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Description Intravenous (IV) fluid therapy is essential in acute care, but inappropriate use can lead to patient harm, waste, and excess cost. At Novant Health, a multi-state healthcare system, a systemwide review identified major opportunities to improve fluid management. In 18 months, over 3 million fluid bags were purchased—normal saline accounted for more than half, and costly albumin was administered 6,000+ times in 2023, with only 24% meeting evidence-based criteria. This, along with risks such as pulmonary edema and renal dysfunction, highlighted the need for action—especially during a national shortage following Hurricane Helene. In response, Novant Health launched a systemwide fluid stewardship initiative through its Precision Clinical Variation Reduction Program. Strategies included standardizing order sets, embedding decision support in the electronic health record (HER), categorizing albumin use, and engaging clinical teams. Results show evidence-based albumin use rose from 45.4% to 87.8%, saving $76,000 and improving care for 326 patients. IV fluid cost savings exceeded $200,000 in just four months. Real-time dashboards and iterative Plan, Study, Do, Act (PDSA) cycles supported rapid scale-up. This program demonstrates how structured, data-driven stewardship can improve safety, outcomes, and cost-efficiency while building resilient clinical systems.