CeriBell (CBLL) Q3 2026 Earnings Call: Revenue Rises 30%, Delirium Launch Begins

Key Takeaways

• CeriBell reported Q3 2026 revenue of $29.3 million, up approximately 30% year over year and 4% sequentially, supported by new hospital accounts and higher utilization within existing accounts.
• Product revenue increased 31% to $22.2 million, while subscription revenue rose 28% to $7.1 million.
• The company added a record 35 hospitals during the quarter, ending Q3 with 747 active accounts. Usage per account grew at a double-digit rate, its highest level since the IPO.
• Gross margin improved to 90% from 88% a year earlier. However, operating expenses rose 36% to $46.9 million, and net loss widened to $21.4 million.
• Management narrowed full-year 2026 revenue guidance to $115 million-$117 million, compared with the previous range of $114 million-$117 million.
• CeriBell began the commercial launch of its delirium monitoring solution and plans a limited market release of its next-generation Omni platform in Q4 2026, ahead of a broader 2027 launch.

Key Financial Results

Sales and marketing expense was $25.0 million, including investment in commercial infrastructure ahead of the delirium launch. G&A expense totaled $14.5 million, including $1.1 million related to ongoing intellectual property litigation. R&D expense was $7.4 million, reflecting investment in new hardware, algorithms and clinical studies.

Business and Operating Performance

CeriBell’s active account base reached 747 hospitals, with 35 net additions during Q3. Management attributed the record account increase to improved execution by the account acquisition team and said the pipeline of accounts awaiting launch remained robust.

Utilization per account grew at a double-digit rate. The company cited expansion into additional hospital departments, provider engagement and patient protocol development as the main drivers. CeriBell expanded into more departments during the first nine months of 2026 than during all of 2025, with growing adoption in emergency departments and ICUs.

The delirium monitoring solution moved from pilot testing into commercial launch. Pilot customers recorded a material increase in headband utilization, according to management. The impact was observed before the New Technology Add-on Payment, or NTAP, took effect on October 1, suggesting that management views clinical utility as the primary adoption driver.

CeriBell is offering delirium monitoring as a software upgrade without an incremental subscription fee. Revenue is expected to come primarily from increased headband utilization. Participating hospitals are asked to support implementation measures such as training more than 80% of nurses and physicians, establishing monitoring KPIs and maintaining sufficient recorder capacity. The company is not requiring contractual minimum-volume commitments.

The company also introduced Omni, its next-generation platform combining point-of-care EEG with video, multiple-day continuous monitoring, EKG compatibility and an optional parasagittal add-on. CeriBell plans a limited market release in Q4 2026 and a commercial launch in 2027.

Two recently FDA-cleared algorithms cover quantitative EEG trending and Amplitude-Integrated EEG Analysis. The related features are expected to be released through a cloud-based software update in 2027. CeriBell also continues to advance its LVO stroke clinical program.

Management Guidance

Management expects full-year 2026 revenue of $115 million-$117 million, narrowing the prior range of $114 million-$117 million. The revised outlook implies annual growth of 29%-31% over 2025.

The guidance does not assume material revenue contributions from the neonate, pediatric or delirium products. Management expects these offerings to contribute more meaningfully in 2027 and plans to provide greater detail on delirium-related revenue with its 2027 guidance.

Based on current tariff policy and inventory levels, management expects gross margin to remain in the high-80% range. Following the refinancing of its debt structure, the company expects annual interest expense to decline to less than $1 million.

CeriBell maintained its objective of reaching cash flow breakeven using existing cash resources. Management said much of the commercial infrastructure needed for its identified 2027 growth initiatives has already been put in place.

Risks and Points to Watch

• Net loss increased to $21.4 million, while adjusted EBITDA loss widened to $12.1 million as operating expenses grew faster than revenue.
• CeriBell could be required to pay $2.9 million in deferred legal fees, depending on the outcome of its current International Trade Commission proceeding.
• Broad adoption of delirium monitoring will take time because implementation requires staff training, workflow changes and close coordination with hospital customers.
• Management has not yet quantified the expected utilization increase or 2027 revenue contribution from delirium monitoring.
• The high-80% gross margin outlook is based on current tariff policy and the company’s existing inventory position.
• Management said newly launched VA accounts initially tend to have lower utilization than a typical account, although usage has increased as CeriBell and its customers gain experience.

Analyst Q&A Highlights

Delirium growth profile: Management expects the near-term benefit, particularly in 2027, to come mainly from higher utilization at existing accounts. Over time, new hospitals may launch seizure and delirium monitoring together, potentially starting at higher usage levels.

Same-store growth: CeriBell tracks actual device utilization through its cloud-enabled platform. Management said utilization reached a record level in Q3, although customer purchases were slightly lower relative to usage during the quarter. Department expansion, physician engagement and protocol development remained the main growth drivers.

Commercial spending: The company said it has largely completed the infrastructure investments needed for its current growth initiatives. Future spending decisions will depend partly on the early performance of the delirium launch and the company’s cash flow breakeven objective.

VA expansion: CeriBell secured a VA commitment broadly in line with the prior year’s level. Management expects the related hospitals to enter the active account base over the next two to three quarters.

Full Earnings Call Transcript

Complete Earnings Call Transcript

Management Remarks

Operator

Thank you for standing by. My name is Jordan, and I'll be your operator today. Welcome to the CeriBell Q3 2026 Earnings Call. [Operator Instructions]

I would now like to turn the call over to Brian Johnston to start today's conference. You may begin.

Brian Johnston

Good afternoon, and thank you all for participating in today's call. Joining me from CeriBell are Jane Chao, Co-Founder and Chief Executive Officer; and Scott Blumberg, Chief Financial Officer.

Earlier today, CeriBell issued a press release announcing financial results for the quarter ended September 30, 2026. A copy of the press release is available on the Investor Relations section of the company's website.

Before we begin, I'd like to remind you that management will make remarks during this call that include forward-looking statements within the meaning of federal securities laws and that these are being made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements contained in this call that relate to expectations or predictions of future events, results or performance are forward-looking statements.

These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. For a list and description of the risks and uncertainties associated with our business, please refer to the Risk Factors section of our public filings with the Securities and Exchange Commission, including our annual report on Form 10-K filed with the SEC on February 24, 2026, and quarterly report on Form 10-Q for the quarter ended September 30, 2026.

This conference call contains time-sensitive information and is accurate only as of the live broadcast today, November 3, 2026. CeriBell disclaims any intention or obligation, except as required by law, to update or revise any financial projections or forward-looking statements, whether because of new information, future events or otherwise.

And with that, I'll turn the call over to Jane.

Xingjuan Chao

Good afternoon, and thank you for joining us for our third quarter 2026 earnings call. Q3 marked another strong quarter for CeriBell as we delivered revenue of $29.3 million, growing approximately 30% year-over-year. Underlying growth was driven by success across both core revenue drivers, adoption by more accounts and deeper penetration within our installed base.

In Q3, we increased our account base by a record 35 hospitals to a total of 747 active accounts. This is a reflection of the continued maturation and strong performance of our account acquisition team. We maintain a robust pipeline of unlaunched accounts that we expect to drive sustained growth in the coming quarters.

Headband utilization also reached a new record in Q3. Year-over-year usage per account grew at a double-digit rate, the highest we have seen since our IPO. This builds on our Q2 momentum and reflects the execution of our playbook, provider engagement, department expansion and patient population protocolization.

Department expansion is particularly accelerating. We have expanded into more departments year-to-date in 2026 than we did during the entirety of 2025, and we expect to continue the pace. These results collectively serve to further validate our core seizure business as a durable growth engine.

Overlaying our core strategy, we are also making progress against several key initiatives we have launched this year to supplement our organic growth. First, we are seeing positive signs out of our newly established strategic account management team. Through top-down engagement with regional health systems, we believe this team will drive new avenues for account growth. While these opportunities unlock at inherently longer sales cycles, we continue to see larger deals advancing through our sales funnel.

Second, our VA and DoD strategy remains a growth driver with strong engagement with both government health systems. In Q3, we secured a commitment to further expand within VA, which should have a positive impact on active accounts and revenue growth in the coming quarters.

Finally, interest in our neonate product remains strong, with ongoing pipeline development and activation of NICUs within new and existing accounts. With strong signal across each of these key 2026 initiatives, we are well positioned to drive continued revenue growth as we move into 2027.

Now, I'd like to turn our attention to delirium, our next major growth opportunity. Earlier this week, we announced the launch of our delirium monitoring solution. We recently concluded a commercial pilot, evaluating clinical utility and adoption among customers already using our seizure platform. Six months later, I'm excited to report that the pilot has shown meaningful impact, both in optimizing patient care and in validating our delirium monitoring solution as a new revenue stream.

The encouraging results we shared last quarter have continued now across a larger number of accounts. Customers reported improvements in clinical decision-making and positive user experiences. In many cases, our solution is enabling long-term monitoring for the first time, which is especially notable in difficult to assess patients.

To illuminate this clinical value, I'd like to share a patient story that highlights the unique benefits offered by our delirium monitoring solution. In this case, a woman in her early 30s with sepsis was admitted to the ICU at a 150-bed community hospital and primary stroke center. The patient was not at neurological baseline. So the care team placed a CeriBell headband to evaluate potential causes. The system returned a seizure negative result and the delirium positive result, giving the team immediate objective direction to focus on delirium management.

Before adopting CeriBell's delirium monitoring solution, this site's delirium assessments were inconsistent and rarely part of routine discussion. Here, the result prompted nurses, physicians and pharmacists to review potential contributors together. In a septic patients, antibiotics was not always questioned. This time, the team identified cefepime, a commonly used antibiotic with neurotoxicity as a potential contributor to patients' delirium and elected to transition the patient to a different antibiotic drug.

Besides the initial delirium detection, CeriBell also enabled continuous monitoring after the antibiotic adjustment. The delirium trend began to decrease. By day 3, the patient was no longer delirium positive. The team believes the objective diagnosis and trend monitoring gave the team a clear reason to revisit the infection treatment decision and the information necessary to determine that their strategy was effective in resolving delirium.

Clinicians at other sites have reported similar experiences, validating our value proposition and driving repeat usage. CeriBell helps care team to recognize delirium rapidly while opening management pathways from medication reviews to nondrug interventions. As these experiences accumulate, we expect adoption to broaden and usage to become entrenched.

Within the pilot, the clinical utility of our system has directly translated into commercial impact. We are seeing a material increase in headband utilization by established customers who subsequently launched our delirium monitoring solution. Future growth is likely to result from patient population expansion, significant clinical utility from simultaneous monitoring for delirium and seizure and engagement with customers. This impact has proven durable with our earliest customers having had at least 120 days of usage following launch.

Importantly, the usage impact was seen before our NTAP went into effect on October 1, suggesting that clinical utility is a primary driver. As we continued refining our launch practices, we have also seen even larger usage impact in more recently launched accounts. Based on these results, we believe that reducing barriers to adoption will enable us to drive meaningful commercial impact.

As we move into commercial launch, we are offering our delirium monitoring solution as a software upgrade to CeriBell customers at no incremental increase to the subscription fee. Instead, we're requiring interested customers to partner with us through program commitments that we believe are critical to maximize clinical utility and sustained usage. For example, we ask our customers to ensure we can train more than 80% of their nurses and physicians during launch processes and align on KPIs for delirium monitoring and management.

We are also working with customers to ensure that they have sufficient recorder capacity to handle the increased patient volume and potentially longer monitoring durations for delirium. This approach ensures that our customers are set up for success with high-quality launches. Providing the product without incremental subscription cost largely avoids lengthy sales and contracting processes that could slow adoption. That said, the launch process that we have seen drive impact requires thoughtful execution over time. Implementing such a disruptive technology involves customers evolving their practice and working closely with our team.

We expect that many accounts will adopt our delirium monitoring solution quickly, but broad-scale conversion will occur over time. We believe this approach will ultimately maximize sustained revenue impact from increased clinical usage, the key metric for revenue contribution from our delirium monitoring solution. We will continue to track the utilization impact as we move from pilot into full launch.

As part of our 2027 financial guidance, we plan to provide a more granular perspective on anticipated revenue impact associated with this greenfield market opportunity. Importantly, our strategy will be executed by our existing sales organization, provide greater leverage of our commercial infrastructure. We look forward to providing updates on these elements of our delirium monitoring solutions impact on our financial performance as well.

Our product development strategy rests on 2 core pillars: enhancing our algorithms to deliver better clinical insights and innovating our hardware platforms to support the algorithms. Our delirium monitoring solution is an excellent example of the first pillar as it expands our reach into new patient populations. We also continue to develop other algorithms that increase the clinical utility of our product for our physician customers.

Two such examples are recently FDA 510(k) cleared algorithms for quantitative EEG trending and Amplitude-Integrated EEG Analysis. Quantitative EEG or qEEG extends 3 functionalities: alpha-delta ratio, relative alpha trending, and burst suppression monitoring. Clinicians commonly use these trends by managing complex neurological conditions to help assess brain distress, reduced blood flow or excessive sedation.

However, these outputs remain largely inaccessible for the bedside clinicians despite their clinical relevance. Our algorithm will change that. We offer our customers greater insights into patients' brain activity. This materially strengthens our value proposition for both bedside users and neurologists. These features will be released via a cloud-based software update next year.

Meanwhile, our LVO stroke clinical program continues to move forward. We are also actively exploring additional algorithm development opportunities to add to our platform. Collectively, these stand to drive more clinical impact and market expansion longer term. We look forward to sharing updates on these potential opportunities in the future.

Very excited about our progress in algorithm development, but we're not stopping there. The second prong of our strategy is focused on enhancing our hardware platform. As we have discussed, we intentionally designed our new hardware platform to expand functionality and integrate additional modalities in support of our vision for EEG as a vital sign.

We are now thrilled to unveil the product name for this platform, Omni. The name Omni, which is Latin for everything, precisely represents our vision for the future. For the first time ever, hospitals can access the speed of point-of-care EEG while maintaining the comprehensiveness of conventional EEG, enhanced by our 8 FDA-cleared algorithms that monitor the brain for seizure, status epilepticus, delirium and other brain stress indicators, all in one platform, Omni.

With Omni, we are introducing video, multiple-day continuous monitoring capability, EKG compatibility and a parasagittal add-on to provide full montage coverage when needed. This delivers the core features of conventional EEG without sacrificing the ease of use, speed and accessibility of point-of-care EEG. Even more critical to our vision, the system was designed to run all our algorithms, enabling brain monitoring across multiple disease states. It is one elegant solution that meets the needs of both bedside clinicians and urologists. The tool we believe, is truly unique. We will initiate a limited market release on Omni this quarter and expect to launch the product in 2027. We will share more details as we get closer to launch.

As I step back, it is clear that our vision of EEG as a new vital sign is no longer theoretical. After scaling our commercial presence and receiving 9 FDA clearances in the last 18 months, we are now closer than ever to bring our vision to market. We see 2027 as a pivotal year. Seizure detection will act as a durable base business. Both account acquisition and utilization are growing independently, compounding each other. Our hardware and software enhancements will extend our category leadership. Our delivery and monitoring solution will be fully launched. And now we have greater conviction in our ability to bring the totality of our innovation into a single product platform, Omni.

CeriBell is at an inflection point. After years of investment and growth, we're excited to begin our new chapter while continuing to deliver singular value to our customers and the patients they care for.

With that, I will now turn the call over to Scott Blumberg, our CFO, to provide a review of the third quarter results and 2026 guidance.

Scott Blumberg

Thank you, Jane, and good afternoon, everyone. As Jane highlighted, total revenue for the third quarter of 2026 was $29.3 million, which is an approximately 30% increase from $22.6 million in the third quarter of 2025 and a 4% sequential increase. The increase was primarily driven by success of our same-store growth strategy in addition to increased adoption of the CeriBell system across new and existing accounts.

Products revenue for the third quarter of 2026 was $22.2 million, representing an increase of 31% from $17 million in the third quarter of 2025. Usage per account in Q3 grew by a double-digit percentage, the highest level we've seen since our IPO. Subscription revenue for the third quarter of 2026 was $7.1 million, representing an increase of 28% from $5.6 million in the third quarter of 2025. We ended Q3 with an active account base of 747 hospitals, representing an increase of 35 accounts in the quarter.

Gross margin for Q3 2026 was 90% compared to 88% in the prior year period, demonstrating our ability to continue generating outsized gross profit that fuels our growth-oriented investments. Based on today's tariff policy and current inventory position, we expect to maintain margins in the high 80% range going forward.

Total operating expenses in the third quarter of 2026 were $46.9 million, an increase of 36% compared to $34.6 million in the third quarter of 2025. Noncash stock-based compensation expense was $7.1 million in the third quarter of 2026 and $3.3 million in the prior year period.

Sales and marketing expense of $25 million in the third quarter reflects continued investment in our commercial organization, including investments in our CAM infrastructure in advance of the launch of our delirium monitoring solution.

G&A expense of $14.5 million in the third quarter include the expenses related to our ongoing IP litigation, which totaled $1.1 million. We expect litigation-related activities to remain low in Q4, so we may be subject to paying $2.9 million in deferred legal fees based on the outcome of our current ITC proceeding.

Research and development expense of $7.4 million in the third quarter reflects investments we've made into our platform, including our next-generation hardware, algorithm development and clinical studies. Outsized growth in R&D expenses has driven meaningful impacts, including accelerating commercial launch of both our delirium monitoring solution and Omni.

Net interest and other expense for the third quarter was $803,000. This includes $1.5 million in expenses associated with the extinguishment of our prior debt facility, partially offset by interest income earned on cash and marketable securities. With our new revolver first debt structure, we expect that interest expense will decrease materially going forward to less than $1 million annually.

Net loss was $21.4 million for the third quarter of 2026 or a loss of $0.55 per share compared to a loss of $13.5 million, or a loss of $0.37 per share in the third quarter of 2025. A weighted average share count of 38.5 million shares was used to determine loss per share in Q3 2026.

Adjusted EBITDA reflects our net loss before interest, taxes, depreciation and amortization expense and also excludes noncash stock-based compensation expenses, legal expenses associated with our ongoing IP litigation and loss from extinguishment of our prior credit facility.

Adjusted EBITDA loss for the third quarter of 2026 was $12.1 million as compared to $9.2 million in the third quarter of 2025. This reflects our continued strategy of thoughtfully deploying gross profits from our expanding revenue base back into the business to pursue long-term growth opportunities.

Our cash, cash equivalents and marketable securities as of September 30, 2026, were $117.5 million. We remain committed to our objective of achieving cash flow breakeven with cash on hand and the strength of our balance sheet and strong gross margin profile give us a high degree of confidence in our ability to do so.

Turning now to our outlook for 2026. We expect full year 2026 revenue to range from $115 million to $117 million, up from our prior guidance of $114 million to $117 million. This represents annual growth of 29% to 31% over 2025. This change to guidance reflects the momentum we're seeing in our core business with success driven both by new account additions and usage within our established account base. This range does not include material contributions from our neonate, pediatric, or delirium products, which we expect will begin to translate to revenue more meaningfully in 2027.

With that, I'll turn the call back to Jane.

Xingjuan Chao

Thank you, Scott, and thank you all for your time today. Q3 reinforced the confidence we have in our trajectory. Our core seizure business is a strong and projectable base. Our delirium pilot has been successful, and we are very optimistic moving into full commercial launch. Our commitment to investing in innovation, including multiple new algorithms and our Omni platform has set the stage for a pivotal 2027.

We have less than 4% penetration in our core seizure market, which tells you how much runway is still ahead of us. And we are advancing into new greenfield markets with urgency and purpose. Our mission to establish EEG as a new vital sign remains our North Star and the progress we made in Q3 give us every reason to push even harder. Thank you again for joining us.

I'll now turn the call over to the operator for Q&A. Operator?

Operator

[Operator Instructions] Your first question comes from the line of Gracia Mahoney from Bank of America.

Question-and-Answer Session

Gracia Mahoney

This is Gracia on for Travis. I just wanted to start out, it looks like the subscription revenues sort of offset a little bit of the upside you had on product revenues this quarter. So I wanted to see if there's anything to call out and change in expectations versus 3 months ago and how that trend informed any -- you're only raising the bottom end of the full year guide while the top end is unchanged and how maybe the new algorithm updates could factor into that outlook in Q4 and into '27?

Scott Blumberg

Thanks, Gracia. Yes, we saw quite a bit of strength on the product margin. That was driven by the same-store growth driver there. We saw record usage, new utilization per account growth, which reflected itself in the product revenue line. Nothing really changes going forward. We still expect the majority of our revenue to come from product, but continue to see subscription as a durable long-term growth driver.

Operator

Your next question comes from the line of Robbie Marcus from JPMorgan.

Henry Walker Householter

This is Henry on for Robbie. Just wanted to ask a little bit more on delirium. And I was wondering, could you talk about any changes to the commercial strategy that you might be planning now that delirium here, maybe in terms of adding new accounts versus deepening accounts? And maybe also on the OpEx side. In the press release, you called out some increased infrastructure costs in advance of that launch. So how should we be thinking about expenses going forward associated with this launch?

Xingjuan Chao

Yes. We see delirium drive both utilization and also accelerate the new account acquisition. The more near term, potentially, especially in 2027, we'll see much more coming from utilization growth as it is quicker to turn our existing accounts to start using delirium in the pilot, we saw a very meaningful utilization increase. However, in the longer term, we also anticipate more and more of our new accounts will start with seizure and delirium together. So the account would launch at a higher usage or higher revenue.

In terms of OpEx, it's very important for us to emphasize that the delirium launch would be leveraging our existing sales team, both our current CAM and TMs. And they -- let's take CAM as example, they already have very strong relationship with ICU. They know the stakeholder. They go to the sites anyway. So not only we can leverage the existing sales force, there is a big synergy between seizure and delirium as well. As we see the accounts grow in the commercial pilot, we see it's a growth of both seizure awareness as well as delirium-related patient expansion.

Operator

Your next question comes from the line of Brandon Vazquez from William Blair.

Brandon Vazquez

Jane, you had mentioned, and I think this was in the press release, too, that your same-store growth had reached double digits in the quarter in the utilization and that it was one of the best numbers you've seen since the IPO. I was hoping you could spend a minute talking about that. One, also maybe clarify a little bit the same-store metric. I think us on the Street use a slightly different like utilization metric. How do you define that? And then two, what's driving it? Is it already seeing some of the benefits of pediatrics that is entering its first full quarter of launch?

Xingjuan Chao

Thank you, Brandon. I'll answer your question about the same-store growth. And in terms of different metrics definition, maybe Scott can help cover that. I would say it's really a continuous execution of the playbook that we have established probably about 18 months ago. We did very thorough way of a series of commercial pilot, and we become very focused on 3 drivers that is departmental expansion, both expanding to other ICU as well as ED and the physician engagement and protocolization.

So we really just continue to build the team, have amazing team in place and continued execution. Particularly, we saw the department expansion is accelerating, as I mentioned. We started focus on emergency department last year, and we start to see a very strong buy-in from the ED as we significantly optimize the patient flow there.

In terms of pediatric and neonate, as Scott mentioned in the call, it's still a little bit too early because we have now close to 750 accounts. Even we launched -- sorry, pediatric and NICU a few months ago, it's still going to take some time because our installed base is so big.

Scott Blumberg

And then as far as the metric definition goes, we run the business and collect data on utilization, since we're a cloud-enabled device, we know precisely when our device is being used as well as a lot of other data around usage patterns. And that's how we monitor the business. That's how we incentivize the team. That number was record high. There was a slightly lower number of purchases relative to usage this quarter. That's not something we endeavor to control. We think over the long term, utilization is the core metric, and that's where we were a record high this quarter.

Xingjuan Chao

Sorry, maybe I'll add one more thing about the same-store growth related to department expansion, that's accelerating. We also see that, that type of usage is even more durable and sustainable because once you are in the department, each year as you launch in the different period of the year, you only capture partial revenue there. So it's not just, oh, we went there usage growth, we actually know precisely the driver and KPI. So that gives us even more confidence that we'll continue this trend.

Operator

Your next question comes from the line of Bill Plovanic from Canaccord.

William Plovanic

Can you hear me okay?

Xingjuan Chao

Yes.

William Plovanic

Okay. So I wanted to talk about just one on delirium. I was wondering if you could help maybe quantify it in some way, shape or form for us in terms of how deep did the pilot go? How long do you think this will take to roll into all of your accounts? And then what type of utilization increases did you see in the pilot? Is this a 25% increase, a 50% increase? I mean how -- or 100% increase? How should we think about this impacting and then how long it takes for the impact?

Xingjuan Chao

Thank you, Bill. It's a bit too early for us to quantify those very important questions you've asked because we are just launching delirium as we speak. However, as we get close to guiding 2027, we should be able to provide more granular guidance there.

Operator

The next question comes from the line of Jayson Bedford from Raymond James.

Jayson Bedford

Congrats on the progress. Maybe just to follow on Bill's question. The delirium pilot, you mentioned seeing material increases in headband utilization. I was just a little unclear. Are you referring just to delirium? Or are you seeing pull-through into higher utilization within seizure?

And then my second question is just on the delirium software rollout. Are there minimum volume commitments tied to this program?

Xingjuan Chao

Yes. Clinically, it's very difficult to separate seizure and delirium, especially in the ICU or the floor setting, and ICU is our main target to launch delirium. So all our commercial pilot sites were in ICU. What we saw -- so all these patients, physicians monitor ICU and -- sorry, seizure and delirium together. So it's very challenging for us to separate. That being said, we have seen multiple drivers in the sites. We saw patient expansion. For example, many sites did not monitor sepsis patient alone just for seizure. And because seizure and delirium together, they start to monitor sepsis patient or other patient population.

We also saw an increase of existing patients and our hypothesis there was because we had more face time with physicians and nursing team. So we are further raising not just the awareness of delirium but also seizure. So we think we're driving both the usage of seizure and delirium together. Again, it's a joint monitor. We don't really separate them.

Scott Blumberg

Yes. As far as the commitments, we're setting up workflows and working with customers to ensure they're set up for success, and that's what we saw the effective in the pilot. It is driving a material impact. As far as contractual obligation to volumes, we're not requiring that. But the degree of consistency of the usage patterns in the pilot gives us high conviction that if customers kind of follow the script here and engage with our customers that we'll see the usage impact.

Operator

Your next question comes from the line of Josh Jennings from TD Cowen.

Unknown Analyst

This is Brian for Josh. I wanted to ask about the VA. You said you've secured a commitment to further expand in the VA. Do you expect to see year-over-year growth in VA account additions in 2027 compared to this year? And can you share anything on the utilization growth that you've seen so far at VA accounts?

Scott Blumberg

Yes. I can cover the volume piece. So the VA runs pretty strictly on a September fiscal year-end calendar. And so the commitment was secured towards the end of last fiscal year for this coming fiscal year. The size of the commitment is reasonably in line with what we saw last year. And so we'd expect those to roll into the account base over the next 2 to 3 quarters or so. We're in a meaningful number of VAs, we're still -- even after we launch these accounts in the minorities, there's plenty of headway to grow.

Xingjuan Chao

And in terms of the VA usage, we don't quantify specific hospital systems. However, in general, when we see the top-down launches, we saw at earlier, the usage tend to be a little bit lower than our typical average account. However, as we gain more experience, also as our customers gain more experience, we do see a growth as we launch more and more VA accounts. As we continue to gain more experience, we have confidence we'll continue to drive not just getting into more VAs, but also sustainable usage in these accounts.

Operator

Your next question comes from the line of Marie Thibault from U.S. Bank.

Marie Thibault

My question is mainly trying to understand the direction sales growth and expense growth might be headed. I'm not asking for 2027 guidance, but just want to better understand when we might start to see an inflection from the territory managers that you added -- started adding a couple of years ago and if we should be expecting increased investments as you move into the delirium launch and continue the neonatal and pediatrics. So just a better understanding of the trends here going forward.

Scott Blumberg

We've made investments this year that really fuel our growth drivers for 2027, which includes the strategic account management infrastructure for the regional health systems, delirium and otherwise. So as far as the infrastructure we have, we've largely made the investments for the stuff that's in front of us. We do pay very close attention to the decisions we make in terms of infrastructure investments, both on sales, R&D and otherwise to ensure that we align with our North Star, which is achieving breakeven with cash on hand. That said, we do evaluate the most recent facts quarter-to-quarter and make investment decisions based on the most relevant and recent information.

So short answer is we feel very good about the infrastructure we have, and we'll pay very close attention to the business, in particular, the success of delirium over the next few months and make the right decision with the right information.

Operator

Your next question comes from the line of Jeffrey Cohen from Ladenburg Thalmann.

Jeffrey Cohen

I wondered if you could expand upon the pilot for delirium with seizure. And could you talk about any learnings as far as the clinical workflow and maybe how that may relate to some of the guidelines that the societies have out there currently?

Xingjuan Chao

Just to make sure I understand your question, you're asking about the workflow related to seizure and delirium and how the guideline -- how -- what existing guidelines have in guiding the usage of seizure and delirium monitor?

Jeffrey Cohen

Yes, and how that may change.

Xingjuan Chao

Yes. The current guidelines are relatively separated when they guide how to triage and monitor seizure and manage seizure versus how they detect and manage delirium. But -- so that's why when we launch these accounts, we often go in and merge these guidelines together. It's more to raise awareness of these guidelines to the patient. I use sepsis patients as example, and there are many clinical evidence publications show that sepsis patients, about 10% to 15% of them, if they have altered mental status in ICU, they would have seizure. And then there are about 60%, 6-0 percent of sepsis patients would have delirium.

And the patient sees right after seizure, they could later develop delirium. And also the symptom of seizure delirium is also very similar. So all this together makes very difficult for the bedside nurse and physicians to decide both, is it patients seizing or having delirium? Also, when you start the management path with of seizure and delirium, are you on the right track? So that's exactly where our device come in. And we can clearly, for example, the case study I shared in the earnings call, this woman in the 30s with septic shock, she could be having a seizure. But our device say, no patients having delirium, so manage your delirium that lead to the medication review of cefepime.

You could see a very similar presentation of patient, but the device might come back, say, no patient seizing, and that would completely change the course, that would treat patients with anti-seizure medication instead of medication review. So that's some example of the workflow. We obviously don't design the workflow for the hospital. We more share other hospitals workflow and the existing guidelines to support our customers.

Operator

There are no further questions. I'd like to turn the call back over to Jane Chao for closing remarks.

Xingjuan Chao

Well, thank you, everyone, for joining the call. We are very excited and proud of what we have accomplished in Q3, and we're very excited about what's ahead of us as well. Look forward to sharing more of the good news moving forward.

Operator

This concludes today's meeting. You may now disconnect.