Blood Management Strategies

We promoted a reduction in blood transfusions for hip and knee replacement surgery. Both patients and the Alberta health system benefited from this clinical practice change.


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New practice and protocols for providing hip and knee replacements proved beneficial. They improved population health and the care experience, and reduced the per capita cost of care. We set out to enlist all care practitioners in the province in integrating the new care path. Amongst a complex, changing health landscape this presented a challenge.

Problems to Solve

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  •  Changing clinical practice
  • Changing culture
  • Appropriate preoperative optimization of patients


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We helped our partner, the Bone and Joint Health Strategic Clinical Network, with promoting provincial practice and culture change for blood transfusions. A provincial group of clinicians, health administrators, and frontline staff met regularly to identify challenges and barriers with changing clinical practice. Adding a measure on blood transfusion rates to ABJHI’s quality reports helped hospitals build on their efforts over time.

Tangible Outputs

  • Updated care path
  • Updated measurement framework
  • Modified balanced scorecards
  • Modified continuous improvement reports


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A strong culture of continuous quality improvement was essential in achieving improvements. Fewer blood transfusions led to better patient outcomes, conservation of precious blood resources, and cost savings to the health system.

From 2009 to 2020, the rate of transfusion in the hip and knee replacement population dropped from 19.4% to 1.5%. This equates to a cost savings of $11.7 million. In actuality cost savings are higher given data limitations (the number of blood products used per procedure and associated savings due to quicker recovery are unknown).

Wait times for hip and knee replacements continue to be a health system challenge. Alberta’s population is growing. Many Albertans are living longer, experiencing increased rates of obesity, and choosing arthroplasty as the “gold standard”. At the same time the demand for hip and knee replacements is increasing, other surgical procedures are falling behind targets.