Hospital Report

Gundersen Moundview Hospital and Clinics

402 W. Lake Street, PO Box 40
Friendship, Wisconsin, 53934
608-339-3331
http://www.gundersenhealth.org/moundview/

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Generated: Monday, October 7, 2024
This hospital does not provide Birth Services
Measure Hospital Result State Average State Benchmark National Average Report Period
Hip and Knee Surgery Complications DNR 3.285 2.76 3.5 7/1/2020-6/30/2023
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Measure Hospital Result State Average State Benchmark National Average Report Period
Catheter-Associated Urinary Tract Infections 0.64 0 1 4/1/2023-3/31/2024
Central Line Associated Blood Stream Infections 0.71 0 1 4/1/2023-3/31/2024
Clostridioides difficile Infections 0.56 0 1 4/1/2023-3/31/2024
Methicillin-Resistant Staph. aureus Infections 0.41 0 1 4/1/2023-3/31/2024
Surgical Site Infection - Abdominal Hysterectomy NA 1.38 0 1 4/1/2023-3/31/2024
Surgical Site Infection - Colon Surgery NA 0.87 0 1 4/1/2023-3/31/2024
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Measure Hospital Result State Average State Benchmark National Average Report Period
Acute Stroke 4.765 0 6.86 4/1/2023-3/31/2024
Chronic Obstructive Pulmonary Disease 9.518 7.97 9.4 7/1/2020-6/30/2023
GastrointestinaI Hemorrhage 2.268 0 2.51 4/1/2023-3/31/2024
Heart Attack DNR 12.112 10.86 12.6 7/1/2020-6/30/2023
Heart Failure 12.496 10.2 11.9 7/1/2020-6/30/2023
Hip Fracture 1.895 0 1.96 4/1/2023-3/31/2024
Pneumonia 17.418 14.58 17.9 7/1/2020-6/30/2023
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This hospital does not provide Mortality - Procedures Services
Measure Hospital Result State Average State Benchmark National Average Report Period
Always Quiet at Night 66 78 62 10/1/2022-9/30/2023
Definitely Recommend Hospital 74 84 70 10/1/2022-9/30/2023
Doctors Always Communicated Well 82 89 80 10/1/2022-9/30/2023
Nurses Always Communicated Well 83 89 80 10/1/2022-9/30/2023
Patient Rated Hospital High 76 85 72 10/1/2022-9/30/2023
Patients Always Received Requested Help 71 82 66 10/1/2022-9/30/2023
Patients Understood Their Care When They Left 56 65 52 10/1/2022-9/30/2023
Room Always Clean 77 88 73 10/1/2022-9/30/2023
Staff Always Explained Medications 66 75 62 10/1/2022-9/30/2023
Staff Provided Discharge Instructions 90 93 86 10/1/2022-9/30/2023
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Measure Hospital Result State Average State Benchmark National Average Report Period
Healthcare Personnel Influenza Immunization 86.517 83.41 94.79 --- 10/1/2023-5/15/2024
In Hospital Fall Associated Fracture Rate 0 0.025 0 0.03 4/1/2023-3/31/2024
Pneumothorax 0 0.008 0 0.02 4/1/2023-3/31/2024
Pressure Ulcers 0 0.05 0 0.07 4/1/2023-3/31/2024
Sepsis-1 DNR 68 68 61 10/1/2022-9/30/2023
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Measure Hospital Result State Average State Benchmark National Average Report Period
Perioperative Blood Clot 0.167 0 0.35 4/1/2023-3/31/2024
Perioperative Hemorrhage 0.313 0 0.23 4/1/2023-3/31/2024
Postoperative Respiratory Failure 0.568 0 0.73 4/1/2023-3/31/2024
Postoperative Sepsis 0.26 0 0.43 4/1/2023-3/31/2024
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Measure Hospital Result State Average State Benchmark National Average Report Period
All Cause Unplanned Readmissions 5 9.23 6.58 --- 1/1/2023-12/31/2023
Chronic Obstructive Pulmonary Disease 18.139 17.3 18.5 7/1/2020-6/30/2023
Coronary Artery Bypass Graft DNR 10.679 9.8 10.7 7/1/2020-6/30/2023
Heart Attack DNR 13.55 12.6 13.7 7/1/2020-6/30/2023
Heart Failure 19.4 17.91 19.8 7/1/2020-6/30/2023
Hip and Knee Surgery DNR 4.33 3.76 4.5 7/1/2020-6/30/2023
Pneumonia 16.134 15.2 16.4 7/1/2020-6/30/2023
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