUIP, 13% NAPBC, and 5% NAPRC programs. TQIP, Trauma Quality Improvement Program.
FIGURE 2.
FIGURE 2.
Safety Net hospitals by number of ACS accreditations. Notably, 51% (167) of safety net hospitals have attained ACS accreditation. About 21% (68) have only 1 ACS accreditation, 15% (48) have 2, 9% (30) have 3, 5% (16) have 4, and 2% (5) have all 5 of the ACS accreditations studied.
FIGURE 3.
FIGURE 3.
Number of safety net hospitals by region. Notably, 35.2% of the Southeast’s safety net hospitals are in Florida and 62.1% of the West’s safety net hospitals are in California. MW, Midwest; NE, Northeast; SE, Southeast; SW, Southwest; W, West.
See this image and copyright information in PMC

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