How to Address a Quality Problem

Abstract

For quality improvement (QI) projects, the Translating Research into Practice (TRiP) framework is an ideal model for developing and addressing topics locally (see Fig. 6.1) (Pronovost et al. BMJ 337:a1714, 2008). The TRiP framework is a four-step process that evaluates best practices with the goal of creating strategies for implementation at a local level. Using high-quality evidence, the TRiP framework utilizes multidisciplinary collaboration to incorporate knowledge translation for broader dissemination of knowledge into practice. Each step focuses on systems of care rather than care of individual patients with engagement of multidisciplinary teams to assume ownership of the QI project. Finally, this framework encourages adaptation so that the QI intervention can meet the culture of the implementing group when expanded regionally or nationally (Pronovost et al. BMJ 337:a1714, 2008). At the Johns Hopkins Hospital, we have successfully utilized this framework to reduce central line-associated blood stream infections (Pronovost et al. BMJ 340:c309, 2010) and improve prescription of risk-appropriate venous thromboembolism (VTE) prophylaxis (Streiff et al. BMJ 344:e3935, 2012). For this purposes of this chapter we will give examples of these successful interventions, though each step can be applied to meet different quality improvement goals.