Visual Alert Level [Neurosurgery Wiki]

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===== Visual Alert Level =====

A **visual alert level** in CUSUM analysis is a predefined horizontal line drawn on the chart that serves as a **trigger point** for clinical or educational attention.

It does not always correspond to formal statistical thresholds but is used as a practical tool to:

  * Highlight when **performance may be deteriorating**
  * Prompt **early review or feedback**
  * Enhance **interpretability** for supervisors, trainees, or quality officers

==== How It Works ====

In the CUSUM chart:
  * The **y-axis** represents the cumulative deviation from expected performance.
  * The **x-axis** represents sequential cases.
  * A **horizontal dashed line** (e.g., at 2.5) indicates the **alert threshold**.

When the CUSUM curve **crosses this level**, it visually suggests that the number or magnitude of complications exceeds the acceptable trend.

==== Why Use a Visual Alert Level? ====

  * Offers a **quick and intuitive signal** for clinical educators and QA teams
  * Simplifies decision-making during **resident supervision**
  * Acts as a **communication tool** in performance reviews and morbidity & mortality (M&M) meetings
  * Encourages **proactive action** rather than reactive analysis

==== Example ====

In our ICP monitor placement example:
  * Target complication rate: ''k = 0.1''
  * Visual alert level: ''CUSUM ≥ 2.5''
  * The CUSUM curve approached this line during the first 12 cases but remained below it, suggesting early variability followed by stabilization.

==== Customization ====

Visual alert levels can be adjusted based on:
  * Procedure risk profile
  * Surgeon experience level
  * Institutional quality standards

They serve not as punitive thresholds, but as **safety-oriented prompts** to reflect and improve.