Kingston Health Sciences Centre (KHSC) provides care to more than 500,000 people across southeastern Ontario. As of 2025, all the hospitals within this region, including Brockville General Hospital, Lennox and Addington County General Hospital, Perth and Smiths Falls District Hospital, Quinte Healthcare, and KHSC, have met national transfusion appropriateness benchmarks and achieved Using Blood Wisely designations.

Medical Director for Transfusion Medicine, Dr. Jeannie Callum, who played a role in the initial launch of the Using Blood Wisely program guidelines at several of these hospitals, made it her goal to unite the entire southeastern Ontario region and leverage shared learnings to ensure that all patients, from Belleville to Napanee and beyond, could access the high-quality care they require.

Working within a broad and primarily rural population, Dr. Callum began KHSC’s improvement efforts by addressing access. She knew that appropriate transfusion practices would only be possible if clinicians and patients had access to blood alternatives such as intravenous iron. This also meant finding and addressing inequities in access, such as ensuring that pregnant individuals had equal access to care and that patients were being treated promptly and with the correct doses. Once these barriers were addressed, the team could focus on education and guideline implementation.

Educational efforts began with a series of Grand Rounds on appropriate use of red blood cell transfusions and other major components. This was followed by rounds on adverse blood reactions, highlighting that blood is not a risk-free resource. For the region’s community hospitals, unable to host Grand Rounds, recordings were made available on the same topics, with a greater focus on specific guidelines.

“We wanted to highlight that there’s a downside to blood,” shares Dr. Callum. “And to get the message that there was a risk-benefit conversation that had to happen with a patient.”

Another vital component of the KHSC strategy was engagement of nurses and the wider allied health team. Dr. Callum’s past quality improvement work on the original Using Blood Wisely guidelines, as well as the START Study and Bloody Easy handbook, were effective in understanding how to engage and empower the health care community.

The team found that implementing these changes went smoother than expected. Particularly in Kingston, there was immediate adoption of guideline recommendations and patient blood management. Instead, these efforts were met with enthusiasm. In more rural sites, like Brockville, they focused much more heavily on clinician education. In the end, they created a community standard of care such that these shifts in transfusion practice came as second nature.

Once KHSC received its designation, sites within the region followed in quick succession. Since achieving the designation, overall blood utilization has improved across the region and Dr. Callum says that they can now complete the majority of surgeries almost entirely without needing a blood transfusion due to excellent deployment of intravenous iron and restrictive use of blood.

When it comes to staff response, it’s clear that this designation was meaningful. “This designation felt like proof that as a team we’re honouring our duty to patients,” says Dr. Callum. “Now people within this region know that when they go to the hospital, we’re trying our absolute best to only give them blood if there’s no other alternative, and we’re trying to do it right.”

Dr. Callum also added that they’re “not done yet.” The team continues to look for ways to make better use of resources, so every step forward improves patient care.