Quality & Safety Report 2026

Quality & Safety R E P O R T 1

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QUALITY & SA FETY REPORT FY26

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ZE RO HAR M

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QUALITY & SA FETY REPORT FY26

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Quality & Safety Report

Table of contents

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5 – Clinical Effectiveness Structure

40 – Quality

6 – Achievements and Recognition

55 – Flow

7 – Zero Harm

60 – Health Impact

31 – Zero Hero Awards

67 – Population Health

34 – Patient Experience

71 – ChristianaCare Way Awards

QUALITY & SA FETY REPORT FY26

Clinical Effectiveness Structure At ChristianaCare, Clinical Effectiveness is foundational to improving the health of our communities. Every day, across every area of care, our caregivers strive to deliver the highest standard of service, ensuring that all patients receive safe, effective, compassionate care with love and excellence.

The framework of our Clinical Effectiveness Structure is built on six pillars — Zero Harm, Patient Experience, Quality, Patient Flow, Health Impact and Population Health. This

structure is designed to support the delivery of safe, high-quality, effective, evidence-based and patient-centered clinical care. Each pillar is fortified by evidence-based practice, quality improvement initiatives, multidisciplinary teams, patient safety programs, education and training and patient and family engagement.

We strive to be among the top comprehensive academic medical centers in the nation for quality and safety based on rigorous benchmarking standards, including the Vizient Quality

and Accountability Scorecard (see page 46), which evaluates more than 100 academic medical centers across six key domains: mortality, efficiency, effectiveness, patientcenteredness, safety and variation in care. In 2020, we ranked 83rd. Since then, we have made significant progress, thanks to the extraordinary dedication of our Clinical Effectiveness committee, councils, caregivers and targeted initiatives across our three campuses, ambulatory practices and HomeHealth. Our ranking improved to 45 out of 122 hospitals in the Vizient Quality and Accountability Scorecard.

Our dedicated, ongoing efforts to deliver the highest possible standards of care are driving key improvements. We continue to identify opportunities and implement initiatives to continue this positive trajectory.

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QUALITY & SA FETY REPORT FY26

“We aspire to be among the top 25 academic medical centers in the Vizient Quality and Accountability Scorecard, and we remain committed to ongoing efforts to achieve our quality and safety goals. Every day, we innovate and improve so that we can deliver the best possible care to patients and communities.”

Varadarajan Subbiah, M.D., MBA, FACP, CHCQM, Chief Clinical Effectiveness Officer

Fiscal Year 2026

Achievements and recognitions

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Zero Harm Achieve year-over-year improvement in clinical excellence through a high-reliability approach, a

culture of safety and a commitment to the identification, prevention and elimination of patient and caregiver harm.

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My why “ChristianaCare represents my community and everyone I care about.

My friends receive care here. My parents, spouse, children and I receive care here. It is not just about making a headline or measuring statistics. It is ensuring that we take care of our community in the best way possible. Even the simple things we do, such as washing our hands properly, have a big impact on patients and caregivers. If I can make sure my loved ones — and everyone else’s — receive safe, high-quality care, all the effort is worth it.”

Ryan Penn, MSM, MLS(ASCP)CMSBBCM, CIC, CPHQ, Infection Preventionist

Zero Harm: Preventable Harm

Preventable Harm Rate

Preventable harm rate improves at Cecil County campus

Harm per 1000 patient days

1.2

The Preventable Harm Rate is a key patient safety measure at ChristianaCare. We measure 19 indicators across our three

1.0 0.8

Through March, the FY26 Preventable Harm Rate is 0.685, higher than the Annual Operating Plan target of 0.660. The rate has decreased by more than 10% from FY23; the number of patients harmed improved by 32%, to 221 from 253.

0.6 0.4 0.2

0.0

hospital campuses and our ambulatory practices. Among them are health care-associated infections, Agency for Healthcare Research and Quality patient safety indicators (PSI) and acute care falls with major injury and falls in ambulatory settings.

Most measures are required for reporting to the Centers for

Baseline

FY26 YTD

Stretch Goal (-2%)

1.200 1.000

Harm per 1000 patient days

Medicare and Medicaid Services (CMS) and tied to pay-forperformance programs (see page 41). Progress in the indicators helps strengthen our core Clinical Effectiveness Structure goal of achieving and maintaining exemplary standing among our academic medical center cohort.

Preventable Harm Rate by Campus

0.800 0.714

0.600

0.770

0.533 0.459

0.400

0.334 0.200

0.271

0.000 Cecil County

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Newark

Wilmington

Cecil County campus improved its preventable harm rate for FY26 year-todate and outperformed the stretch goal. Newark and Wilmington have seen small increases in harm.

Zero Harm: Hospital Acquired Infections (HAIs)

ChristianaCare’s Christiana Hospital, Union Hospital and Wilmington Hospital have each received an ‘A’ grade in the Spring 2026 Leapfrog Hospital Safety Grade, a national distinction that recognizes ChristianaCare’s achievements in protecting patients from harm and providing safe health care.

Reducing HAIs: A continued focus on patient safety Health care-associated infections contribute to increased mortality, morbidity and costs, making prevention a key priority

in ChristianaCare’s commitment to zero harm.

Hospital Acquired Infections 70

4.0

60

3.5 3.0

50

2.5 2.0 30

1.5 20

1.0

10

0.5

0

0.0

CAUTI

CLABSI

C-Difficile FY25 Cases

MRSA FY26 Cases

FY25 Rate

SSI-Colon

FY26 Rate

SSI-Colon improved compared to FY25. Small increases were seen in CLABSI, CAUTI, MRSA and C. difficile, which presents the greatest opportunity.

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SSI-Fusion

Rate

Cases

40

“These awards reflect the extraordinary commitment of our caregivers,” said Kert Anzilotti, M.D., MBA, FACR, chief physician executive and president of the Medical Group of ChristianaCare. “Their everyday dedication to patient safety — preventing harm, strengthening trust and caring for every patient — defines ChristianaCare and makes the safety of our patients our highest priority. As a result, hospitals across ChristianaCare continue to earn top safety grades.”

Zero Harm: Clostridioides difficile (C. difficile)

Efforts to stem C. difficile infections accelerate C. difficile infection rates have increased since FY25. In response, the health system has initiated several interventions that are contributing to early improvements, including:

C-difficile Cases

• Detailed case reviews of every hospital-onset case, identifying opportunities with early detection, laxative use and text ordering.

C-diff Rate

SIR

14

3.5

12

3.0

10

2.5

8

2.0

6

1.5

4

1.0

2

0.5

0

0.0

vs. hospital-onset.

• Implementing additional signage to remind caregivers to use soap and water rather than alcohol gel, which is not effective against C. difficile spores, after leaving the room of an infected patient.

• Close collaboration between Infection Prevention caregivers and the Ambulatory Safety Program, including Bleach Blast: cleaning high-touch surfaces and common areas with bleach.

• Instituting hand wipes for bedbound patients and bedpan and commode liners to minimize

Number of Cases

time of admission, nearly doubling the number of cases correctly identified as community-onset

• Education on constipation protocol, stool documentation, C. difficile testing and hand hygiene.

Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26

contamination.

• Partnership with Environmental Services to educate caregivers completing daily discharge cleaning and to monitor cleaning procedures.

• An increased focus on antimicrobial stewardship. In FY26, we observed an increase in ceftriaxone at the Newark campus and implemented interventions for improvement. (See page 54 — antimicrobial stewardship.)

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FY26 YTD, the C. difficile infection rate rose by 29%. Although the observed-to-expected standardized infection ratio remains below the National Healthcare Safety Network of 1.0, at 0.52, it now exceeds the Vizient 50th percentile of 0.40.

Cases per 10,000 patient days

• Using the electronic health record to notify caregivers of the presence of diarrhea at or near the

Zero Harm: Surgical Site Infections (SSIs)

Surgical Site Infections - Spinal Fusion

Reducing SSIs through education

8

5.0 4.0

6

Number of Cases

Surgical site infections (SSIs) are among the most common preventable surgery-related complications, particularly with colorectal procedures.

Reducing SSIs is critical to improving patient outcomes and surgical success. Key efforts at ChristianaCare include:

5

3.0

4

2.0

3

2

1.0

1 0

• Partnering with Surgery to improve documentation of pre-existing infections and

0.0

SSI Rate (# per 100 procedures)

7

Following an increase in SSISpine Fusion cases in FY24, incidence improved slightly in FY25 and has seen substantial improvement year-to-date FY26, with the rate decreasing 32%, to 1.43 from 2.10.

post-surgical findings to improve accuracy of SSI counts.

SSI Cases

SSI-Fusion Rate

Rolling 12 mo Rate

• Holding Surgical Grand Rounds focusing on surgical hand scrub and skin prep.

• Mandatory web lesson for surgeons, physician assistants and operating room staff on proper surgical hand scrub and skin prep.

• Piloting timers at scrub sinks to ensure proper duration of hand scrubbing. in-OR observations and just-in-time coaching.

• In-depth reviews of each SSI to identify opportunities for improvement.

• Focus on colon SSI prevention bundle elements and improved adherence.

Number of Cases

• Partnering with the Virtual Education and Simulation Training Center to perform

8

16.0

7

14.0

6

12.0

5

10.0

4

8.0

3

6.0

2

4.0

1

2.0

0

0.0

SSI-Colon Cases

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SSI-COLON Rate

Rolling 12 mo Rate

SSI Rate (# per 100 procedures)

Surgical Site Infection: Colon Procedures

Our surgical site infections for colon procedures have improved consistently since fiscal year 2024, reaching 2.23 in FY26 from 8.49, a 74% decrease.

Zero Harm: Hand Hygiene

Strengthening hand hygiene compliance ChristianaCare’s Hand Hygiene Steer works with unit leaders to improve caregiver hand hygiene practices through education, data analysis and targeted interventions. Key interventions include implementing:

• A hand hygiene video campaign and a slogan campaign with more than 300 entries, resulting in posters and

Hand Hygiene Contributing Factors

Distractions/ Forgets 14%

other signage targeting patients, visitors and caregivers.

Hands full (supplies, equip, meds) 9%

• A pilot program to assess patient and caregiver hand hygiene rates in ambulatory clinics.

• Increased hand hygiene observations by unit-based leaders and Infection Prevention to meet Leapfrog

Perception that if nothing touched, HH not needed 10%

Choice not to wash 20%

recommendations of at least 200 hand hygiene observations per unit each month.

Other 1% Dispenser location 0%

• A new question in the hand hygiene observation tool to encourage observers to engage in direct discussions

Dispenser empty/ broken 0%

with caregivers.

• Focus groups with unit leaders.

• Ongoing caregiver and unit recognition for excellence in hand hygiene.

Improper Use of Gloves 46%

• A “Gloves Off” pilot to improve proper glove use. Infection Prevention observations identified improper use of gloves as the greatest opportunity, representing almost 40% of identified contributing factors.

• An updated fingernail policy (as overly long or artificial nails impede hand hygiene).

• Emergency Department-focused activities, including adding and moving alcohol-based hand sanitizer, dispensers, education about gloves and hand hygiene requirements and creation of an Emergency Department hand hygiene dashboard.

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Each campus improved hand hygiene compliance in FY26, with overall compliance increasing To 94% from 92%. Of ChristianaCare's 66 units, 95% of met their monthly observation goal (generally 200 observations), and 83% exceeded 90% compliance.

PSI-90 Composite

Zero Harm: Patient Safety Indicators (PSI 90)

PSI 90 continues to serve as a core composite measure of patient safety performance. To support our long-term quality and safety goals, we are comparing our rates to not only all academic medical centers, but also to the top-performing academic medical centers — a rigorous, aspirational standard.

• Intense focus on the 10 patient safety indicators that comprise the weighted PSI-90 composite score has led to a 38% reduction in the PSI-90 score since 2022. With a score of 0.48 in 2025, ChristianaCare outperforms academic

medical centers and the top-ranking academic medical centers.

• Six PSIs, 3, 6, 8, 9, 13 and 14 outperform top-performing academic medical centers. Current trend data suggests year-over-year improvement across these indicators.

AMC

National

1.2

Risk-Adjusted Smoothed Rate

PSI 90 score continues to improve in comparison to other academic medical centers

ChristianaCare

0.98

1.0 0.8

0.95

0.84

0.78

0.73

The PSI-90 Composite Rate has improved year-overyear, decreasing 38% since 2022, to 0.48 from 0.78.

The rate is well below the national level and is better than our academic medical center peer group.

0.83

0.69

0.6 0.48 0.4 0.2 0.0 2022

2023

2024

2025

Patient Safety Indicators 2025 vs. Academic Medical Center Peers ChristianaCare

AMC

Top AMC

Hosp Acquired Pressure Injuries (PSI 3) Iatrogenic Pneumothorax PSI 6) In Hospital Fall w Fracture (PSI 8) Postop Hemorrhage/Hematoma (PSI 9)

• PSI 11 has improved compared to FY25. Efforts are underway to reach the

Postop Acute Kidney Injury (PSI10)

goal of exceeding top-performing academic medical centers (see page 15).

Postop Respiratory Failure (PSI11)

Periop PE/DVT (PSI12)

• PSI 10 is at risk for year-over-year decline. All PSI 10 cases are now reviewed through Event Review Teams, a change from prior years that strengthens oversight, accountability and learning opportunities (see callout, page 15).

Postop Sepsis (PSI13) Postop Wound Dehiscence (PSI14) Accidental Puncture/Laceration (PSI15) 0.0

0.5

1.0

1.5

Observed v Expected Ratio

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2.0

2.5

ChristianaCare outperforms top-ranked academic medical centers in eight of the 10 PSIs; PSI 11 has opportunity compared to the top academic medical centers.

PSI 10 has opportunity compared to all academic medical center peers.

PSI 3: Hospital-Acquired Pressure Injury (HAPI)

Zero Harm: Hospital-Acquired Pressure Injury (PSI 3)

After an increase in FY25, ChristianaCare’s PSI 3 pressure injury rates fell below national benchmarks in FY26. A systemwide Hospital-Acquired Pressure Injuries (HAPIs) committee implemented interventions to reduce HAPIs, including:

0.69

0.70

Cases per 1000 patients

Continuous improvement keeps HAPI rates below national benchmarks

0.80

0.60

0.64

After identifying an increase in HAPI in FY24, action plans including a dark skin tone assessment and a perfect care bundle of evidencebased interventions led to a 44% reduction in the HAPI rate FY26 year-to-date, to 0.39 from 0.69 cases per 1,000 patients.

0.57 0.46

0.50

0.39

0.40 0.30

0.20 0.10

• Pressure injury prevention rounding for high-risk patients.

0.00 FY22

• Updated patient criteria for specialty support surfaces.

FY23

FY24

FY25

FY26 YTD

• Weekly HAPI huddle alerts.

• A review of offloading devices, including a pilot trial of a wedge designed to maintain a 30-

PSI 3: HAPI Trend by Race 2024

FY26 data to date suggest that 35% of HAPIs systemwide were related to medical devices, with oxygen tubing identified as the most common device involved. Since switching to a new flexible nasal cannula tubing, zero Medical Device-Related HAPIs have resulted from nasal cannulas in FY26 to date. We also developed nursing education and a Medical Device-Related Pressure Injury Prevention Bundle, launched in February 2026, to help nurses identify early signs of pressure injuries related to medical devices and interventions to put in place or escalate to the provider.

To reduce disparities in HAPIs, which disproportionately affected patients with darker skin tones, ChristianaCare implemented the objective Monk Skin Tone scale to improve skin assessments.

(Learn more on page 75.)

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Number of Cases

A system-wide restart of HAPI Triads is slated for Q4 FY26. Acute skin failure cases increased in FY26YTD, underscoring the need for continued diligence.

2025

Series3

Series4

30

1.40

25

1.20 1.00

20

0.80 15 0.60 10

0.40

5

0.20

0

0.00 Total

White

Black

Other

Cases per 1000 patients

degree lateral turn, the evidence-based standard for pressure injury prevention.

Following implementation of the Monk Skin Tone scale, HAPI rates improved by 42% overall. Rates for Black/ African American and Other race patients improved over 55% and are now similar to rates for White patients.

Zero Harm: Postoperative Respiratory Failure, Acute Kidney Injury (PSI 11 and PSI 10)

Postoperative Acute Kidney Injury Predictive Model

Expanded monitoring, analysis and clinical initiatives improve performance PSI 11 performance exceeds benchmarks for all academic medical centers and has improved compared to FY25, suggesting that practice changes and monitoring efforts are having a positive impact. Key interventions to reduce postoperative respiratory failure have included:

To improve PSI 10, we developed a Postoperative Acute Kidney Injury Predictive Model that identifies patients at elevated risk using a calculated percentage risk score. The model is in pilot testing in patients with hip fractures and will expand to additional service lines following workflow optimization and validation.

PSI 11- Postoperative Respiratory Failure 5

2.0%

4

1.6%

positive end-expiratory pressure to prevent atelectasis in obese patients following cardiac surgery.

Upcoming priorities include refining pilot workflows, standardizing guidance where appropriate and deepening serviceline–specific analyses.

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Cases

Rate

Mar-26

Feb-26

Jan-26

Dec-25

Nov-25

Oct-25

Sep-25

Aug-25

Jul-25

Jun-25

May-25

Apr-25

Mar-25

Rolling 12 month rate

PSI 11 cases improved 36% FY26 year-to-date, to 7 from 11, while the rate decreased 25%, to 0.43% from 0.58%

PSI Rate

0.0% Feb-25

0 Jan-25

0.4%

Dec-24

reduce reintubation risk, Cardiac Surgery is using higher

1

Nov-24

• Clinical Initiatives: To optimize extubation practices and

0.8%

Oct-24

surgery have emerged as the most prominent contributors to current trends and will remain areas of focused review.

2

Sep-24

service lines, improving visibility into specialty-specific trends and cross-cutting risk factors. Cancer surgery and cardiac

1.2%

Aug-24

• Trend Analysis: Reintubations are being tracked across all

3

Jul-24

ensuring consistent evaluation, identification of contributing factors and actionable learning and follow-up.

PSI Cases

• Monitoring and Review: All PSI 11 cases undergo event review,

We have also updated our trend monitoring approach to include acute kidney injury across all stages and service lines, enabling earlier identification of emerging trends and proactive intervention before progression.

Zero Harm: Falls

ChristianaCare hospital campuses decrease fall rates through multi-faceted interventions

Focused interventions:

• Increasing Fall Perfect Care Cipher rounds on units with recent falls with major injury to reinforce standards, observe practice patterns and identify opportunities for improvement.

Acute Care Inpatient Fall Rate 2.5

Falls per 1000 Patient Days

Acute inpatient fall rates have improved across our three campuses since FY22. When the fall rate began to exceed projections for FY26, the systemwide Fall Prevention and Mobility team responded quickly with a series of fall-reduction strategies:

Acute inpatient falls rates for two of three campuses remain below the NDNQI Magnet© Benchmark and have improved by over 50% for the Cecil County campus since FY22. Since FY22, there have been over 400 fewer falls across the three campuses.

2.0 1.5

1.0 0.5 0.0

FY22 Newark

• Sharing Fall Standards, patient-focused messaging and a Nurse FAQ to Nurse

FY23 Wilmington

FY24

FY25

Cecil County

FY26 YTD

NDNQI Magnet© Benchmark

Managers for consistent sharing during unit huddles.

• Reviewing and reinforcing risk-specific fall interventions with nursing staff through unit huddles and monthly mandatory education.

expectations with providers.

• Collaborating with External Affairs to design and implement a “Safety Tops Privacy” poster for bathroom doors to reinforce safe patient toileting practices and normalize the expectation for staff presence.

Number of Falls

• Creating an “In the Know” communication to reinforce Fall Standards and

20 18 16 14 12 10 8 6 4 2 0

0.45 0.41 0.34

15

FY22

0.29

0.29

12

12

FY24

FY25

18

FY23

Falls with Major Injury

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FY26 YTD

Major Injury Rate

0.50 0.45 0.40 0.35 0.30 0.25 0.20 0.15 0.10 0.05 0.00

Falls per 10,000 patient days

Falls with Major Injury (Acute Care & Emergency Departments)

Falls with Major Injury have decreased by 29% since FY23, from 0.41 per 10,000 to 0.29 per 10,000 patient days in FY25 and is holding steady in FY26.

Zero Harm: Falls ChristianaCare hospital campuses decrease fall rates through multi-faceted interventions

Strengthened safety protocols and clinical decision support

Piloting

• Using a Fall Risk Patient Perception Tool on Unit 4E to capture patients’ understanding of their fall risk and inform individualized education and engagement strategies.

medical units at Newark campus to ensure consistent activation of alarms and support early detection.

• Fall Prevention Rounding by specially trained mobility interns with a standardized checklist during downtime at Wilmington campus.

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QUALITY & SA FETY REPORT FY26

of the bed.

• Implementing a safety alert on low–air-loss mattresses, including detailed criteria for appropriate use.

• Utilizing Posey bed alarm boxes on several

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• Developing new guidelines for sitting on the side

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• Deploying targeted education to emergency department caregivers to support clinical differentiation and management of patients whose presenting diagnoses may increase fall risk, enabling more tailored and effective fall prevention Implemented a standard process and workflow that incorporates pharmacy review and recommendations into the patient care planning process for patients at high risk for falls on the behavioral health unit.

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Data-driven continuous improvement

• Conducting weekly fall reviews on all three campuses to identify trends, contributing factors and improvement opportunities.

• Performing monthly analyses of R2L and Fall Perfect Care data to identify system-level trends and guide targeted interventions.

• Disseminating lessons learned and best practices through a monthly newsletter.

Zero Harm: Falls

HomeHealth outperforms state and national falls benchmarks ChristianaCare HomeHealth Falls with Major Injury

Since FY21, ChristianaCare HomeHealth has had fewer Falls with Major Injury than state and national benchmarks. The agency continues to take a multidisciplinary approach to fall prevention. Its ongoing efforts to reduce falls include:

1.00% 0.90%

0.80% 0.70%

• Implementing individualized interventions to improve safety,

0.60%

such as recommending home modifications and equipment.

• Providing individualized home exercise programs for strength and balance.

Incidence (%)

• Using a multifactor tool to assess a patient’s fall risk.

0.50% 0.40%

0.30%

• Collaborating during team case conferences to identify challenges and opportunities.

0.20%

In FY26, HomeHealth maintained its standing below state and national benchmarks.

0.10%

0.00% FY21

FY22 CC HomeHealth

FY23 State Benchmark

FY24

FY25

FY26 YTD

National Benchmark

In FY26YTD through January, HomeHealth maintained a lower incidence of Falls with Major Injury compared to state and national benchmarks.

The incidence of HomeHealth Falls with Major Injury increased to 0.73% in FY26TD from 0.52% in FY25.

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Zero Harm: Falls

Ambulatory practices maintain improved fall rates

• Disseminating Huddle Tips on Falls Best Practices to reinforce

• Assigning training in LearningSpace.

• Strengthening the Ambulatory Falls Sub-Committee by increasing meeting frequency, engaging additional stakeholders and increasing review of ambulatory fall events as well as increasing communication and dissemination of lessons across the ambulatory practices.

• Enhancing processes to support high fall-risk patients with

1.8

16

1.6

14

1.4

12

1.2

10

1.0

8

0.8

6

0.6

4

0.4

2

0.2

0

0.0

Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26

cognitive impairment, ensuring they receive additional assistance.

Number of Falls

awareness in clinical settings.

18

Ambulatory Practice Falls

Fall Rate (rolling 12 mo)

Falls in Medical Group office practices have decreased by 52% since FY24, to 0.53 from 1.11 falls per 10,000 visits. However, reporting of falls increased slightly from FY25 to FY26, including a significant rise from Imaging Services in September 2025.

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Falls per 10,000 office visits

Ambulatory Falls

The Ambulatory Falls Subcommittee implemented multiple interventions to address ambulatory-specific risks for patient falls. Among the strategies were:

Zero Harm: Medication Safety

Virtual Acute Care Nurses identify and correct medication reconciliation errors Improving Medication Reconciliation accuracy (MedRec), the process of accurately documenting and communicating patients’ medication regimens, is a National Performance Goal and an area of opportunity.

Virtual Acute Care Nurse Medication Reconciliation Interventions 180 166 160

In acute care, MedRec occurs during admission to provide

140

errors can cause patient harm and increase readmission rates.

120

Virtual Acute Care nurses now independently review MedRec after provider finalization but before patient discharge to identify

and correct errors.

In a pilot run in 2025 (11.5 months), voluntary reporting via the Report2Learn system demonstrated interventions on 94 patients,

and 166 medication errors were prevented.

This program has the potential for an annual return on investment (after deducting cost to ChristianaCare) of over $2.5

million due to decreased readmissions.

Number

continuity of care and at discharge, when the patient receives a revised plan of care and drug regimen. After discharge, MedRec

100

94

80 60 40

20 0 Patients

Interventions

During the 2025 Medication Reconciliation pilot, Virtual Acute Care Nurses identified and corrected 166 medication errors for 94 patients, an average of 1.8 interventions per patient.

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Zero Harm: Caring for the Caregiver

Care for the Caregiver program sees increasing demand for peer support Since 2015, ChristianaCare’s Care for the Caregiver program has provided emotional support to caregivers experiencing distress. This

Care for the Caregiver 600

evidence-based approach helps decrease acute and chronic stress reactions for caregivers, which supports patient safety.

Number of Requests

The last two years have seen the highest utilization in program history.

In 2025, Care for the Caregiver saw 479 referrals, the second-highest volume in program history. In addition to individual support, Care for the Caregiver fulfilled 20 requests for group support, reaching 250 additional caregivers. A team of 42 trained peer supporters makes this program possible.

500 400 300 200

100 0 2018

Caregivers who received support after experiencing an adverse event scored higher across all Culture of Safety domains than those who were not supported. Statistically significant scoring differences were observed in Teamwork, Organizational Learning, Clinical Management Support for Patient Safety and Hospital Management Support for Patient Safety.

2019

2020

2021

2022

2023

2024

2025

Reason for Referral to Care for the Caregiver Staff Concern 22%

Patient Trauma/Harm 7%

Other 4%

In 2025, ChristianaCare was named a Wellbeing First Champion by ALL IN: Wellbeing First for Healthcare, a distinction that recognizes that credentialing applications are free from intrusive and stigmatizing language around mental health care and treatment.

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Patient Code/death 25%

Medication/ Medical Error 2% Staff Death 2%

Workplace Violence 38%

Requests for Care for the Caregiver have increased substantially since the program's inception. In 2025, there were almost 500 requests for peer support for either oneself or a colleague.

Supervisor requests for peer support on behalf of a colleague accounted for 60% of referrals in 2025.

Zero Harm: Caregiver Injury

Initiatives prioritize caregiver safety, aim to reduce injuries Ensuring caregiver safety is a critical priority. ChristianaCare’s OSHA recordable injuries have increased from 348 to 374 (7.5%)

OSHA Recordable Injuries Lost Time

for the same period (July-February) from FY25 to FY26. The recordable rate increased from 4.6 to 4.9.

Medical treatment

Working restricted

Recordable Injury Rate

400

6 374

350

Inpatient nurses had the most injuries (23%) in FY26.

Needlesticks/sharps were the most common cause of recordable injuries, often linked to improper activation of safety features. We are now implementing initiatives including:

348 300

4.9

5

4.6

needlesticks/sharps injuries occur and steps to mitigate risk.

• Safe sharps handling education that provides manufacturerrecommended practices for handling devices used throughout the health system.

• Efforts to standardize the hypodermic needles used throughout the system and replace the snap-style safety caps with slide-style safety caps, which are more effective at

250

200

3

150 2 100 1

50

reducing injuries.

0

0 FY25

FY26

OSHA recordable injuries increased 7.5% FY26 YTD. The greatest increase was in injuries requiring medical treatment, which rose by more than 19%.

22

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Recordable Injury Rate

• Communications to raise awareness about how

Number of Caregiver Injuries

4

Zero Harm: Caregiver Injury Initiatives prioritize caregiver safety, aim to reduce injuries During the same period, we saw roughly a 15% drop in recordable patient-handling injuries, which can be attributed to

Type of Injury 180

training, education and enhanced adherence to safe patienthandling best practices for caregivers, such as:

Environment, Equipment, Posture, Safety (PEEPS) safe patient handling team.

• Implementation of new interactive online web-eds.

Number of Injuries

• Increased hands-on class offerings from the Patient,

160 140 120

100 80

• More unit-based focused educator presence, support and mentoring, along with unit leadership oversight to ensure that caregivers complete safe patient handling training requirements and adhere to best practices, policies and procedures.

• An increased budget for slings, resulting in fewer shortages.

60 40

20 0

FY25

FY26

Needlestick/sharps account for most recordable injuries and increased by 19% from FY25 to FY26. Patient-handling injuries decreased by almost 15%.

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Zero Harm: Workplace Violence

Workplace civility initiatives enacted in response to rising violence

violence alerts logged in FY26 through May 31 Mar-26

Jan-26

Nov-25

Sep-25

Jul-25

May-25

Mar-25

0.0

Jan-25

• Expanded support for Clinical Safety Nurse Coordinators. In a pilot on select

330 Nov-24

in ChristianaCare's four emergency departments. From January 1 through May 20, 2026, a total of 20,003 screenings led to the confiscation of 753 items.

1.0

Sep-24

• Enhanced non-ambulatory patient and visitor weapons screening

Violence alerts protect caregivers

Jul-24

workplaceviolence, with outreach to 211 caregivers in FY26.

2.0

May-24

• A Public Safety Investigator to support caregivers affected by

Mar-24

eventsand risk in the community using publicly available data.

3.0

Jan-24

• A real-time AI platform called Dataminr that detects early signals of

4.0

Nov-23

• Clinical Management Optimization through safety and clinical care planning.

5.0

Sep-23

Increased visibility of the Patient and Visitor Code of Conduct.

6.0

Jul-23

•

Systemwide Physical Assault Rate Physical assaults per 200,000 worked hours

ChristianaCare has been taking bold steps to combat workplace violence and ensure a safer environment for caregivers. Led by the Systemwide Interprofessional Workplace Civility Steer, key interventions include:

Workplace violence is an act or threat occurring at the workplace and can include: verbal, nonverbal, written or physical aggression; threatening, intimidating, harassing, discriminatory or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients or visitors.

Newark units, physical assaults decreased by 22% compared to baseline.

• Doll Therapy and patient diversional resources and guides.

• Ongoing monitoring of self-reported workplace violence events through a near real-time dashboard that tracks the type of violence and role of individual committing the violence (patient, visitor, caregiver, other person) to identify opportunities for interventions.

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The rate of physical assaults reported by caregivers was relatively flat from FY24 through March FY26. However, the rate of increase in physical assaults reported by caregivers improved from 39% in FY24 to just 3% through March FY26 following the implementation of numerous interventions.

We developed a standardized process to alert caregivers when a patient or visitor has a history of violent or aggressive behavior through documentation in the electronic medical record.

These violence alerts went live in all inpatient, emergency department and ambulatory office practices in March 2025, providing caregivers with early warnings to implement safety precautions and strategies when caring for these patients.

Zero Harm: Workplace Violence

SMART solutions empower ambulatory care teams to handle aggressive patients I am knowledgeable about resources and procedures to keep caregivers safe from aggressive patients or visitors.

From 2021-2025, voluntary workplace violence reporting increased by 636% in our ambulatory offices. A gap analysis revealed opportunities to build an infrastructure of centralized public safety resources, increase follow-up after workplace violence events and create standardized workflows to help caregivers gain confidence in their ability to manage patients and visitors behaving aggressively.

The SMARTeam analyzed 136 ambulatory workplace violence reports and directly engaged with 54.3% of ambulatory caregivers involved in workplace violence incidents following analysis of event reports from February to August 2025 – exceeding the initial goal of 10%.

• ALICE, a national civilian active shooter response training program, has been implemented for all caregivers in Medical Group ambulatory practices.

• The System-Wide Civility Steer is working to replicate components of the SMARTeam systemwide.

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80%

% of responses

An exhaustive literature search revealed limited interventions specific to the ambulatory setting, despite increasing incidents of workplace violence in healthcare. We created the Strategic Management Ambulatory Response Team (SMARTeam), an innovative model that expands upon the practice of applying an interdisciplinary assessment to emerging workplace violence situations, using evidence-based interventions.

100%

60%

40%

20%

0% PRIOR to the SMARTeam visit Strongly Agree

Agree

Neutral

AFTER the SMARTeam visit Disagree

Strongly Disagree

Following SMARTeam visits to caregivers' offices or meetings, the percentage of caregivers surveyed who either agreed or strongly agreed that they are knowledgeable about workplace violence resources and procedures increased from 36% to 76%. In addition, 86% of caregivers surveyed agreed or strongly agreed that they know how to report workplace violence events including threats, harassment and verbal abuse.

Zero Harm: Workplace Violence

Protecting caregivers from bed bugs

HomeHealth strengthens workplace violence response, debrief process • ChristianaCare HomeHealth implemented a

HomeHealth WPV Event Response

structured workplace violence debrief process

20

to strengthen event response. Follow-up completion improved to 100% of reported

100%

100%

92% 18 82%

workplace violence events in FY26 year-todate, strengthening accountability and organizational response.

79%

16

80%

• Workplace violence reporting remained stable after implementation of structured debriefs, suggesting continued caregiver willingness to

report events and a psychologically safe reporting environment.

WPV Reports (#)

14 12

60%

10 8

40%

6

20%

2

0%

0%

FY24 YTD

FY25 YTD WPV Reports

Follow-up Completion

FY26 YTD Debrief Utilization

HomeHealth increased structured post-event debrief utilization from 17% to 79% and improved event follow-up completion from 92% to 100% from FY25 to FY26.

26

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• Bed bug-related injuries were

reduced to 0.0 by August 2025.

• PPE was reduced from five

23%

4

0

Bed bugs are an occupational hazard for caregivers who deliver care in patients’ residences. At ChristianaCare HomeHealth, an OSHA-recordable injury rate of 0.0 for bed bug-related injuries was maintained from January 2021–January 2024. However, in 2024, four bed bug-related injuries occurred, including two OSHA-recordable injuries. A team of HomeHealth caregivers initiated quarterly education for best practices and a pilot of new bed bug personal protective equipment (PPE), gathering feedback on fit, usability and efficiency. Then, they distributed the upgraded PPE, which includes a hooded coverall suit with attached foot coverings, statewide. Outcomes included:

separate items to two. Per-use PPE costs decreased from $3.29 preintervention to $2.38 postintervention (a 28% reduction).

• The time to don PPE decreased

from 225 seconds pre-intervention to 90 seconds post-intervention (a 60% reduction).

• HomeHealth caregivers reported feeling more protected and supported.

Zero Harm: Culture of Safety

ChristianaCare strengthens safety culture with measurable improvements ChristianaCare assesses its progress toward high reliability and a strong safety culture every two years through the Hospital Survey on Patient Safety Culture and the Medical Office Survey on Patient Safety Culture. Both tools are validated by the Agency for Healthcare Research and Quality. To address opportunities for improvement, we are implementing strategies such as:

• An evidence-based teamwork and communication strategy.

• Local culture-building activities.

• A standardized practice area improvement model that includes all caregivers.

• A new safety curriculum, tools and resources.

• Executive Leader Rounds (see page 36).

• An interdisciplinary team to review and analyze workplace violence events.

• Workplace violence training resources for medical office caregivers.

• A “Pathway to Safe Care” that supports medical office leaders to take steps to align patients’ behavior with the Code of Conduct.

• Efforts to increase caregiver awareness of workplace violence resources.

• Safety risk assessments within medical offices.

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Zero Harm: High Reliability and Diagnostic Excellence​

Efforts launched to boost reliability, diagnostic excellence​ A roadmap for maximizing reliability​

Implementing diagnostic excellence across systems​

ChristianaCare is on a journey to become a high-reliability organization.

The goal: maintains zero harm through a robust safety culture fueled by proactive patient safety practices and standardized processes.

Diagnostic errors are a major contributor to patient harm in healthcare facilities nationwide. As part of a national study on diagnostic safety sponsored by the Agency for Healthcare Research and Quality and the RAND Corporation, a multidisciplinary team at ChristianaCare is creating and implementing a standardized process to identify, review and respond to patient safety events involving diagnostics safety across all three campuses by spring 2027.

We are now planning an assessment to evaluate existing structures, processes, culture and performance related to quality and safety across the system. Findings will help identify strengths to build upon, gaps requiring focused attention and opportunities to standardize best practices. The results will inform a clear, prioritized roadmap for implementation, ensuring that the transition to high reliability is datadriven, inclusive of frontline perspectives and aligned with the organization’s strategic goals for safe, reliable and equitable care.

The assessment is targeted for summer 2026.

The team is assessing organizational readiness, developing a roadmap to measure diagnostic safety, identifying and learning from diagnostic safety events and creating tools to translate findings into improved clinical practice.

During the pilot phase, the team is using a validated screening tool (SaferDx) to review the care of patients with a discharge diagnosis of acute mesenteric ischemia, a serious condition marked by a sudden loss

of intestinal blood flow, and identify opportunities along the diagnostic pathway. Reviewers have selected 104 out of 207 cases for additional review and used the SaferDx tool on 31 cases, confirming the diagnoses of acute mesenteric ischemia and analyzing for diagnostic opportunities.

The goal is to expand and collaborate across clinical disciplines and diagnoses.

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Elevating the caregiver voice The Get Rid of Waste (GROW) program, launched by the Center for WorkLife Wellbeing as a pilot for surgical Advanced Practice Clinicians, empowers front-line teams to shape a more efficient work environment.

Caregivers share barriers that affect their work so departments can address inefficiencies with caregiver-informed solutions. Submissions are reviewed and advanced by trained champions and leaders, promoting shared decision-making and timely problemsolving.

Two teams of four champions are using GROW (Surgical and Cardiac Advanced Practice Clinicians) and two teams of four champions are joining GROW (Outpatient Psychiatry Advanced Practice Clinicians and ChristianaCare Hospitalist Partners).

6

completed

5

5

in progress

pending the Epic move

submissions

Zero Harm Awards

Honoring excellence in patient safety on the journey to Zero Harm ChristianaCare’s Zero Harm Awards recognize hospital patient care units, HomeHealth teams across Delaware, Perioperative Services departments and ambulatory practices that have maintained zero cases of preventable harm in one of nine harm categories for at least 12 months. From July 2025 through

March 2026, 123 awards were given, including two awards for 12 years (144 months) with zero harm.

CECIL COUNTY CAMPUS

CLABSI 24 months 12 months

ICU SSU, MSU PCU

132 months 84 months 72 months 36 months 24 months 12 months

SSU ICU MSU

C. difficile 60 months 24 months

29

|

TSU TNU 5B, C6MS 3C, CEAD 4E, NCCU, 3A, NICU, 4B, BMT, 5C

BMT TNU CEAD 3C, 5D 2C, 4C, TMU, 6B, SCCC, NCCU 3B, 5C, 5A, C6MS, 7E

MRSA

CDU MSU

QUALITY & SA FETY REPORT FY26

CLABSI

72 months 48 months 12 months

CAUTI

MRSA 84 months 48 months 12 months

C. difficile

96 months 72 months 36 months 24 months 12 months

MSU SSU, ICU, PCU

CAUTI 84 months 48 months 12 months,

NE WA RK CA MPUS

108 months 84 months 72 months 60 months 36 months 24 months 12 months

|

ZE RO HAR M

TNU BMT CEAD 6A, C6MS 4B, 7E, 5A, 4E 4D, 6B, 2C 5E, 3B, TSU, 5C

All Falls

12 months

CEAD C6MS SCCC, 3B, 7E, TNU PCM, TSU

Zero Harm Awards

Honoring excellence in patient safety on the journey to Zero Harm WIL MIN GTON CAM PUS

24 months

CLABSI 132 months

7S

72 months 60 months

Rehab (6W) WCCU

24 months 12 months

WICU 4N/5W

A MBULATOR Y PR ACTICES

Hypertension Admissions 24 months 12 months

84 months 60 months

BMT WCCU

48 months 36 months

6S 4N/5W

(primary care & endocrinology)

24 months 12 months

|

PC Linden Hill, PC Kennett PC Hope & Healing, PC Lantana, CP Gateway, PC at Home, PC Woodstown

HOMEHEALTH CLABSI 24 months 12 months

C. difficile

30

PC Westgrove, PC Kennett, PC Riverfront, PC Smyrna, Cardiology Consultants-NJ PC Hope & Healing, PC Springside, CHF CHR 1070

Short-Term Complications of Diabetes Admissions

MRSA 7S

CD Team 1 NC Team 2

CAUTI

72 months

7N

36 months 12 months

4W, 6S, WICU 7S

QUALITY & SA FETY REPORT FY26

CLABSI CAUTI 36 months

(primary care & cardiology practices)

7S 4N/5W 6S WICU WCCU 7N

144 months

WICU

36 months

CAUTI 144 months 132 months 108 months 84 months 60 months 24 months

HOSPITAL CARE AT HOME

All Falls

24 months 12 months

|

ZE RO HAR M

NC Team 4 CD Team 3, NC Team 5, CD Team 1, NC Team 8

MRSA 36 months

C. difficile 36 months

PER IOPERA TIV E S ER VICE S Surgical Errors 60 months 36 months 24 months 12 months

GI Lab-WH, PACU-WH Endoscopy-Union, Interventional Radiology-Union, Wound Center-Union, OR-Union, Wound Care Center HVIS PACU-CH

Zero Heroes

Zero Hero Awards

January 2025 Julie Ing, Pharmacist, and Katie Jackson, Pharmacist Good Catch: An IV chemo drug was erroneously renewed for seven days due to a PowerChart issue with “hard stop” orders.

Outcome: A stop rule was implemented in PharmNet to warn pharmacists of incorrect renewals to prevent

Recognizing Caregivers For Preventing Harm At ChristianaCare, safety is a team effort. The Zero Hero Award recognition program supports caregiver reporting of good catches. A “good catch” may be an unsafe condition that increases the risk of patient or caregiver harm or a near miss where a safety issue was recognized and resolved, preventing harm from reaching the patient or caregiver.

|

February 2025

Ania Castagna, Radiology Section Supervisor, and Tarrant Bonds, CT Scan Technologist Good Catch: A patient presented for a CT of the lower extremity with contrast. In the PowerChart printout of the order, only 19 of the patient’s 21 allergies were listed. The patient was prepped for the procedure,

brought in for the scan and asked if they had ever had contrast and experienced symptoms. The patient disclosed a history of an allergy that caused their throat to close. The technologist immediately stopped, exited the room to check the paperwork and noticed no allergy listed. Then, they went into PowerChart and saw the allergy at the end of the list. The attending was contacted, and the procedure was changed to a CT without contrast.

Outcome: This incident led to a character limit increase for requisitions in radiology and other departments, effective February 13, 2025.

Each month, a Zero Hero awardee is selected from good

February 2025

catches reported through the Report2Learn event reporting platform that resulted in essential system improvements.

Liz Nappi, RN

The awardee is nominated by the Zero Harm Council. The caregiver who receives the Zero Hero award is recognized and highlighted through internal communication platforms, including Bravo recognition. All monthly awardees are eligible for the annual Zero Hero Award, which is presented at the annual ChristianaCare Way Awards ceremony.

31

mixing chemotherapy and reduce the potential for patient harm. An electronic solution now prevents renewal messages from being sent to clinicians’ inboxes.

QUALITY & SA FETY REPORT 2 F Y0 22 66

|| Z Z EE R RO O H HA AR RM M

Good Catch: A patient without IV access and a critically low blood glucose level required intramuscular Glucagon. The awardee discovered that intramuscular Glucagon is not available in AcuDose outside the ICU. Outcome: This issue was escalated to the Wilmington Huddle and System Huddle to consider the systemwide impact of intramuscular glucagon being unavailable in AcuDose outside of the ICU for patients with hypoglycemia and without IV access. Glucagon has been added to all the Omnicell cabinets.

Zero Heroes March 2025

June 2025

Jessica Coppola RN and Denise Simpers, RN

Jo Bessman, RN

Good Catch: While setting up for an operative procedure, the circulating nurse went to the AcuDose to retrieve Monsel’s solution and found it empty. Pharmacy informed staff that the

Good Catch: The sliding scale for insulin has been removed from the handheld Spectralink devices under medication administration. It was previously available under additional

medication was out of stock and backordered. Tranexamic Acid was suggested as an alternative; however, the physician was not comfortable with this option.

comments. To verify the ranges to determine the correct dose, the nurse had to write down the scale or leave the room to consult a computer.

Outcome: The inventory was missed because the drug was not from our main distributor.

Pharmacy ordered it and implemented an inventory process to avoid this outcome in the future.

Outcome: The issue was escalated to IT and Oracle Cerner. Oracle investigated a cloud update released in April 2025 and is assessing an application code issue. Work is ongoing to determine the root cause and find a solution.

April 2025 Emily Ray, PharmD

July 2025

Good Catch: An etomidate vial was found open and empty in an intubation kit when preparing a patient for intubation.

Jennifer Mulford, RN, and Kristen Connell, RN

Outcome: Pharmacy initiated a process to ensure that the kit is verified and sealed by a pharmacist for final review. Pharmacists, nurse managers and the ICU team on the Cecil Campus

received education about proper disposal of open or used vials in sharps containers to ensure that they don’t re-enter circulation.

Good Catch: Medication scanners were not connecting to the server, despite refreshing and restarting the app, resulting in an inability to scan medications.

Outcome: The issue was escalated to IT. The cause was identified as an Oracle Health multi-client outage and a network change. The network change was reverted, which corrected the issue.

August 2025

May 2025 Judi Smith, CFE, Director of Operations, Ambulatory Specialty Network Good Catch: Lynx Messenger was deployed in the Preventive Medicine and Rehabilitation Institute Lab in 2023. During deployment to the remaining practices and services, Public Safety tested one of the lab’s workstations and found that Lynx Messenger was not on the desktop. The

cause: The desktop had been refreshed since the original deployment in 2023. The keyboard was still marked with the panic stickers, but no alert would have been sent if the keys were pressed.

Caregivers in the lab were unaware that the new desktop did not have Lynx Messenger on it.

Outcome: Ambulatory Workplace Safety and Civility leadership consulted with IT and Security to resolve this issue.

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Lisa Carr, Clinical Engineering Supervisor, and Samantha Greenlaw, MSN, Nursing Manager Good Catch: Issues were reported with med scanner connections, telemetry packs connecting to the CNS, WOW connections and telemonitors with an "out of area" alarm. Cardiovascular Nursing reported that equipment was dropping off network, and EKGs and carts were not transmitting.

Outcome: Calls were placed to IT and Clinical Engineering to assess the situation. The "out of area" alert indicates the monitor is not connecting to the network. The cause was determined to be a WiFi access issue, and an additional access point was added. The telepack WiFi signal was

not strong enough to keep them connected, so another access point was added to the room. For Cardiovascular Nursing, access points were rebooted.

Zero Heroes September 2025

November 2025

Elizabeth Allen, RT

Anna-Marie Woodham-Auden, M.D.

Good Catch: While on back-to-back transports and waiting for a new patient, a circuit test on the Tv-100 kept failing. Respiratory Therapy was contacted to confirm proper setup and assess

Good Catch: When attempting to place an order for an RSV vaccine for an infant, only the adult vaccine came up in the system. RSV NICU Nirsevimab should be an option, especially for

reasons for failure. After ensuring all pieces were in place and tight, the circuit still did not pass.

Another circuit was tried, and the heater was changed three times, but the ventilator still failed the test. After multiple equipment changes and troubleshooting, the team contacted the transport center for a new transporter to arrive at BayHealth.

residents who are not familiar with the system.

Outcome: The Transfer Center sent another Prehospital Services crew with a back-up NICU transporter to the scene. The original incubator with the ventilator was returned to the NICU for

November 2025

evaluation, which determined that the ventilator had undergone a software update that caused the circuit failure. The device company and Clinical Engineering removed the update and installed the previous version.

Good Catch: While scanning morning medications, the scanner shut off despite a full battery.

Outcome: We identified that we were out of support on the Android operating system on the

Kimberly Zirpolo, PCT Good Catch: A 12-hour sitter was assigned to a COVID-positive patient on medication for COVID. There was no hand sanitizer in the room. There was a sink and towel dispenser on the wall in the

December 2025 Ashley Coxe, Pharmacy Tech

patient room, but no soap dispenser. The nearest hand sanitizer was outside the room, and the sitter could not leave the room without a nurse’s permission or coverage.

Good Catch: Medication packaged by the logistics center did not have a scannable barcode for inpatient operations.

Outcome: Infection Prevention performed an immediate evaluation. Unit leadership placed a

Outcome: The pill pick machine was not correctly printing the barcodes. Pharmacy located the problem and resolved it, removing all medications without clear bar codes for repackaging.

work order for installation of hand soap and sanitizer dispensers.

|

Jackie Trickey, RN

devices. We upgraded the devices to the latest version of the operating system to minimize crashes and reduce the impact to patient care.

October 2025

33

Outcome: 'RSV antibody' was added to the order catalog synonym name to account for a provider searching for RSV instead of the medication name. An age-based filter was applied to the order sentences: "Nirsevimab is not indicated for patients over 24 months of age".

QUALITY & SA FETY REPORT FY26

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Patient Experience Engage all caregivers to serve our patients with love and excellence, providing an ideal experience across the

continuum of care.

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PATIEN T EX PERIE NC E

My why “I tell everyone that I have the best job in the world because I believe in creating a safer health care environment with every fiber of my being.

I love working behind the scenes to ensure patient safety, a foundational component of patient experience. My team is like an invisible force that helps our frontline caregivers take care of patients. We aim to prevent complications so that patients and families can focus on healing.”

Tara Woodside, DNP, RN, CPHQ, Patient Safety & Accreditation Manager

Patient Experience: The Way We Care

Establishing The Way in human-centered care In FY 25, ChristianaCare reimagined our Patient Experience framework with the launch of The Way We Care.

In FY26, we homed in on 10 critical elements to implement The Way We Care:

• making improving the patient experience a strategic priority • defining patient experience • developing a narrative and ensuring leaders use it • communicating the narrative system-wide

• forming a cross-functional team to lead the strategy

The Way We ​Care Service Standards ChristianaCare's service standards — The Way (Take the time, Help with heart, Explain what to expect, Welcome warmly, Accept responsibility, You make a difference) — reflect actionable and observable behaviors.

• developing a focused, dynamic data strategy • defining behaviors and linking them to the definition and narrative

• integrating patient experience efforts into strategic talent management • implementing new best practices We're implementing tactics such as a Patient Experience Playbook to help caregivers understand our service standards, monthly screensavers highlighting service standards, phone etiquette skills training and recognition for excellence in The Way We Care.

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PATIEN T EX PERIE NC E

These standards guide how patients and families are treated, emphasizing consistency, respect and compassion.

Patient Experience: Executive Leadership Rounds, The Way We Care Awards

Celebrating caregivers who help with heart The Way We Care Awards spotlight dedication to exceptional patient experiences. For providing experiences that drew such high praise from patients and their loved ones, 58 caregivers received

recognition at The Way We Care Awards 2026 on April 15.

• Values and Behaviors

• Worked Together to Meet Needs

Jalisa Simpson, Joy May, Morgan Roberts, John Kime, Phillp Scott, Donna Draper, Michele Brown, Nichelle Belton, Katie Gottstein and Michael Latsch.

• Doctor Communication

Taylor Cave, Malyne Saint Pierre, John Cheng, Roger Liu, Rachel Cortese, Mariah Reinmiller, Kayla Brown-Nance, Douglas Rowe, Alison Neidlein, Rick Zock, Heather Moser, Kate Sisler, Lesa Anderson and Margaret DeMaris.

• THE WAY Service Standards

Blake Griffitts, Erik Marshall, Gregory Halla, Michelle Kelly, Jessica Tansey, Janice Tildon-

Burton, Matthew Burday, Carlos Reyes, Neelambari Kerkar, Jessica Bradley, Cheng Zhou and Jeffry Zern.

• Nurse Communication

Kellie Kessler, Vera Naumova, Brandi Johnson, Rebecca Wooters, Kevin Canady and Kevin Scheler.

• Excellence Demonstrating Nurse Bundle Tiffany Douglas

Madison Reese, Brianna Castagna, Robin

• THE WAY Service Standards Overall

Brayerton, Jordan Chesley, Jessia Kaufmann, Christopher Horne and Michelle Evans.

Lauren Absher

• Responsiveness of Hospital Staff Abdul Bangura, Gabrielle DeVeglio, Azalia Schultheis, Diamond DuPree, Augustin Dauphin,

Jenna Tigue and John Savage.

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PATIEN T EX PERIE NC E

Executive Leadership Rounds model The Way We ​Care In January 2026, ChristianaCare established Executive Leadership Rounds to support patients and caregivers.​ Patient rounding welcomes patients, builds rapport and trust, assesses satisfaction with care and recognizes staff. Caregiver rounding nurtures trust and psychological safety, increases visibility of senior leadership, recognizes caregivers’ contributions and offers opportunities to share ideas. Executives can help escalate and resolve important issues as needed and communicate feedback with local leaders and caregivers. ​ Executive leaders round at least twice per month for 45 to 60 minutes, visiting multiple areas annually. Through April 2026, 29 executives made rounds at the Newark campus, 15 in medical practices, 14 at the Wilmington campus, nine at the Cecil County campus and eight in procedural platforms.

Patient Experience: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey

HCAHPS Overall

Focus on key drivers leads to improvements in perceptions of care

We identified key drivers, survey questions strongly associated with overall performance, as focus areas of improvement for FY26: communication with

Target

80%

Positive Response (%)

The HCAHPS survey offers critical insight into how patients perceive our care and their experience with us.

Jul25-March26

60%

Although there was incremental improvement in each of the three key driver domains, none met target.

Communication with nurses had the largest improvement; help toileting is the top opportunity.

40%

20%

nurses, communication with doctors and help with toileting. The Wilmington campus exceeded targets in all three domains. The Cecil County campus exceeded targets for communication with nurses and doctors. Opportunities remain to improve systemwide.

0% Communication-Doctors Communication-Nurses

Help Toileting

Campus HCAHPS Communication-Doctors

Evidence-based best practices aligned with The Way were implemented across the system to help drive improvement for each survey question and included teach-back, nurse leader rounding, bedside shift report and purposeful hourly

90%

rounding. Campus-specific councils were convened to examine and improve processes, services and communication methods across care settings to improve patient experiences, build loyalty, attract new patients and improve overall outcomes.

70%

Communication-Nurses

Help Toileting

Positive Response (%)

80%

60% 50% 40% 30%

20% 10% 0% Newark

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QUALITY & SA FETY REPORT FY26

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PATIEN T EX PERIE NC E

Wilmington

Cecil County

Through March 2026, Wilmington campus exceeded target in all three domains, with help toileting 4.4 percentage points above target. Cecil County exceeded targets for Doctor and Nurse Communication by over 1 percentage point.

Patient Experience: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey Positive Response (%)

Unit-level initiatives drive progress toward areas of improvement

PPeP Units: Communication with Doctors

• Improving the quality and consistency of bedside shift reports.

60% 40%

20% 0%

C5A

Interventions drove improvements in units’ performance across the three key domains. The largest increases were in Help Toileting, with an average of six percentage points above targets, and Communication with Nurses, five points above target on average.

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QUALITY & SA FETY REPORT FY26

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PATIEN T EX PERIE NC E

UPCU

Target

80% 60%

40% 20% 0% C5A

C5E FY26 YTD

W4N/5W

W4W

UPCU

Target

PPeP Units: Responsiveness (Help Toileting) Positive Response (%)

medication side effects and teach-back initiatives.

W4W

100%

C4B

• Rounding focused on organizing bedside areas and ensuring bathroom cleanliness.

• Improvement in medication education, including huddle and staff meeting education,

W4N/5W

PPeP Units: Communication with Nurses

• Collecting patient questions and concerns before multidisciplinary rounds.

• Quality checks and communication tools to document cleaning activity.

C5E FY26 YTD

Positive Response (%)

• Flow charts to help unit staff understand expectations shared by ancillary departments.

80%

C4B

Patient care units on each campus were identified for intense focus by the patient experience team based on FY25 percentile rankings and patient volume. The PX Performance Excellence Program (PPeP) unit leaders and caregivers worked closely with the patient experience team to review data, identify opportunities and implement interventions such as:

• Cross-team collaboration to improve flow, role clarity and communication.

100%

80% 70% 60% 50% 40% 30% 20% 10% 0% C4B

C5A

C5E

FY26 YTD

W4N/5W

Target

W4W

UPCU

Patient Experience: Emergency Medicine

Delivering timely care

Emergency Departments 70

In FY26, the Emergency Medicine service line focused on caregiver teamwork and communication, consistent and standard nurse bundle

65.3

63.2

64.6

60

55.9

57.4

50

Positive Response (%)

execution, partnering with environmental services, food and nutrition services and patient escort to strengthen relationships and improve performance, and implementing The Way service standards. Initial action plans included NPO Policy, Whiteboards, Teach-back, Commit to Sit and Capacity/Throughput.

64.5

Leaders identified operational drivers of patient experience across the four Emergency Department sites, linking site-specific improvements to key measures of throughput:

40

36.1

The Emergency Departments improved by an average of 1.5 percentage points in all domains from the first quarter of FY26 (baseline). The greatest improvement was in Arrival scores.

38.3

30 20 10 0 Arrival

Nurses

Doctors

FY26 Jul-Sep

Overall Assessment

FY26 Oct-Apr

• Provider-in-Triage (PIT): This care delivery model at Christiana and Wilmington hospitals was designed to decrease door-toprovider times and reduce left-without-being-seen rates.

Freestanding Emergency Department, physicians can meet patients virtually upon check-in to prepare for immediate needs, reducing emergency room wait times. This service is now available on a volunteer basis. Scheduling will begin in the next fiscal year.

• Core processes updates: Core processes were modified in two Christiana cores, and Middletown core B was extended to reduce Emergency Department length of stay and boarding.

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PATIEN T EX PERIE NC E

80 70

Positive Response (%)

• Tele-triage: Now in a pilot at Union Hospital and the Middletown

Performance by ED

60 50 40 30

20 10 0 Christiana

Union

Arrival

Wilmington

Nurses

Doctors

Middletown

For the Nurses and Doctors domain, relatively high scores indicate strong clinical quality.

Low Arrival scores for the three hospital-based Emergency Departments are consistent with front-end throughput opportunity; Middletown's higher Arrival shows stronger throughput.

My why

Quality

“As a clinical nurse specialist, I view everything from three spheres of impact: patient, nurse and healthcare system. Everything we do shapes the future for our patients and the communities we serve.

Drive health outcomes as a national leader in clinical excellence through continuous improvement in

effectiveness, timeliness and efficiency of care provision.

I have a responsibility, a voice and a platform to do what's best for our patients. For me, that means approaching my work with thoughtfulness, intention and foresight.

To continuously improve care quality, we have to think ahead and learn from each other every step of the way.”

Michael Szeliga, MSN, APRN, AGCNS-BC, CMSRN, CPHQ, FCNS, Lead Clinical Nurse Specialist, Newark Campus, Acute Care & Women's & Children's

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Quality: Overall Hospital Quality Star Rating

CMS also operates three value-based (pay-for-performance) programs — the Hospital Readmission Reduction Program, which reduces payments for excessive readmissions; the Hospital-Acquired Conditions Reduction (HAC) program, which penalizes hospitals with high rates of preventable infections and safety events; and Value-Based Purchasing (VBP), which rewards hospitals for quality and efficiency. (Maryland has its own program and is exempt from these three — see page 42.) No penalties were assessed for the HAC program. Minor penalties were assessed under HRRP (0.01% pay reduction) and VBP (0.46% pay reduction).

Readmission Rate

Excess Readmission Ratio

20.0%

1.2

18.0% 1.0

16.0% 14.0%

0.8

12.0% 10.0%

0.6

8.0%

ERR (1 = expected)

30-Day Readmission Rate

The Centers for Medicare and Medicaid Services (CMS) Overall Hospital Quality Star Rating evaluates hospital performance across five key domains: mortality, safety of care, readmission, patient experience and timely and effective care. In 2026, our Christiana and Wilmington hospitals maintained their strong 4-star rating. Union Hospital improved from a 3-star rating to a 4-star rating.

4.0%

0.2

2.0% 0.0%

0.0 AMI

COPD

HF

Pneumonia

CABG

THA/TKA

Hospital Acquired Conditions Measure Result [b]

National Mean

1.2 1.0 0.8

ChristianaCare's performance was better than the national mean in three of the six measures.

0.6 0.4 0.2 0.0 CMS PSI 90

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QUALITY

Readmission rates in our Delaware hospitals were better than expected across five populations.

0.4

6.0%

Score

ChristianaCare achieves key quality milestones in CMS ratings

Readmission Rates

CLABSI

CAUTI

Surgical Site Infections

MRSA bacteremia

C.difficile

Quality: Maryland Health Services Cost Review Commission

Cecil County campus earns top Maryland Hospital Acquired Conditions Score Hospital Acquired Conditions Score 120.0%

100%

100.0%

86%

80.0% Score

In FY24, ChristianaCare’s Union Hospital incurred a 0.83% financial penalty under the Maryland Hospital-acquired Conditions (MHAC) program due to incidences of preventable complications. In response, the hospital implemented measures, including provider education and collaborative case reviews, which have reduced complications and improved MHAC scores. The hospital far exceeded its goal to improve or maintain its MHAC score at or above 60%. In CY2025, Union Hospital ranked first in the state of Maryland with an MHAC score of 100%.

60.0% 40.0%

By reducing potentially preventable complications in 2025, Union Hospital increased the HAC score to 100% from 35%, exceeding the goal for the performance period, ranking first in the state of Maryland and qualifying for a financial reward.

60% 35%

20.0%

0.0% CY 2023

CY 2024

CY 2025

100.00% 98.00%

Benchmark, 97.37%

96.00%

Threshold, 95.55%

94.00%

Base Period, 95.11%

92.00% 90.00%

97.23% Survival CY2025

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QUALITY

Goal

Inpatient Survival

% of Discharges

In addition, over the last four years, Union Hospital has consistently improved its survival rates as measured by Maryland’s Quality-Based Reimbursement (QBR) program. The mortality measure includes risk-adjusted survival rates for patients with targeted conditions such as heart failure and pneumonia. Through collaborative chart reviews with a focus on prioritizing diagnoses and an improved mortality review process aligned with the health system, Union Hospital exceeded its CY2025 goal (an adjusted survival rate at or above 95.55%) by reaching 97.23%.

Survival improved by over 2% from the base period, exceeding the threshold goal and approaching benchmark (top 5%), earning Cecil County 9 out of 10 points in the Quality-Based Reimbursement program.

Quality: Ambulatory Diabetes Care Standards

Multidisciplinary approaches improve care for patients with Type 2 diabetes Diabetes Standards of Care

Type 2 diabetes remains a leading cause of morbidity and mortality in the United States. ChristianaCare is committed to following data and best practices and coordinating efforts across departments to help patients with Type 2 diabetes manage blood glucose and reduce the risk of complications. Key interventions include:

patients scheduled for the upcoming week.

• Improving hemoglobin A1c monitoring: We increased point-of-care testing to maintain a closer view of blood sugar control.

• Proactive scheduling: We book appointments for patients to return to the office for chronic disease management no less than every six months.

Percent of Patients with Diabetes

• Identifying care gaps: Deploying a trigger tool to help caregivers address gaps in care needs for

100.0%

80.0%

60.0%

40.0%

20.0%

• Increasing use of Intelligent Retinal Imaging Systems (IRIS): This software screening tool integrates eye exams into routine visits to detect diabetic retinopathy, a leading cause of blindness. We are incorporating IRIS into rooming processes and sharing daily eye exam opportunities in our huddles.

0.0% HbA1c Monitoring

Mar-25

HbA1c Control ≤ 9

Mar-26

Retinal Eye Exam

Target

• Increasing outreach across disciplines: Ambulatory practice nurses in Primary Care have implemented ambulatory care-sensitive conditions education visits and outreach calls for hospital follow-up for Type 2 diabetes patients. Pharmacists now meet with patients with

uncontrolled diabetes between primary care visits to optimize medications, provide support and assist with prior authorizations for GLP-1 medications and drug assistance programs for qualifying patients.

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QUALITY

The Core primary care practices, caring for almost 20,000 patients with diabetes, improved all 3 key evidence-based standards of care in 12 months and are exceeding targets in 2 of the 3.

Hemoglobin A1c control increased 2.5%, to 80.7% from 78.8%; annual retinal eye exams improved almost 9%, to 45% from 41%.

Quality: Sepsis Sepsis Bundle Key Early Actions

Sepsis continues to be the leading cause of death in U.S. hospitals. Early recognition and treatment are paramount to decrease mortality. As a result of targeted interventions, ChristianaCare’s sepsis capture rates surpass those of top academic medical centers, as reported by the Agency for Healthcare Research and Quality, indicating early identification of sepsis cases, which is crucial for reducing morbidity and mortality.

Median Time (min)

Sepsis capture rate increases, mortality rate decreases

First Lactate

Blood Culture

Antibiotic

Linear (First Lactate)

Linear (Blood Culture)

Linear (Antibiotic)

Median times to the early lifesaving evidence-based actions improved during 2025. Time from triage to blood culture completion decreased 23%, to 144 from 187 minutes, and time to antibiotic administration decreased almost 15%, to 234 from 274 minutes.

300 250 200 150 100 50 0 2025-Q1

To improve sepsis recognition in systemwide emergency departments in FY26, triage screening criteria and dedicated sepsis workflows were implemented to identify and treat affected patients sooner.

Key improvements included:

2025-Q2

2025-Q3

2025-Q4

Medical Sepsis Mortality Index

• Improvements in median door-to-lactate, door-to-blood culture and door-toantibiotic times.

• The Emergency Department prioritized prehospital sepsis alerts by calling sepsis alerts overhead, with a multidisciplinary team responding to the bedside to expedite sepsis care.

• Sepsis bundle compliance via a modified abstraction process improved in this patient population by 58% compared to the 2025 average.

Mortality Index Better . . . Expected . . . Worse

2.0 1.8 1.6 1.4 1.2 1.0

0.8 0.6 0.4 0.2 0.0

2022 2022 2022 2022 2023 2023 2023 2023 2024 2024 2024 2024 2025 2025 2025 2025 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

ChristianaCare

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QUALITY

All AMC's

Our Mortality Index decreased by 65% between quarter 1 of 2022 and Q4 of 2025, to 0.60 from 1.68. The Index is now consistently below our academic medical center peers. Sepsis mortality decreased 53% from 2022 to 2025, to 7.8% from 15.1%, and is now below our peer rate of 8.3%.

Quality: Sepsis

Cecil County campus improves SEP-1 compliance by enhancing case reviews SEP-1 Bundle Compliance 70.0%

60.0% 58.1% 50.0%

Percent Compliance

The Severe Sepsis and Septic Shock Early Management Bundle, or SEP-1, is a complex CMS composite quality measure that promotes severe sepsis and septic shock treatment guidelines. The hospital set a goal to improve SEP-1 compliance, meeting or exceeding the threshold rate of 59%. By aligning sepsis programs with systemwide resources and reviewing all non-compliant sepsis cases to recognize and act on opportunities for improvement, the hospital improved and nearly reached its target, achieving a compliance rate of 58.12%.

49.5%

50.5%

CY2023

CY2024

40.0%

30.0%

20.0%

10.0%

0.0%

Compliance

Threshold

Union Hospital’s Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) compliance rate rose to 58.12% in CY2025.

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QUALITY

CY2025

Quality: Vizient Quality and Accountability Scorecard

ChristianaCare rises in peer rankings, excels in Mortality, Safety and Variation in Care

ChristianaCare exceeded the medians among academic medical centers overall and in three key areas — mortality, safety and variation in care. Patientcenteredness and effectiveness present our greatest opportunities. We anticipate that interventions to reduce length of stay (see page 56) and the extensive efforts of the Patient Experience subcommittees will have a positive impact on HCAHPS scoring and will drive improved rankings (see page 37).

Rank

Vizient Q&A Rank Trend 100 90 80 70 60 50 40 30 20 10 0

87

83

84 76 66 54

45

45 out of 122 hospitals from 83 of 100 hospitals.

2021

2022

2023

2024

2025

2026*

Q&A Rank among AMC Peers 2020

2026*

120

112

100 80

60

101

96 70

79

82 72

53

51

40

30 12

10

0 Mortality

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QUALITY

comparison to our academic

*2026 period 0, reflecting 2025 data with 2026 methodology

20

46

ChristianaCare's ranking in medical center peers improved to

2020

Rank

In the Vizient Quality and Accountability Scorecard, ChristianaCare's overall ranking among academic medical centers improved to 45 among 122 hospitals, placing us in the top 36%. The scorecard is an annual performance report measuring the quality of inpatient care across six domains: Mortality, Efficiency (length of stay and cost), Safety, Effectiveness (readmissions and excess hospital days), Patient-Centeredness and Variation in Care.

Efficiency

Safety

Effectiveness

Patient Centeredness Variation in Care

Our ranking among 122 academic medical center peers improved in three domains, with Mortality and Safety exceeding our Top 25 goal with ranks of 10 and 12, respectively. The greatest opportunities are Effectiveness (Readmissions/Excess Days) and Patient Centeredness.

Quality: Vizient Quality and Accountability Scorecard ChristianaCare rises in peer rankings, excels in Mortality, Safety and Variation in Care (continued)

One of ChristianaCare’s most notable achievements is our ranking of 12 in the Mortality domain. After receiving a ranking of 72 in 2022, with a mortality index of 0.99, an interdisciplinary team led by Clinical Documentation convened to improve our outcomes.

Efforts included conducting a standardized review of all mortality cases, ensuring clinical documentation integrity to assure appropriate and complete coding for accurate risk adjustment and establishing a process to identify trends in mortality with direct feedback to service lines for possible care delivery opportunities.

The observed-to-risk-adjusted mortality index improved by 36%, to 0.63, and is now significantly below expected.

Another notable achievement is the 10 ranking in the Safety domain, down from 72 in 2020. substantial improvement was seen in PSI 3, Hospital-Acquired Pressure Injuries (see page 14), as well as PSIs 6, 9 and 11 through efforts of the PSI 90 Steer (see page 13).

Mortality Rate

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Expected Mortality

2020

5.00 4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00

2026 YTD

PSI-03 HAPI PSI-09, Postop Hemorrhaage/Hematoma PSI-13, Postop Sepsis CLABSI

SSI-Hysterectomy

Mar-26

Jan-26

Nov-25

Sep-25

Jul-25

May-25

Mar-25

Jan-25

Nov-24

Sep-24

Jul-24

May-24

Mar-24

Jan-24

Nov-23

Sep-23

Jul-23

May-23

Mar-23

Jan-23

Nov-22

Sep-22

Jul-22

May-22

Mar-22

Total Hip/Knee Complications

Jan-22

Percent Mortality

Observed Mortality

Safety Domain Scoring

3

2

1

0 -1 Worse . . . Mean . . . Better

-2

-3

The inpatient mortality rate has improved 20% since 2022, while the

Scores improved in four of the five Patient Safety Indicators; Surgical Site Infections for

expected mortality increased by 26%. Observed mortality is significantly

Abdominal Hysterectomy scored maximum points with zero cases for the year. Surgical site

below expected (p<0.01).

infections for colon procedures is the area of greatest opportunity.

QUALITY & SA FETY REPORT FY26

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QUALITY

Quality: Vizient Quality and Accountability Scorecard ChristianaCare rises in peer rankings, excels in Mortality, Safety and Variation in Care (continued)

Q&A Rank Among Community Hospital Peers

The Cecil County campus received its first Quality & Accountability scorecard in 2025, ranking No. 76 out of 243 peer community hospitals. The campus set an aspirational goal to reach the Top 50. Year-to-date 2026, the overall rank has improved to 68 out of 274 hospitals, placing the campus in the top 25%.

250

235 221 204

200

192 169

Rank

150 122

120 100

76

68

50

38

34 11

4

1

0 Overall

Mortality

Efficiency

Safety 2025

Effectiveness

Patient Centeredness

Variation in Care

2026 YTD

Ranking among 274 community hospital peers improved overall and in three domains, with Mortality, Safety and Variation in Care exceeding the campus's Top 50 goal.

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Quality: Advance Care Planning

Focused efforts increase use of Advance Care Planning

• Establishing Advance Care Planning workflows in the Acute Care for the Elderly unit

Advance Care Planning 50.0%

45.0% 40.0% % patients age 65+

ChristianaCare aims to increase Goals of Care discussions and documentation across all emergency departments and inpatient service lines. The goal is to move from foundational workflows to scalable enterprise capability through early identification, reliable documentation and feedback and infrastructure for scale. Key efforts include:

The percentage of patients aged 65 and older and attributed to our primary care practices has improved 48% since our FY22 baseline period, to 45.1% from 30.5%.

35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0%

• Embedding Advance Care Planning earlier in the primary care

0.0% FY22

continuum, prioritizing frail, high-utilizer patients and highrisk populations

300

on patients with advanced lung disease, heart failure and cancer, where goals of care clarity have the greatest impact

250

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FY25

FY26

200

Palliative care referrals and encounters have increased substantially since FY23.

Annualized volumes for FY26 show a 72% increase, to 2888 from 1682.

150

100 50 0 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26

commonly used Advance Care Planning forms onto one platform, including the updated the Delaware Medical Orders for Scope of Treatment (DMOST) form.

Number of Patients

populations, not delayed until acute deterioration, with a focus

MyDirectives, a statewide Advance Care Planning ecosystem slated to launch in 2027. This system will incorporate many

FY24

Palliative Care Referrals & Encounters

• Extending Advance Care Planning to high-risk specialty

Christiana Care is also highly engaged in implementing

FY23

Quality: Advance Care Planning Focused efforts increase use of Advance Care Planning A statewide Advance Care Planning ecosystem with MyDirectives provides a secure, HIPAA-compliant digital

solution, allowing treatment preferences to be documented and accessed at all points of care through direct integration with electronic medical record platforms, accessibility for emergency medical services through integration with the pre-hospital record and a community-facing platform where patients and families can own their documents. .

Statewide, the anticipated benefits of the Advance Care Planning ecosystem include enhanced care coordination and efficiency, increased goal-concordant and medical orderconcordant care and reduced costs by avoiding burdensome and unwanted interventions near the end of life.

Non-Acute Hospice Referrals 500 450 400 350 300 250 200 150 100 50 0

361 308

Non-Acute Referrals to AccentCare for hospice services have increased 53% since FY 2024, to 470 from 308 (July to March). HomeHealth and Primary Care at Home make over half of referrals.

FY24 YTD HomeHealth

PC At Home

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FY25 YTD Physician Practice

CareVio

FY26 YTD Palliative Care

Oncology

Swank/Neurology

ACP Trigger Actions

ChristianaCare's growing efforts to enhance Advance Care Planning, including the development of disease-specific Advance

Care Planning triggers, are helping clinicians and patients close gaps in advance care planning earlier in the care continuum.

Future efforts will support expansion into additional high-risk specialties and aligning nursing and physician education and care management capacity with plans to scale Advance Care Planning efforts.

470

40 Min Appt, 110, 63%

Follow-Up Scheduled, 29, 16%

Palliative Referral, 3, 2%

Not Met, 33, 19%

81% of ACP triggers resulted in actions being taken, with the majority through a 40-minute scheduled appointment, allowing sufficient time for goals-of-care conversations.

Quality: Readmissions

Helping patients stay healthy after discharge Patient Alignment and Care Transformation (PACT)

Meds to Beds: a healthy handoff​

Increasing hospital readmissions and emergency department returns were straining hospital capacity. In response, we developed the Patient Alignment and Care

Many patients face challenges accessing prescribed medications after hospital discharge because of limited community pharmacy hours, prior authorization

Transformation (PACT) program, which supports patients through structured followup, proactive outreach and improved access to post-discharge resources.

challenges, drug costs and transportation needs.

Program components include:

• Digital check-ins. Patients receive a text message the day after discharge to monitor symptoms, support their needs and identify potential complications early.

• A PACT Discharge Hotline. Patients can call a dedicated hotline to address questions, clarify discharge instructions and access support.

• Proactive Outreach for High-Risk Patients. Patients with high-risk chronic conditions receive follow-up outreach after discharge to ensure medications, appointments and other care needs are addressed.

• Discharge Resource Folders. Each patient receives a packet that organizes instructions and connects them with appropriate resources.

PACT launched with a soft rollout in August 2025. Early data suggest favorable trends toward reducing 7-day emergency department returns. Ongoing monitoring and expanded implementation will provide clearer insights into long-term

outcomes.

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Meds to Beds programs, where medications are delivered to patients’ bedsides before discharge, can reduce 30-day readmission rates. However, enrollment in ChristianaCare’s Meds to Beds program, launched in 2021, remained low due to fragmented enrollment procedures across campuses, limited patient messaging and lack of integration within the electronic medical record.

A multidisciplinary team designed standardized workflows among clinicians, nurses, care managers and Pharmacy with PowerChart integration, which launched in fall 2024. The results:​

• The average monthly number of patients enrolled increased by 116%, to 504 from 233 in the five-month baseline.

• Patients who enrolled in Meds to Beds had a 10% lower read mission rate than those who did not participate.

• Average monthly sales for the ChristianaCare Retail Pharmacy increased by $32,344.

Quality: Pediatric Care Center

Pediatric center achieves strong quality outcomes, extends ChristianaCare’s reach to new patients and families Our 24/7 Pediatric Care Center in Newark offers a calm, family-friendly environment for emergency and short-term inpatient care. Since opening in October 2022, the center has achieved excellent outcomes in patient reach, experience, throughput and care quality:

• Of the nearly 13,000 patients seen emergently during months 19-36 of operation, more than 35% were new to ChristianaCare. The center cared for patients from 549 zip codes, an 83% increase from the first 18 months.

• A Child Life Specialist has provided supportive interventions to more than 570 patients and families.

• More than 50% of pediatric patients who visited the Newark Emergency Department were transferred to the Pediatric Center. 88.5% of pediatric emergency patients seen on the Newark campus were seen at the Pediatric Care Center. Quality outcomes include:

o 95% of patients were discharged home. o 1.47% 72-hour return rate. o 0.21% 72-hour return rate with readmission. o 0.41% left without treatment.

• We are hiring more fellowship-trained pediatric emergency medicine providers to meet patient acuity and volume needs.

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Partnership with Children's Hospital of Philadelphia Expands Local Access to Pediatric Specialized Care In April 2026, we launched a strategic pediatric affiliation with Children’s Hospital of Philadelphia (CHOP), expanding access to world-class specialized care for children across Delaware and the surrounding region. The collaboration integrates CHOP’s specialized services with ChristianaCare’s network, creating new access to advanced pediatric treatments for Delaware families and reducing the need for families to travel long distances for care.

Quality: Opioid Use Disorder

Interventions support growing number of patients presenting with medetomidine withdrawal Opioid Withdrawal Trend Number of Inpatient Discharges

Opioid use disorder continues to be a crisis nationwide, with fentanyl the top cause of opioid overdoses and medetomidine a growing threat. In FY26, ChristianaCare saw a 10-fold increase in admissions for withdrawal from medetomidine, an adulterant. To help patients recover and reduce readmission, ChristianaCare is implementing interventions that have decreased in-hospital overdoses and improved caregiver safety:

250 200 150 100

50 0

• Implementing an inpatient opioid

to aid medetomidine withdrawal, a novel disease process.

• Optimizing ratios of caregivers and educating caregivers about opioid use disorder and withdrawal.

Opioid Withdrawal Length of Stay 7.00

Average Hospital Days (#)

withdrawal order set and order sets for the Emergency Department and step-down units

6.00

5.00 4.00 3.00 2.00 1.00 0.00

• Increasing safety protocols, such as visitor restrictions and patient handouts.

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Inpatient admissions for opioid withdrawal increased with the introduction of medetomidine in the street drug supply in our region.

QUALITY

After implementing an order set for precedex for medetomidine withdrawal, length of stay decreased and continues to improve.

Quality: Antimicrobial Stewardship

Multidisciplinary interventions reduce unnecessary antibiotic use Centers for Disease Control data indicate that outpatient prescriptions for penicillins, cephalosporins, fluoroquinolones and macrolides are increasing in the region, while C. difficile infection rates are rising nationwide. These data underscore the importance of judicious antimicrobial use in acute and ambulatory care. At ChristianaCare, key efforts include:

• Multi-platform education and updated guidelines: o Antimicrobial Stewardship Competency

uncomplicated urinary tract infections. The

o In 2025, we implemented a vancomycin AUC-based dosing

was assigned in in Learning Space to inpatient nursing, pharmacy technicians

emergency department clinical decision support tool was updated to reflect updated

and pharmacists and clinicians to share best practices for antimicrobial stewardship at ChristianaCare, is a Joint Commission and CMS requirement. As of May 22, 2026, the compliance rate is 77%. A second phase is underway.

urinary tract infection definitions.

protocol at two campuses — Wilmington and Cecil County — with Newark scheduled for go-live in September 2026.

More than 80% of patients are achieving the target AUC range of 400–600 within 48 hours of therapy, demonstrating early attainment of therapeutic goals.

Incidence of acute kidney injury has decreased significantly.

o The five Ds of antimicrobial stewardship — diagnosis, drug, dose, duration and de-

use at Christiana Hospital, we implemented targeted education on use of cefazolin (not ceftriaxone) for non-purulent cellulitis and

QUALITY & SA FETY REPORT FY26

acquired pneumonia, urinary tract and skin and soft tissue infection in acute care and ambulatory settings in alignment with updated Infectious Disease Society of America recommendations.

stewardship pharmacists in Vocera to make them more accessible.

o After observing an increase in ceftriaxone

|

o We updated guidelines for community-

o We updated the title of the antimicrobial

escalation — were reinforced in walking rounds, quizzes and meetings.

54

• Vancomycin AUC monitoring:

|

o We created an abbreviated penicillin allergy algorithm to be shared with unit physicians.

QUALITY

• Pharmacy interventions: o From January 2025 through January 2026, clinical pharmacists across all three hospital campuses made 12,165 interventions dedicated to antimicrobial stewardship. The most common interventions included adding a stop date and discontinuing therapy when appropriate. During the same period, antimicrobial stewardship pharmacists made 5,304 interventions. The most common interventions included discontinuation of therapy, drug information or de-escalation of therapy.

My why

Flow

“I'm still an active emergency physician who sees patients, and I want to provide the best care and experience possible.

Streamline the flow of patients across our health care system through improved organizational efficiencies, elimination of

waste and coordination of transitions of care.

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FLOW

I want to make sure that we have the right quality guardrails for our patients and caregivers to ensure that we can deliver the right care as efficiently as possible.

When we do our job well, the impact multiplies across communities.”

Christian Coletti, M.D., MHCDS, FACEP, FACP, ambulatory clinical effectiveness officer

Flow: Hospital Length of Stay

ChristianaCare reduces length of stay across campuses Length of Stay Index Cecil County

Newark

Wilmington

Target-Cecil County

Target-Newark

Target-Wilmington

1.4 1.2

Observed v Expected

ChristianaCare’s focus on efficiency and patient-centered care has improved hospital length of stay and care transitions over the past year. Improvements in discharge workflows, weekend discharge rates and optimized diagnostic turnaround times — particularly for MRIs and observational CTs — contributed to reduced length of stay across our hospital campuses.

1.0

All three campuses improved their observed to risk-adjusted length of stay index to below target. The average improvement was over 6%.

0.8 0.6 0.4 0.2 0.0

LOS Index by Disposition 1.6

Observed v Expected

1.4 1.2

1.0 0.8

0.6 0.4 0.2 0.0

Home

Home Health FY25 YTD

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FLOW

Inpatient Rehabilitation Facility FY26 YTD

Skilled Nursing Facility

The observed-to-risk-adjusted expected length of stay index improved for post-acute placement.

The greatest improvement was in placement to skilled nursing facilities with a 12% improvement, to 1.05 from 1.19. Placement to inpatient rehabilitation facilities remains an opportunity with length of stays 30% above expected.

Flow: Care Transitions

Optimized workflows reduce authorization turnaround time ChristianaCare has partnered with Palantir, a global leader in data analytics and artificial intelligence, to analyze barriers to discharge and develop actionable insights to optimize discharge processes for enhanced patient care and operational efficiency.

Post Acute Care Planning with Palantir Post

Authorization Turnaround

Pre

In a pilot of select patients from July to December 2025, caregivers using the PostAcute Care Planning tool initiated

authorization earlier than in prior time periods. The average authorization turnaround time decreased from 1.4 days to 1.2 days. We are now expanding the pilot.

1.4

1.2

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

Average Days

AI predictions through Palantir enabled care managers to initiate authorization for post acute services earlier, reducing turnaround time by 14%, to 1.2 from 1.4 days, a savings of almost five hours per patient.

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FLOW

1.6

Flow: Discharge Efficiency

Weekend discharge efficiency improves in Wilmington In FY25, Wilmington Hospital discharged half as many patients on Saturdays and Sundays as on weekdays. To close the gap and increase weekend discharge volume, we identified and improved a key factor that was delaying discharge: turnaround time for imaging tests, especially MRIs. At our Wilmington Hospital, the average turnaround time for inpatient and observational MRIs decreased by nearly three hours in FY26, despite a 17% volume increase compared to FY25. We also initiated formal Multidisciplinary Rounds on weekend days across all campuses.

Wilmington MRI Turnaround Time 40

35

34.2

31.5 30

Hours

25

20 15.6 15

12.7

10

5

0 Inpatient

Observation

FY 25

FY 26 YTD

Target

The time to complete an MRI decreased by more than two hours for inpatients and observation patients. Observation improved by 19%, to 12.7 hours, and is better than target.

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FLOW

Newark

Flow: Discharge Efficiency

100%

% of Time

Improving surge capacity across campuses

80%

52%

60% 40% 20%

High hospital occupancy and suboptimal patient flow, including congestion in emergency departments and patient boarding, negatively impact care quality, safety and patient experience.

21%

79% 48%

0% Jan-Mar25 Normal-Surge Level 2

During the winter of FY25, the Newark Emergency Department had a median boarding time of 4.4 hours and a median time from arrival to departure of 11.5 hours for admitted patients. The 100%

% of Time

80%

10%

42%

60%

90%

40%

20%

58%

0% Jan-Mar25

Jan-Mar26

Normal-Surge Level 2

• A 52% reduction in boarding hours.

• Time spent in critical surge levels of three or higher at Christiana Hospital dropped from 94% in January 2025 to 14.9% in January 2026.

100% 80%

% of Time

• A reduction in patients leaving before they were seen by a provider from 6.2% to 4.3%.

12% 55%

60%

88%

40% 20%

• An increase in discharge efficiency from 13.5% to 18.8%.

45%

0% Jan-Mar25

Normal-Surge Level 2

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QUALITY & SA FETY REPORT FY26

Surge Level 3-5

Wilmington

• A 23% reduction in time from arrival to left emergency department for admitted patients.

59

Surge Level 3-5

Cecil County

Wilmington Emergency Department had a median boarding time of 4.25 hours and a median time from arrival to departure of 12.4 hours for admitted patients.

A multidisciplinary team set out to optimize flow during peak volume across all three hospital campuses. The team identified two primary triggers – emergency department boarding census (unassigned beds) and waiting room volumes. Then they devised a data-driven capacity surge plan including staff redistribution, auxiliary bed activation, task reprioritization and increased flow huddles to discuss capacity status and actions for improvement. The project, which went live in October 2025, achieved:

Jan-Mar26

|

FLOW

Jan-Mar26

Surge Level 3-5

My why

Health Impact

“Every patient that we see should receive the highest quality care that we can provide regardless of their ability to pay.

We have a duty to find and reduce barriers as much as possible and acknowledge that not every patient we see has the same opportunities or social determinants of health. Many patients have difficulty accessing care in traditional settings, and we work to ensure that our non-traditional practice settings in the community meet the same quality and safety standards as every other practice so that everyone receives the highest quality care that we can deliver.”

Leading the nation in population health outcomes by ensuring every person receives the best care in the right

setting while reducing the total cost of care.

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HEALTH IMPAC T

Ben Golden, M.D., Medical Director for the ChristianaCare Medical Respite Program at the New Castle County Hope Center and Medical Director of Mobile Health Services Outreach

Health Impact: Community Health Workers

Primary Care Community Health Workers turn trust into measurable impact

Utilization Reduction Inpatient Admissions

-0.54

Hospital Readmissions

ChristianaCare extends care beyond the exam room by anchoring trusted Community Health Workers in 11 primary care practices in Delaware.

ED Visits

HEALT H IMPAC T

-0.8

-0.6

-0.4

-0.2

0

$2.5 Total Savings $2.16M

Cost/Saving ($M)

$2.0 $1.5

Net Benefit $1.22M

$1.0

$0.5

$0.0

|

-1

Return on Investment

instability, appointment access and health literacy, Primary Care Community Health Workers help close gaps to reduce

QUALITY & SA FETY REPORT FY26

-1.2

Average Change per Patient per Year

By addressing transportation barriers, food insecurity, housing

|

-0.47

-1.4

diabetes and hypertension. Many are uninsured or insured through Medicaid or Medicare. In a structured six-month engagement, Community Health Workers help patients navigate resources, build self-management skills and stay connected to care.

61

-1.19

PC Cancelled Visits

The Primary Care Community Health Workers program serves patients with complex medical needs, such as uncontrolled

disparities in care and prevent avoidable hospital use. More than half of participating patients experienced fewer emergency department visits, while the majority had no inpatient admissions or readmissions following program completion, demonstrating a durable benefit rather than shortterm displacement of care.

-0.82

The 219 patients who completed the 6-month Primary Care Community Health Worker program reflect the program’s full annual reach. A rigorous patient-level analysis demonstrated statistically significant reductions in hospital utilization, including emergency department visits, inpatient admissions and readmissions. These reductions were observed across a diverse patient population and reflect improvements in care stability, particularly among patients with higher baseline utilization.

Program Cost $0.94M

ROI 1.30

Total savings based on utilization reductions were $2.16 million.

Excluding $0.94M in program costs led to a net benefit of $1.22M and an ROI of $1.30 per $1 invested. Net savings per patient was $5,587.

Health Impact: Community Medicine Mobile Van

Delivering primary care services directly to the community

Key benefits of the program include:

Mobile Van Primary Care Visits 160

140

120

Number of Visits

The Community Medicine Mobile Van program brings care directly to individuals in high-risk communities.

We deploy mobile services, such as chronic disease screening, immunizations, medication review and patient education to community locations where residents face elevated clinical and social risks. Utilization in FY26 has consistently exceeded FY25, suggesting progress toward more equitable, convenient access to care for communities with elevated clinical and social risks.

100

80

60

• Earlier detection of uncontrolled chronic conditions, closing screening gaps and identifying medication safety risks.

• Reducing delays that can lead to disease progression and avoidable acute events.

• Improved care transitions through engagement that supports referral and follow-up pathways, which are especially critical for high-risk patients who may otherwise disengage from care.

40

20

0

Jul

Aug

Sep

Oct

Nov

FY 2026

FY 2025

Dec

Jan

Feb

Mar

The Mobile Van delivered 914 primary care visits in FY26, up almost three times the FY25 total. New patient visits increased by 48%, to 180 from 121. Van utilization averaged over 100% during the year.

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HEALTH IMPAC T

Health Impact: THRIVE

Integrated Cardiovascular-Kidney-Metabolic Care serves at-risk patients Nearly 90% of U.S. adults meet the criteria for at least the early stages of CardiovascularKidney-Metabolic (CKM) syndrome, a cluster of conditions that increases mortality risk.

Care is often fragmented across specialties, driving high costs and inconsistent care.

Our solution, Thrive CKM, represents a paradigm shift: a team-based, episode-driven, hybrid-first delivery model that addresses the interconnected nature of CKM. This evidence-based integrated practice unit features protocolized pathways that blend clinical optimization, self-management, lifestyle coaching and support from physicians, registered nurses, registered pharmacists, social workers and coaches. The program launched at the Wilmington campus with:

CKM Quantitative Staging

Stage 3: Subclinical CKM

• Data-Driven Patient Identification: A systematic approach to identifying and enrolling eligible patients into comprehensive CKM care pathways using population health analytics, registries and referral channels.

Stage 4: Clinical CKM

Stage 1: Pre-HTN/ Diabetic Risk Stage 2: Pre-CKM Risk

• Prioritized Access for Risk-Based Populations: Enhanced access for Medicare Advantage, Medicaid ACO and Medicare ACO patients through two pathways: recovery (patients with heart failure, peripheral arterial disease, coronary artery disease and CKM risk factors) and prevention (patients with comorbid CKM risk factors).

• A Collaborative Care Pathway: Intensive clinical optimization with remote patient monitoring and guideline-directed medical therapy, lifestyle medicine, medically tailored meals and groceries, selfcare resources, sociobehavioral support and advance care planning.

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HEALTH IMPAC T

At launch, the focus population for Thrive CKM is the 27% of patients over age 65 in Stage 4 Clinical CKM (with 90-120 day episodes of care) and the 36% of patients in Stage 2 with multimorbid hypertension and Type 2 diabetes (with 45-60 day episodes of care).

Health Impact: Hope Center

A critical bridge from hospital to stable housing

In FY25, a comprehensive evaluation of the Hope Center revealed an opportunity to improve flow. Using systems thinking, Lean Six Sigma principles and advanced data analytics, the team mapped workflows, identified delays, established clear performance indicators and standardized processes to create a proactive, performance-driven system.

Key results include improved patient throughput, reduced length of stay and sustained room utilization. We remain focused on

identifying patients earlier during hospitalization, streamlining referral pathways and strengthening coordination with local partners.

Number of Discharges

25

20

15

10

0

Length of Stay 300 250 200 150 100 50 -

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HEALTH IMPAC T

By reducing delays and improving care transitions, Hope Center discharges have increased 73% FY26 year-to-date compared to the same period in FY25, to 133 from 77, and are projected to reach 145

by June 2026.

5

Average Length of Stay (days)

For patients experiencing homelessness or housing instability, being medically ready for discharge does not always mean being truly ready to leave the hospital. Our Hope Center, a 36-room medical respite facility located in New Castle County, Delaware, serves as a bridge, a clinical safety net where patients can safely recover after hospitalization while their social, housing and care coordination needs are addressed.

Throughput

A core goal of the Hope Center is to be a temporary bridge, not a longterm destination. The Hope Center reduced the average length of stay 69% FY26 year-to-date, from 188 to 59 days, reflecting timely transitions to housing and services while ensuring patients receive the support needed to recover safely.

Health Impact: Exceptional Patient Care Plans

Streamlined Exceptional Patient Care Plans reduce hospital utilization

35%

of completed care plans are for pain management (or pain with medical and/or behavioral management).

of completed care plans are for sickle cell disease.

900 800 700

2500 800

2000

2084

600 528

1500

500 1125

400 1000 300 200

Utilization (hospital days)

65%

Hospital Utilization Pre-Post Exceptional Care Plans

Number of Encounters

Exceptional Patient Care Plans — specialized, documented care plans for patients with complex medical or psychiatric conditions — can help caregivers deliver consistent and efficient care across treatment settings.

All Emergency Department and inpatient providers can now refer patients for consideration for an Exceptional Patient Care Plan through an order in the patient’s electronic medical record. From January 2025 to March 2026, 178 patients were referred for Exceptional Patient Care Plans, and 61 care plans were completed. Emergency department and inpatient care utilization decreased after plan implementation.

500

100 0

0 Pre-Care Plan

ED

Post Care-Plan

Inpatient

Observation

Utilization

Exceptional Care Plans reduced hospital utilization for patients with complex conditions. Hospital encounters decreased 34% after completion of Exceptional Care Plans, to 528 from 800.

Inpatient admissions decreased by 43%, while emergency department visits decreased by 30%.

Hospital days (utilization) decreased by 46%. On average, patients had 15 fewer hospital days.

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HEALTH IMPAC T

Health Impact: School-Based Health Centers

Enhancing access to care for health and learning ChristianaCare’s School-Based Health Centers provide prompt, coordinated care to underserved student populations. By addressing students' acute and chronic health needs on site, we support better attendance, safer environments and improved health and education outcomes.

In FY26, utilization increased because of targeted school and family communications, stronger coordination with school staff and standardized scheduling. During the 2025–2026 school year, 13,157 students were enrolled in ChristianaCare School-Based Health Centers, which delivered over 22,000 medical, behavioral health and nutrition visits in FY26 — an increase of more than 2,300 compared to FY25, We also conducted over 6,600 risk assessments to proactively identify students’ physical, behavioral and psychosocial needs and connect them with interventions, supports and follow-up care.

Scheduled

Actual

100%

80%

Utilization (%)

We have provided school-based healthcare services in Delaware for more than four decades, making us a trusted, dependable provider. We operate School-Based Health Centers in 19 high schools and six elementary schools across diverse communities in New Castle County.

School-Based Health Center Utilization

60%

40%

20%

0% FY25

Jul-25

Aug-25

Sep-25

Oct-25

Nov-25

Dec-25

Jan-26

Feb-26

Appointments scheduled increased over 45% in FY26, reaching 80% in March from 55% in FY25. Appointments kept (actual utilization) improved by almost 56%, to 70% from 45%.

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HEALTH IMPAC T

Mar-26

Population Health Leading the nation in population health outcomes by ensuring every person receives the best care in the right

setting while reducing the total cost of care by 5%.

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POPULAT ION HE ALT H

My why “Navigating healthcare can feel difficult or intimidating, especially during times of acute need, when patients are at their most vulnerable moments.

As caregivers, we're fortunate to have the tools to meet patients where they are. In every interaction, we can give patients a gift by helping them understand, navigate and selfmanage their healthcare, which ultimately helps them and the community to thrive. It's important to show patients that they can trust us so that they feel safe and empowered to participate in their care. We can help them feel more comfortable utilizing resources and asking for help.”

Amanda Bryden, MSM, MSN, RN, MEDSURG-BC, GERO-BC, CCM Manager, Care Management

Population Health: Hospital Care at Home

Hospital Care at Home services improve patient outcomes Case-Mix Adjusted Hospital Utilization Rates

ChristianaCare’s Hospital Care at Home program follows patients in a 30-day Center for Virtual Health Boost program after discharge.

To smooth the transition from hospital to home, Hospital Care at Home registered nurses coordinate discharge planning. An interdisciplinary team then reviews all 30-day readmissions among Hospital Care at Home patients to assess opportunities to improve and lessons learned.

Key outcomes include:

in December 2021, Hospital Care at Home has not had any CLABSI, C. difficile or MRSA infections. We have had only one CAUTI to date. Caregivers follow inpatient healthcare-acquired infection prevention guidelines and processes, conduct chart

reviews and complete real-time education and safety huddles.

10.0%

9.7% 8.8%

Rate (adjusted for case mix)

• Reduced exposure to hospital-acquired Infections: Since the program’s inception

12.0%

8.7%

8.0%

7.5%

7.2%

6.9%

6.7% 6.1%

6.0% 4.6% 4.0%

• Reduced utilization of skilled nursing facilities: From July to December 2025, only 0.31% of patients who accepted Hospital Care at Home were discharged to skilled nursing facilities, compared to 13% of patients who rejected Hospital Care at Home.

• High participation in Meds to Beds: The Hospital Care at Home enrollment rate in Meds to Beds (learn more on page 51) is 53.7%. The systemwide enrollment rate is 31.1%.

• Reduced acute readmissions: In FY26, 6.1% of patients who were seen in the Boost clinic or completed a 30-day nursing post-discharge program were readmitted within 30 days, a decrease from 7.4% in FY25.

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POPULAT ION HE ALT H

2.0%

0.0% Escalation Rate

30-Day ED Return Rate

FY24

FY25

30-Day Readmission Rate

FY26 YTD

Unplanned hospital utilization by Hospital at Home patients has improved across all metrics since FY24. Emergency department (ED) returns decreased by24%, to 4.6% from 6.1%, readmissions decreased 23%, to 6.7% from 8.7%, and escalations of care from home to a brick-and-mortar hospital decreased almost 10%, to 8.8% from 9.7%.

Population Health: CareVio

CareVio, a subsidiary of ChristianaCare, is a care management program that collaborates with patients and healthcare teams to help people stay well.

25% 30-Day Readmission Rate

CareVio task force reduces inpatient admissions and readmissions

Impact of the Task Force on Readmissions

This CareVio task force, established in April 2025 to address patients in the shared Highmark Medicare Advantage product, improved patient engagement and utilization within just three months through early engagement and activation, education and medication optimization. Starting in August 2025, this team became responsible for onsite, bedside visits in ChristianaCare acute care settings to help establish ongoing relationships with CareVio after discharge. Results include:

• A 56% improvement in primary care provider utilization.

• Increased successful engagement, with program enrollment reaching 100% of the target.

10% 5%

Total Readmit

Transitional Care Comprehensive Post Acute Care Management Case Management

Pre Task Force

Successful ClosureCareVio Admit Program

100% 80%

80%

Transitional Care Management-Unable to Reach

60% 45% 40%

16%

20%

11%

0%

Successful Closure-CareVio Admit Program Pre Admit RN

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POPULAT ION HE ALT H

The Task Force decreased readmissions for the Highmark Medicare Advantage population by more than 26%. Improvements were seen across all 3 programs, with the greatest decrease for CCM which improved almost 56%, to 7.1% from 16.1%.

Task Force Engaged

CareVio Admit RN Program

Closure/Unable to Reach (%)

• Improved emergency department utilization.

15%

0%

• Decreased total inpatient, unplanned admissions.

• A more than 20% decrease in readmissions.

20%

Transitional Care ManagementUnable to Reach

Post Admit RN

Onsite bedside visits by the CareVio Acute RN increased successful program closure by 78%, to 80% from 45%, and decreased the percentage of patients that could not be reached for the Transitional Care Management program by 32%, to 11% from 16%.

Population Health: BOOST

BOOST programs enhance care with virtual teams Our caregivers support patient well-being and reduce hospital visits through the Center for Virtual Health’s BOOST programs.

BOOST Patients 30-Day Program 7%

Hospital Care at Home 24%

• Acute BOOST ensures a seamless transition from hospital to home discharge clinic visits, care coordination, home health orders, secure text messaging with care teams and more.

Alterwood 4%

• Ambulatory BOOST supports ongoing health through care coordination, patient monitoring, RN triage and virtual consultations through ondemand and same-day video visits.

Provider 65%

Automating geocoding to deliver high-quality care to all

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BOOST: Readmission /ED Return Rate Trends Readmission/ED Return Rate (%)

To ensure that all patients benefit from our virtual health programs, our Center for Virtual Health geocodes all populations and uses the Area Deprivation Index to compare clinical and quality outcomes at the neighborhood level. Best-in-class measurement tools could geocode only 2,000 patients with a 95% match rate in 30 minutes using one license costing $4,200 per year. The Center for Virtual Health team developed an automated, scalable solution using RStudio TIGER/Line® Shapefiles (Census.gov) that is 100 times faster, encoding 200,000 patients in 30 minutes with zero licensing cost while maintaining privacy and data integrity. The solution is now available to analytic teams across ChristianaCare.

FY26 year-to-date through April, 1,517 patients were seen by a provider in the BOOST clinic (65%) and/or completed a 30-day postdischarge program. 370 Hospital Care at Home patients (24%) participated in the BOOST program.

16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% FY25

Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26 Apr-26

30-Day Readmission Rate

ED Return Rate

Readmit Target

FY26 year-to-date, 30-day readmissions for patients participating in BOOST decreased 16%, to 6.2% from 7.4% in FY25 and are well below the 14% target.

ED returns improved over 3%, to 8.3% from 8.6%.

ChristianaCare Way Awards

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WAY AWA RDS

ChristianaCare Way Awards President’s Award Sustainability Meets Safety: A Data-Inspired Model for Ambulatory Care To improve ChristianaCare’s ambulatory safety infrastructure across 200+ decentralized offices, interprofessional subgroups designed scalable interventions, including local engagement, communication, staff recognition, event review, education, accountability and reporting tools. Results included a 65% increase in event reporting, a 23% increase in Good Catches and a 153% increase in QuickSubmit use, saving 189 caregiver hours.

Value Award Meds to Beds: A Healthy Handoff Delivering medications to patients before discharge can improve medication adherence and decrease readmission rates. The Meds to Beds program, which delivers discharge medications to patients’ bedsides before they leave the hospital, was reinvigorated at the Cecil, Newark and Wilmington campuses through PowerChart integration and standardized workflows among nursing, care managers and pharmacy. By July 2025, Meds to Beds enrollment had tripled to over 500 patients per month. Readmissions for

participants were 26% lower than for non-participants.

Transformation Award Risk Avert: Violence Alert!

Workplace violence is a recognized, growing national hazard in health care. To reduce violence against caregivers, an interdisciplinary team designed a PowerChart documentation process and workflow to create an alert for patient or visitor risk of violence at all inpatient, emergency department and ambulatory office practices. From March to August 2025, 92 patients and seven visitors had a violence alert in the medical record, enabling Clinical Safety Nurses to proactively round. This intervention led to a 23% decrease

in physical assaults from February to July 2025.

Strengthen the Core: Safety Gold Award Disrupt the Central Venous Catheter Life Cycle The risk of central line-associated bloodstream infections (CLABSI) increases with the use of central venous catheters, and timely removal reduces the risk of CLABSI. Unit observations revealed inconsistent practices among nurses in assessing the need for central venous catheters and the indications for removal. The Medical Intensive Care Unit

developed the acronym “HOOPS” to help nurses identify when temporary central venous catheters are no longer indicated and decrease their duration of use. The median central venous catheters dwell time decreased from four to three days, and total central venous catheters days decreased by 21%.

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ChristianaCare Way Awards Strengthen the Core: Safety Silver Award Bundle Up! Reducing Colorectal Surgical Site Infections (SSIs) After identifying a persistent increase in colon SSIs in early 2024, a team of nurses, physicians, advanced practice clinicians and infection preventionists enhanced the existing colorectal SSI prevention bundle and provided targeted education about opportunities to reduce colon SSIs. The multifaceted interventions focused on perioperative services, the post-anesthesia care unit and the operating room. As a result, colon SSIs decreased by 62% in 14 months.

Strengthen the Core: Safety Bronze Award Don't Let the Bed Bugs Bite Bed bugs are an occupational hazard for health care workers who deliver care in patients’ residences. After more than three years with zero bed bug-related injuries, ChristianaCare HomeHealth had four such injuries in 2024. An interdisciplinary team of caregivers conducted a cause-and-effect analysis of existing processes and infection prevention practices and established a multi-phase approach that included best-practice education and new personal protective equipment. HomeHealth had no bed bug-related

injuries through August 2025.

Strengthen the Core: Quality Gold Award Project OWL- Oxygen Within Limits to Stop Retinopathy of Prematurity Benchmarking through the Vermont Oxford Network identified an increased rate of retinopathy of prematurity in very-low-birth-weight infants in the Neonatal Intensive Care Unit in 2022. The key driver was the time spent within a target oxygen saturation range of 90%-95%. A team of physicians/neonatologists, neonatal nurse practitioners, nurses and respiratory therapists implemented multidisciplinary education, a bedside auditing and intervention process and regular review of patient trends during medical rounds. The

percentage of patients’ time spent within the target oxygen saturation range improved, and Retinopathy of Prematurity rates decreased from 42% to 19% in 2024.

Strengthen the Core: Quality Silver Award Working on Wellness Plan To create an efficient, integrated approach to help patients close care gaps and actively manage their health across all primary care practices, IT, the Center for Virtual Health and the Medical Group integrated registry measures, upcoming actions and a goal-tracking dashboard into the patient portal. Over five months, open care gaps decreased by 31%.

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ChristianaCare Way Awards Strengthen the Core: Quality Bronze Award Braden + AI: Combining Pressure Injury Prediction With Intelligent Risk Integration Although widely considered the standard, the Braden Scale for Hospital-Acquired Pressure Injury risk assessment flags 43% of patients as high risk with a 42% false-positive rate, leading to unnecessary interventions. A team from Wound, Ostomy and Continence services, Nursing and Data Science integrated Braden scoring with AI to improve risk prediction, piloting an AI-based real-time dashboard on units 5C and 3D to help nurses prioritize patients. Braden plus AI improved sensitivity from 61.3% to 77.5% and reduced false

positives from 42.4% to 17.2%. Patients flagged as high risk dropped from 42.5% to 17.5%. In pilot units, sensitivity rose by 23.5% and false positives fell by 24.3%. Earlier identification enabled targeted care such as offloading, moisture control, consults and support surfaces.

Strengthen the Core: Patient Experience Award Every Pill Has a Story: Know Yours! Increasing Medication Side Effect Education Clear, consistent medication teaching, including side-effect instruction, promotes patient engagement and medication adherence. In FY24, the HCAHPS “staff-described med side effects” on unit 4B was below its target. 4B leaders collaborated with the unit’s RN IV to develop training and side effect cards for patient education during the main medication pass, incorporating language preferences and teach-back. Individuals were recognized for compliance through the Bravo! employee recognition program and huddles. Patient experience scores increased, and the processes were initiated on four more surgical units. Favorable HCAHPS results have already been validated on one of these units.

Strengthen the Core: Flow Award and People’s Choice Award High-Sensitivity Troponin: A Paradigm Shift in the Diagnosis and Management of Acute Coronary Syndrome High-sensitivity cardiac troponin (cTn) testing can more rapidly detect or rule out acute coronary syndrome, a leading cause of mortality and morbidity, than conventional cTn testing. Workgroups completed an IT build, clinician and nurse education and laboratory staff training to implement high-sensitivity cTn testing in December 2023. A retrospective cohort study found statistically significant increases in the diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) and in the percentage of patients discharged from the emergency department. Overall efficiency and standard of care were improved through algorithmic reflex testing.

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ChristianaCare Way Awards End Disparities Award Decreasing Hospital-Acquired Pressure Injury (HAPI) in Patients with Darker Skin Tones Recent studies have identified disparities in HAPI incidence in patients with darker skin tones. At ChristianaCare, HAPI incidence among Black or African American patients was two to three times higher than that of white patients. Caregivers from the Wound, Ostomy and Continence team, Health Impact, Nursing leadership, pressure injury preventionists and clinical informatics used the objective Monk Skin Tone scale to improve skin assessments for adult inpatients on two medical units at Wilmington Hospital (4N/5W). Nurses

reported a 56% increase in confidence discussing skin tone. Confidence in accurate skin assessment doubled. There were zero HAPIs during the pilot period, and the pilot is expanding to more units.

Enable Every Caregiver to Thrive Gold Award ACTion: Putting Improvement in Our Caregivers’ Hands Course evaluations from the Achieving Competency Today (ACT) Quality Improvement course revealed opportunities to translate course learnings into improvements in job performance. Team members from iLEAD, Quality and Safety, The Academy, faculty members from across the system and interprofessional participants collaborated to enhance the course with videos, new curricula, checklists and a partnership with the University of Delaware Center for Health Profession Studies. Nearly 1,000 caregivers have participated in ACT, completing 146 projects. Business Results scores increased 10%, Learning Effectiveness increased 9% and Job Impact increased 2%. Learning confidence in QI improved 42%.

Enable Every Caregiver to Thrive Silver Award It’s Okay Not to Be Okay: Reducing Caregivers’ Barriers to Seeking Mental Health Care

Up to 43% of health care providers cite licensure and credentialing concerns as barriers to accessing mental health care. The Center for WorkLife Wellbeing team collaborated with Human Resources, Caregiver Health Services, Behavioral Health, the Medical-Dental Staff Office, the Government Affairs team and Legal, as well as the American Medical Association and the Dr. Lorna Breen Heroes’ Foundation, to reduce barriers to help-seeking for caregivers. In September 2024, Delaware Senate Joint Resolution 6 passed, requiring the removal of stigmatizing language from Delaware health care professional licensing applications and renewal forms. ChristianaCare was recognized as a Wellbeing First Champion, and more than 60% of nurses and physicians reported increased perceptions of safety accessing mental health care.

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ChristianaCare Way Awards Healthy At Home Award Advancing Advance Care Planning Across the Continuum Advance care planning can improve patients’ health care experiences near the end of life. An interdisciplinary team of caregivers in palliative care, acute care and ambulatory care clinicians, HomeHealth, population health, information technology and Clinical Effectiveness established a centralized view of advance care documents in the electronic medical record, improved care documentation goals, launched a website for patient education and implemented electronic triggers to identify the highest-risk patients. Advance care

planning for primary care patients increased by 20%, goals of care increased by 20%, and referrals to hospice increased by 34% for non-acute patients and 40% for acute patients.

Operational Improvement Gold Award Enhancing Medication History Accuracy at Wilmington Hospital In 2024, 12% of Report2Learns occurrences in the Wilmington Hospital Emergency Department were related to medication reconciliation, and medication discrepancies made up 4% of patient grievances. To reduce medication discrepancies, pharmacists, operations, pharmacy technicians, nurses, providers and data analytics developed a risk algorithm to

identify high-priority patients and placed two pharmacy technicians in the Emergency Department, who completed histories for 40% of admissions with a median time of eight minutes from the admit order. Pharmacists corrected more than 35 errors based on these histories monthly, and medication discrepancies decreased by 50%.

Operational Improvement Silver Award Why Don’t You Just Meet Me in the Middle? Reducing Outlier Drug Utilization The Medication Use Evaluation Subcommittee identified opportunities to align the use of calcitonin injection, epoetin alfa and iron sucrose with best clinical practices and reduce high utilization rates identified in Vizient benchmarking data. In partnership with Utilization Management, the subcommittee implemented PowerChart clinical decision support

tools, such as alerts for inappropriate lab values for epoetin and parenteral iron. Vizient rankings improved for all three medications, with the largest decrease in iron sucrose from the 95th percentile to the 71st percentile.

Operational Improvement Bronze Award Automated Geocoding for Equity Measurement Measuring equity is essential to ensuring our neighbors benefit equally from innovative programs. Best-in-class measurement tools could geocode only 2,000 patients with a 95% match rate in 30 minutes by a single user on a license costing $4,200 per year. The Center for Virtual Health Analytics developed an enterprise-level solution that supports geocoding of 200,000 patients in 30 minutes at no additional cost. The solution is available to analytic teams across ChristianaCare and is now being used to assess readmission rates across socioeconomic strata.

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ChristianaCare Way Awards Operational Improvement Bronze Award Automated Geocoding for Equity Measurement Measuring equity is essential to ensuring our neighbors benefit equally from innovative programs. Best-in-class measurement tools could geocode only 2,000 patients with a 95% match rate in 30 minutes by a single user on a license costing $4,200 per year. The Center for Virtual Health Analytics developed an enterprise-level solution that supports geocoding of 200,000 patients in 30 minutes at no additional cost. The solution is available to analytic teams across ChristianaCare and is now being used to assess readmission

rates across socioeconomic strata.

Operational Improvement Honorable Mention Award Ensuring Every Heartbeat Counts: Improving the Ambulatory ECG Process Information technologists, nurses, advanced practice clinicians, physicians and compliance collaborated to increase provider signing of electrocardiograms (ECGs), crucial diagnostic tests to assess the heart’s electrical activity and detect potentially dangerous conditions. Event reviews by the Primary Care and Community Health Emergency

Response Teams identified more than 3,600 unsigned ECGs. IT corrected inconsistencies in order workflows. Practice leaders were given a job aid and a report with a centralized list of unsigned ECGs. Within seven months, the number of unsigned ECGs decreased by 75%.

Magnet Transformational Leadership Gold Award From Reporting to Learning: Building a Continuous Feedback Culture HomeHealth identified an opportunity to strengthen its safety culture and improve event reporting through a Just Culture lens. The HomeHealth director of Quality/Risk Management, quality specialist and risk specialist collaborated with system partners to identify best practices for event reporting workflows. As a result, they implemented an

Event Review Team, used the SAFER framework to guide structured, non-punitive event analysis and developed a QuickSubmit form. The number of people responsible for event review dropped from 18 to three, the time to submit an event decreased by 14%, and the time to close an event decreased by 58%.

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ChristianaCare Way Awards Magnet Transformational Leadership Silver Award Conversation is Critical: Teaching a Framework for Peer Feedback The Medical Intensive Care Unit had the highest employee turnover rate at the Newark campus in 2023. To engage nurses, decrease turnover and improve patient care on the unit, the team collaborated with the Center for WorkLife Wellbeing to develop structured peer feedback education that facilitates direct communication and meaningful dialogue.

Skilled Communication, True Collaboration and Workplace Civility scores improved, and turnover rates decreased from 9.9% to 6.9%. In 2024, the average nurse turnover

nationwide was 18.4%.

Magnet Transformational Leadership Bronze Award Dialysis Without Distress: Redesigning Access and Urgency for Nurse Satisfaction On-call hemodialysis nurses were experiencing burnout due to frequent calls for low-acuity tasks while the unit was closed. In FY23, there were 638 call hours. Hemodialysis Unit nursing leaders collaborated with the Vascular Access Nursing team and nephrologists to define urgent versus emergent dialysis needs and uptrain vascular access nurses to

access dialysis fistulas and grafts for intensive care unit patients receiving sustained low-efficiency dialysis. Total call hours decreased to 517 hours by FY25, and nurses’ satisfaction improved by 15%.

Magnet Structural Empowerment Gold Award Leading with Love: Enhancing Healthy Work Environments via Meaningful Recognition In summer 2024, the results of the Caregiver Voice Survey pointed to an opportunity to improve recognition and professional development opportunities on unit 5E. Meaningful recognition strategies, including leader-to-nurse, nurse-to-nurse and patient-to-nurse, were implemented. The Healthy Work Environment assessment of leadership and

collaboration increased significantly, and Caregiver Voice Survey results improved by 24%.

Magnet Structural Empowerment Silver Award Defying Gravity: Standardizing Falls Best Practices in Ambulatory About 20% of patient falls in health systems occur in ambulatory practices. The Ambulatory Falls Subcommittee partnered with ambulatory nurses, physicians, advanced practice providers, operational partners, data analysts, physical therapists and information technologists to develop an evidence-based best-practice falls virtual resource for caregivers in

the primary care service line and at the Helen F. Graham Cancer Center & Research Institute. They also established a workflow to share lessons learned from patient falls. About 77% of caregivers participated, with an eight-point difference between pre- and post-test scores. The fall rate decreased by 33%.

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ChristianaCare Way Awards Magnet Structural Empowerment Bronze Award Empower & Elevate: Charge Nurse Leadership Retreat Charge nurses serve as mentors to their peers and are key resources for patients, families and caregivers; however, staff nurses often transition into charge nurse roles without formal leadership training. Based on the results of a Learning Needs Assessment, Acute Medicine Nurse Leaders and technical experts from Infection Prevention, Nursing Professional Development and Capacity/Resource Management developed a Charge Nurse Retreat to improve nursing leadership, communication and resource management

skills for the Newark Medical, Oncology and Observation Unit Service Line. 64% of charge nurses participated, and 100% of attendees felt they could apply the learnings. The content has now been shared with other campuses and service lines.

Magnet Exemplary Professional Practice Gold Award Back to Basics: Decreasing Hospital-Acquired Pressure Injuries (HAPI) on 5E In FY24, 5E, a 36-bed cardiovascular stepdown unit at Christiana Hospital, saw an increase from six to 12 HAPIs. The 5E Nursing leadership team identified equipment needs, began weekly rounds with the Wound, Ostomy and Continence team, conducted daily reviews of high-risk patients, established perfect care rounds and random audits and instituted post-event mandatory debriefing. 5E reduced HAPI by more than 50%, from 12 to five.

Magnet Exemplary Professional Practice Silver Award Pressing Matters: A Collaborative Initiative to Decrease HAPI In FY24, the Transitional Medical Unit (TMU) noted a rise in unit-based HAPIs, totaling nine, including five in January. The TMU’s Comprehensive Unit-Based Safety Program reintroduced daily Cipher rounding, and certified wound treatment associate nurses conducted weekly and new-hire rounding to deliver education and reinforce evidence-based practices. HAPI prevention was also emphasized in daily unit huddles, multidisciplinary rounds and monthly team meetings to inform and empower staff. Unit-acquired pressure injuries have been eliminated since April 2024.

Magnet Exemplary Professional Practice Bronze Award PCU/ICU: The Mission of Two Units for Pressure Injury Elimination, Cecil Campus FY23 and FY24 data revealed an opportunity to reduce Hospital-Acquired Pressure Injuries (HAPIs) at the Cecil County campus. Over 70% of HAPIs occurred in the Intensive Care Unit (ICU) or Progressive Care Unit (PCU). ICU and PCU leaders, skin champions, Quality and Safety, and Wound, Ostomy and Continence Nursing initiated a program that provided targeted education and required nurses to capture photos of patients’ sacrums and heels upon admission, after transfers and every Wednesday. The ICU and PCU reduced HAPI by 64% and 33%, respectively, and the overall incidence of HAPI at the Cecil County campus improved by 37.5%.

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ChristianaCare Way Awards Magnet New Knowledge, Innovations & Improvement Award Improving Mobility in Critically Ill Heart Failure Patients In critically ill patients with heart failure, immobility during hospitalization is associated with longer stays and poorer outcomes. The ChristianaCare Cardiovascular Critical Care Complex team identified an opportunity to increase consistent use of the Johns Hopkins Activity and Mobility Promotion tools, which were implemented hospital-wide in 2022. The team developed ICU-specific mobility training and incorporated mobility into multidisciplinary rounds. Time to mobility for heart failure patients decreased by 8%, and ICU length of stay decreased by 29%.

Accelerate Growth: Environmental Sustainability Gold Award Rx for a Greener Planet As patient enrollment in the Specialty Pharmacy Program grew, the volume of non-curbside recyclable Styrofoam packages shipped increased from 1,933 in FY22 to 12,567 through March of FY25. The Specialty Pharmacy Program team identified alternative packaging that is curbside recyclable, maintains temperature control for at least 36 hours and does not increase overall costs. By April 2025, all controlled room-temperature medications were shipped without Styrofoam, resulting in an 8.4% in cost savings that totaled $27,000 in just the first five months of the program.

Accelerate Growth: Environmental Sustainability Silver Award Partners in Repurposing: Reducing Waste, Strengthening Communities In 2023, the Newark campus generated nearly 39,000 tons of waste, including salvageable medical supplies and furniture. The Medical Supply Donation and Landfill Diversion initiative was established to reduce landfill waste and redirect resources to communities in need. Through collaborations with nonprofit organizations, including Project Cure, which

received unexpired surplus medical supplies, and Habitat for Humanity, which picked up usable furniture and medical equipment, more than 24 tons of medical supplies were diverted from landfills by June 2025, reducing carbon emissions and providing nearly $1.2 million of resources to community organizations.

Accelerate Growth Award Doing More of What We Do Well: Recalibrating Rehab In FY25, the Center for Rehabilitation at Wilmington Hospital was staffed for an average daily census of 18 patients, with the capacity to accommodate 26. Given the unit’s awardwinning outcomes and the community’s unmet need for inpatient rehabilitation care, the center launched an initiative to expand its capacity. The team increased its staffing, reconfigured its facility to maximize gym space and improve flow and engaged frontline caregivers in optimized group therapy. The average daily census increased by 5.8 patients, discharges increased by 31%, stroke length of stay decreased by 8%, and contribution margin increased by 41%.

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ChristianaCare by the Numbers Admissions

63,239 Births

6,574

Radiology Procedures

Hospital-based Lab Tests

610,011

5,083,557

Surgical Procedures

Primary Care Office Visits

37,866

330,335

Outpatient Visits

871,156

Home Health Visits

Urgent Care Center Visits

179,58

308,984

Our People

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Jobs Throughout Our Community

Volunteers (120,780 volunteer hours)

14,967

29,886

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Virtual Visits

126,238 Emergency Dept. Visits

234,783 Christiana Hospital Wilmington Hospital Union Hospital Middletown ED

101,206 65,727 32,564 35,286

About ChristianaCare Headquartered in Wilmington, Delaware, ChristianaCare is one of the country’s most dynamic health care organizations, centered on improving health outcomes, and innovating to make high-quality care more accessible, equitable and affordable. ChristianaCare includes an extensive network of primary care and outpatient services, home health care, urgent care centers, four hospitals (1,440 beds), a freestanding emergency department, a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive

stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health. It also includes the pioneering Gene Editing Institute and a 10-bed neighborhood hospital in West Grove, PA. ChristianaCare is nationally recognized as a great place to work. ChristianaCare is rated by Newsweek as one of

the World’s Best Hospitals and is continually ranked among the best in the U.S. in national quality and safety ratings. ChristianaCare is a nonprofit teaching health system with more than 315 residents and fellows. With its groundbreaking Center for Virtual Health and a focus on population health and value-based care, ChristianaCare

is shaping the future of health care.

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