National studies demonstrated the average range of AKI to be approximately 9% in the THA/TKA elective population. After conducting a data analysis at this health system, it was identified that the acute kidney injury (AKI) and hypotension complications in the elective TKA/THA population had significantly high rates post procedure. A multidisciplinary team set a goal to reduce post-operative acute kidney injury and hypotension rates in the elective orthopedic THA/TKA population by 25% within one year of project implementation. A long term goal was established to reach top decile performance for AKI and hypotension in the elective total joint population. Focus would be directed towards identifying patients who may be at risk for AKI and hypotension pre-operatively and mitigating their risk factors for AKI and hypotension. A series of decision support mechanisms were developed to drive improved patient outcomes based on the modifiable risk factors were identified to improve patient care.