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Waiting time is one indicator of health services. The increase in waiting time in the Emergency Department (ED) has an impact on longer treatment days, increased mortality and reduced patient satisfaction. The purpose of this study was to determine the length of stay for services at the emergency department of the Tangerang General Hospital using lean method to determine waste at each stage of activity. This research method is operational research with qualitative and quantitative approaches, primary data sources taken from direct observation using time motion study techniques and in-depth interviews. The waiting time at the ER at the Tangerang Regency General Hospital is 852.92 minutes for inpatients and 564.24 minutes for outpatients. The length of time for each service is as follows: triage is 11.83 minutes, waiting time for an emergency room doctor examination is 32.25 minutes, drug administration time and action is 22.33 minutes, waiting time for laboratory examination is 106.07 minutes, waiting time for examination radiology 140.15 minutes, waiting time for specialist doctor consultation 146.54 minutes, waiting time for inpatient registration 164.8 minutes, waiting time for inpatient admission 58.5 minutes, patient administration time going home 89.6 minutes. The largest nonvalued added activity is waiting for specialist consultations. Found 2 types of waste, namely waiting (93.3%) and motion (6.7%). After conducting an analysis using the 5 why method, the root of the problem was found in the number of nurses, not yet maximally carrying out tupoksi, hospital information system applications that are less user friendly, specialist doctors are not standby and consultation SOPs are not optimally run, lack of clinical experience of doctors ER, as well as the unavailability of the ward. The conclusion, t the waiting time in the ER at the Tangerang General Hospital exceeds the standard time (4 hours). The lean approach is appropriate to look for waste in health service activities so that problem solving efforts can be obtained to improve service waiting times in the IGD RSU Tangerang Gneral Hospital
Penelitian ini dilatarbelakangi kenyataan bahwa Instalasi Gawat Darurat merupakan suatu unit pelayanan di rumah sakit yang harus dapat memberikan pelayanan yang cepat dan tepat agar tujuan dari pelayanan gawat darurat dapat tercapai dan sekaligus memberikan kepuasan kepada pasien atau keluarganya.
Tujuan penelitian ini untuk mengetahui gambaran umum waktu tunggu persiapan operasi cito di IGD dan faktor-faktor yang berhubungan dengan waktu pelayanan terhadap pasien yang akan menjalani operasi cito.
Jenis penelitian ini merupakan studi kasus dengan pendekatan kualitatif. Data dan informasi mengenai proses pelayanan diperoleh melalui wawancara mendalam, fokus grup diskusi, observasi partisipatif dan telaah dokumen. Sedangkan data mengenai waktu pelayanan diperoleh melalui pencatatan waktu pelayanan mulai dari tahap penetapan operasi sampai saat dilakukan sayatan pertama di meja operasi.
Hasil penelitian menunjukkan bahwa waktu tunggu persiapan operasi cito di IGD RS Karya Medika I berhubungan dengan lamanya persetujuan operasi dari keluarga atau penanggung jawab biaya, ketidaksiapan SDM kamar operasi termasuk dokter operator dan dokter anestesi, serta keterbatasan peralatan operasi.
Untuk mempersingkat waktu pelayanan terhadap pasien yang akan menjalani operasi cito, RS Karya Medika I perlu menetapkan kebijakan tentang penanganan pasien operasi cito, memperbaiki manajemen SDM kamar operasi dan sistem pengadaan alat kesehatan.
The background of the research was the fact that Emergency Care Unit is a particular service unit in hospital which has to be able to respond quickly and effectively in order to achieve the goals of emergency care service and at the same moment to deliver satisfaction to the patients and their families.
The purpose of this research was to know the general picture about the waiting time of cito operations in the Emergency Departement and the factors associated with the time of service to patients who will undergo cito operations.
This type of research was a case study wih a qualitative approach. Data and information regarding the service process were obtained from indepth interviews, focus group discussion, participant observation and document review, while data regarding the service time was gained from recording and calculating the time taken starting from the moment of surgery decision until the moment of the first incision on the operating table.
The result from the research showed that waiting time for the preparation cito operation in the Emergency Departement at Karya Medika I hospital associated with informed concent from the family or the insurance, human resources, and the equipment of operation.
To minimize the waiting time for preparation cito operation in Emergency Departement, Karya Medika I Hospital need to establish policies regarding the handling of patients cito operations, to improve human resource management and procurement of medical equipment systems.
Instalasi Gawat Darurat (IGD) memegang peranan penting dalam penanganan awal trauma berat untuk mencegah kematian maupun kecacatan. IGD Rumah Sakit Cipto Mangunkusumo (RSCM) telah menerapkan sistem “Cipto Code Trauma” sejak 2019 untuk menjamin waktu tanggap trauma berat < 5 menit, meski capaiannya belum memenuhi target. Penelitian ini dilakukan untuk menentukan faktor-faktor yang menjadi determinan waktu tanggap trauma berat di IGD RSCM, yang diharapkan dapat bermanfaat untuk perbaikan sistem. Penelitian dilakukan secara retrospektif terhadap pasien trauma berat yang berkunjung ke IGD RSCM tahun 2023-2024. Analisis dilakukan terhadap faktor pasien, struktur, dan proses layanan. Dari 124 sampel yang memenuhi kriteria inklusi dan eksklusi, karakteristik pasien terbanyak yaitu usia dewasa, laki-laki, dengan mekanisme kecelakaan lalu lintas, dan memiliki lebih dari 1 jenis cedera. Pasien umumnya datang tanpa Ambulans dan tanpa komunikasi pra-RS. Tanda vital saat datang sebagian besar normal. Pasien terbanyak datang pada malam hari, saat kondisi IGD padat, dengan jumlah tenaga di IGD mencukupi. Hanya 51,6 % pasien menggunakan jaminan. Rerata waktu tanggap trauma berat yaitu 12 menit 42 detik. Didapatkan bahwa faktor usia pasien, transportasi menggunakan Ambulans, frekuensi nadi saat pasien datang, waktu shift pelayanan di IGD, dan jumlah tim yang bertugas berhubungan dengan waktu tanggap pasien trauma berat di IGD RSCM. Waktu tanggap trauma berat tidak berhubungan dengan luaran pasien yaitu kebutuhan perawatan intensif maupun kematian.
Emergency Room (ER) plays a significant role in the initial management of severe trauma to prevent morbidity or mortality. Since 2019, ER of Cipto Mangunkusumo Hospital (CMH) have established “Cipto Code Trauma” system to ensure the response time of < 5 minutes, although the target has not yet been achieved. This study is performed to determine factors associated with response time for severe trauma in ER CMH, which could be beneficial for system improvement. This is a retrospective study on severe trauma patients admitted to ER CMH from 2023-2024. Analysis performed towards patient, structure, and process factors. Among the 124 samples fulfilling the inclusion and exclusion criteria, most patients are adults, men, due to traffic injury, and had more than 1 injury. Patients generally came without Ambulance nor prehospital communication. Vital signs were mostly normal. Patients mostly came on the night shift, during a crowded ER, and received by an adequate number of ER staff. Only 51,6 % of patients were covered with insurance. Mean response time was 12 minutes and 42 seconds. Patients’ age, Ambulance transportation, initial heart rate, time of service by shift, and number of personnel are associated with response time for severe trauma in ER CMH. Response time for severe trauma is not associated with the outcome of critical care requirement or mortality.
Implementation of ISO 9001:2008 Quality Management Standards have beenimplemented in BRSU Tabanan since 2009 in an effort to improve the quality ofcare , but there are still complaints against the ministry in BRSU Tabanan . Untilnow, this has never been done in the Emergency Room service performanceanalysis on the application of ISO 9001:2008 Quality Management StandardBRSU Tabanan . This study was conducted aimed to determine and analyze theperformance of services in the emergency department on the application of ISO9001:2008 QMS in Emergency Room BRSU Tabanan.Do months from August toOctober , 2013, with a qualitative research method that comes with thequantitative data is secondary data quality objectives in the Emergency Room asindicator performance .. Respondents service satisfaction in the emergencydepartment for patients or their families were coming month of August to October2013, which are willing to fill out a questionnaire , as many as 150 people .Emergency Room staff and staff working in the field of service of at least 3 yearsas respondents in the application of ISO 9001:2008 QMS Emergency Room are71 . In-depth interviews to the Board of Directors as an informant were 3 peoplein the achievement of performance information in the Emergency Room and theapplication of ISO 9001:2008 QMS . Data were analyzed using content analysis .The results show the performance of services in the Emergency Room alreadywell on target mutul 9 of 12 quality objectives in the Emergency Room . Qualityobjectives is not good customer complaints , customer dissatisfaction with theservices of doctors and patient mortality in Emergency Room ≤ 24 hours .Required an increase in the budget aimed at improving the quality of humanresources in the emergency department with increasing hospital revenue ,completing facilities for intensive care and resocialization of the application ofQMSKeyword : Performance Emergency Room Services, ISO 9001:2008 QMS
Analysis of Outpatient Installation Pharmacy Waiting Time at Special Hospital of Drug Addiction Jakarta in 2023 Abstract Prescription services waiting time in outpatient installations is one of the indicators for evaluating the performance of pharmaceutical installations that affects the quality of hospital services. Hospitals need to effort that prescription services waiting time meet the Minimum Service Standards (SPM). Through the Lean method with the Value Stream Mapping approach, this study aims to determine the prescription service procedures at the outpatient installation of RSKO Jakarta, identify value added and non-value added and waste that occurs so that factors that cause waste can be analyzed which can be prevented through the strategy recommendations obtained. This is a qualitative research with data collection obtained through observing and recording the e-prescriptions services waiting time at the RSKO outpatient installation, extracting in-depth information from informants and reviewing documents. Observations were made on 20 concoction medicine recipes and 10 concoction medicine recipes. The selection of informants was carried out using a purposive sampling technique and interviews were conducted with patients to obtain value from the customer's perspective according to the principles of the Lean method. The data obtained is then analyzed to obtain the factors affecting the prescription services waiting time duration using a fishbone diagram then a scoring system is carried out by assessing the urgency, severity and growth aspects of the cause problem so that priority recommendations can be formulated. The results of research conducted in April-May 2023 found that the average waiting time for prescription drug services was 49.25 minutes (VAR 17.5%) and for concoction drugs 80.2 minutes (VAR 33%), which means that it still exceeds the SPM set by KMK No. 128 of 2009 (no concoction drug recipe < 30 minutes, concoction drug recipe < 60 minutes). Some of the factors that cause waste are inefficiency in human resources, pharmaceutical inventory systems that have not been automated, inadequate evaluation/monitoring of drug use, the absence of a separate system for emergency prescription services, prescription service SPO that has not been adjusted with the establishment of prescription response time quality standardsfor each process, networks information system that frequently down/loads repeatedly and patient’s interruption for asking information. It is hoped that in the future an improvement strategy can be carried out to improve the waiting time for prescription services; increasing HR efficiency through arrangements so that during peak hours pharmaceutical HR focuses on working on the duties and functions of prescription services, facilitating a pharmaceutical inventory system with an automated system, implementing an evaluation system for monitoring drug use more effectively so that procurement planning becomes more accurate, regulation separates prescription services from the emergency room, providing SPO in accordance with prescription service implementation, separate the information system network between patient services and office and providing reachable information for pastient (visual management).