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.

• 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

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.

• 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.

• 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.