Anesthesia in Mongolia has undergone a period of major development over the past 17 years, thanks to the work of the Mongolian Society of Anesthesiologists (MSA) and the support of the World Federation of Societies of Anaesthesiologists and the Australian Society of Anaesthetists. The specialty has made major advances in training and in its standing among medical specialties in Mongolia. The MSA has produced members who are leaders in the development of anesthesia as well as emergency medicine and critical care. This has been achieved by engagement between the Ministry of Health and MSA, and with inexpensive but efficient programs to educate trainees and provide continuing professional development. There is now major work being done to achieve the Lancet Commission on Global Surgery goals of safe and accessible surgery for the population in a country that faces significant challenges of remote communities with vast distances.

Background There is a strong evidence base supporting the implementation of patient blood management systems to treat preoperative anaemia and reduce perioperative transfusions, yet implementation of these systems remains limited. The patient blood management practices at Northern Health are currently under review. This study evaluates the prevalence of anaemia in the Northern Health surgical cohort and determines the current blood management practices of each surgical unit to create recommendations for a hospital-wide implementation strategy that can be used as a framework for quality improvement in similar metropolitan hospitals.Methods Preadmission and perioperative data were collected for adults undergoing elective major surgery from orthopaedics, gynaecology, urology, colorectal and hepatobiliary units between April 2018 and March 2019. Data were analysed using the Shapiro-Wilk, the Kruskal-Wallis and Fisher's exact tests.Results A total of 697 patient files were analysed. 14Á2% of patients were anaemic at preadmission clinic with 37% of these attributable to iron deficiency. Anaemic patients had a higher rate of transfusion (P < 0Á05), length of stay (P < 0Á05) and complications (P < 0Á05) when compared to non-anaemic patients. The orthopaedic unit was the best performing in key areas of patient blood management. The orthopaedic unit successfully treated 44% of patients with anaemia, which was more than urology (33%; P < 0Á05), colorectal (25%; P < 0Á05) and hepatobiliary (0%; P < 0Á05). ConclusionThe orthopaedic unit has the most effective method for treating preoperative anaemia. We recommend that a hospital-wide patient blood management system be modelled from the current orthopaedic system and address specific barriers identified within each unit.