continuous quality improvement total quality management and reengineering one hospitals continuous quality improvement journey in recent years there has been significantly increasing interest in the application of continuous quality improvement cqi and total quality management tqm in the health care arena this case analysis is designed to identify and assess the strategies and processes that led to the successful implementation of cqi in the emergency care center at st marys hospital in grand rapids mi instillation of continuous tube irrigation in the septic knee at arthroscopy a technique the arthroscope was employed to install a continuous closed tube irrigation system in four septic knees in three patients who had complex medical problems this simple technique may be accomplished by the orthopedic surgeon with limited arthroscopic expertise in the open drainage versus closed aspiration dilemma that surrounds the management of septic arthritis this semiinvasive procedure offers promise as an alternative treatment in complicated cases of pyarthrosis of the knee