Surveillance for quality assessment: III. The critical assessment of quality indicators.

The first two articles in this series reviewed the reasons for widespread acceptance of surveillence and control methods in hospital infection control programs, and discussed important factors contributing to the successes and failures in applying this approach to noninfectious nosocomial events.1,2 The quality assurance program "targets of surveillence" identified in these articles are referred to as "quality indicators" by other authors and have been defined as "a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities."3 This article highlights those attributes of quality indicators that should be critiqued prior to implementation in a patient care review environment and discusses methods of improving quality indicator performance with ongoing monitoring and evaluation.