===== Acceptable Risk Policy =====

An **acceptable risk policy** defines the maximum complication rate that an institution, department, or surgical training program considers tolerable for a specific procedure, patient population, or supervision level.

This policy directly influences the **reference value (k)** used in CUSUM analysis and helps determine when performance remains within safe boundaries.

==== Why It’s Important ====

  * Establishes **clear expectations** for surgical quality
  * Serves as a benchmark for **performance evaluation**
  * Promotes **fair comparison** across individuals and teams
  * Guides decisions about **training thresholds**, credentialing, and escalation of care

==== How to Define Acceptable Risk ====

The acceptable risk should be based on:
  * **Historical institutional data**
  * **Evidence from peer-reviewed literature**
  * **Patient safety standards**
  * **Level of supervision**
  * **Case complexity profiles**

Example (for ICP Monitor Placement):
  * Acceptable complication rate (infection, hemorrhage, malposition): **10%**  
  → Set ''k = 0.10'' in CUSUM formula

In high-risk populations or emergency settings, a slightly higher threshold (e.g., 12–15%) may be reasonable.

==== Policy Implementation Tips ====

  * Define acceptable risk levels **per procedure**.
  * Document policies in surgical protocols or quality assurance guidelines.
  * **Review annually** to adapt to changing technologies, training levels, or outcome data.
  * Ensure all surgeons and trainees are **aware of the defined thresholds**.

==== Integration with CUSUM ====

  * The acceptable risk policy provides the **reference rate** for CUSUM.
  * Deviations from this benchmark are interpreted within the policy’s context.
  * Helps distinguish between **random variation** and **true underperformance**.

Having a well-defined acceptable risk policy ensures that performance monitoring is **transparent, consistent, and ethically grounded**.