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"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV: 169-173Dentist is a specialist who must treat all types of disorder practically, involving the stomatognathic system. Unfortunately not all society has recognized the dentist's value within the "Total Healt Care System". ln developed socieus, the dentist is required to be involved in handling the emergencies, although not all members of the profession seem adequately prepared to deal with them without physician's help. In other hand, we know that most patient come the dental clinic as out patients, and therefore if emergency cases occurs in a dental clinic, it requires emergency treatment immediately. This might be caused by the lack of consciousness; it is only a temporary condition where the patient usually recovers quickly after first aid has been administered. However, the dentist might also be confronted with a more serious condition, which may present a great risk for the patient's life such as anaphylactic shock. In this condition, the dentist must know precisely which step to take if there is an emergency case. This paper discussed about emergency situation in dental practice and its management, so that the dentist can manage emergency cases in the dental practice in order to avoid any harmful action for the patient's life."

"Indonesia merupakan negara dengan keadaan geografi cenderung sering terjadi bencana alam. Demikian pula Jawa Barat yang mempunyai banyak gunung berapi yang masih aktif. Maka menjadi pertanyaan sudahkah Rumah Sakit Umum Daerah di wilayah Cirebon siap menghadapi bencana ?Penelitian ini bertujuan untuk mengetahui kesiapan Rumah Sakit Umum Daerah di Wilayah Cirebon dalam menghadapi bencana, dilakukan studi deskriptif dengan rancangan komparasi atas standar Baku terhadap keadaan 7 Rumah Sakit Umum daerah, melalui pendekatan kuantitatif data sekunder dan kualitatif.Informan dalam penelitian ini seluruh Direktur RUD dan seluruh Kepala Instalasi Instalasi Rawat Darurat se-Wilayah Cirebon. Digunakan analisa univariat dari data kuesioner kemudian dilakukan pembobotan sehingga dihasilkan skor kesiapan IRD, selanjutnya dilakukan analisa kesenjangan melalui wawancara mendalam dengan memperhatikan apa, siapa, mengapa, dimana, kapan dan bagaimana ketidaksiapan IRD.Hasil penelitian menunjukkan bahwa seluruh Rumah Sakit Umum Daerah di Wilayah Cirebon tidak siap menghadapi kegawat daruratan bencana/sehari-hari. Setelah dilakukan analisa kesenjangan maka yang menjadi alasan ketidak siapan adalah;Pertama: kurangnya dukungan para Direktur Rumah Sakit Umum Daerah terhadap Sistem penanggulangan Gawat Darurat Terpadu Bencana/Sehari-hari (SPGDT-B/S) yang disebabkan antara lain adalah kurangnya pemahaman akan SPGDT-B/S, kurangnya sosialisasi tentang standar klasifikasi IRD di Indonesia, standar kendaraan pelayanan medik dan yang penting juga adalah keterbatasan RSUD ermasuk Pemerintah Kota dan Kabupaten.Kedua: kurangnya kepedulian Kepala IRD selaku manajer penanggulangan kegawat daruratan terpadu bencana dalam mengelola sumber daya akibat kurangnya dukungan manajemen. Ketiga: kurangnya sosialisasi SPGDT-BIS serta dukungan akan kelengkapan sumber daya IRD dari Departemen Kesehatan Khususnya Direktorat Jenderal Pelayanan Medik.

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Indonesia is a state that geographically tends to face with natural disasters. So the question is, are general hospitals ready to face disasters?

This research aimed at knowing the readiness of General Hospital at Cirebon Regions in facing with disasters. This research is a descriptive study using comparative design based on the standard to the conditions of 7 General Hospital through qualitative and quantitative data approaches.

The informers in this research are all Directors of General Hospitals and all Head of Emergency Units at Cirebon regions. A uni-variant analysis is used generated from questionnaire data then scoring it to make level of readiness of emergency unit. Then a gap analysis was done through in-depth interview with take into consideration what, who, why, where, and when, and how the un-readiness of emergency unit.

The result of research shows that all general hospitals in Cirebon regions are not ready to face with daily emergency/disaster. After it is analyzed, the reason for unreadiness is due to:

First: lack of support from all director-of hospital to the Integrated System of Daily Emergency/Disaster Management (SPGDT-BIS) that caused by lack understanding to SPGDT-BIS, lack of socialization of standard classification of Emergency Unit in Indonesia, standard of medical service vehicle, and the important thing is lack of budget of general hospital including District and City Government.

Second: lack of attention of l-lead of Emergency Unit as manager of integrated emergency management in managing resources due to lack of support from management. Third: lack of socialization of SPGDT-BIS and support to the completeness of resources of emergency unit from Department of Health particularly from Directorate of Medical Services."

"Menurut standar nasional, pelayanan obstetri harus mampu melakukan tindakan bedah sesar emergensi dalam waktu 30 menit dari keputusan dibuat (response time). Evaluasi pada tahun 2012, RSUP dr Kariadi tidak dapat memenuhi standar tersebut.Penelitian ini bertujuan untuk mengetahui angka response tim bedah sesar emergensi dan faktor–faktor yang menyebabkan tidak tercapainya standar tersebut.Dilakukan penelitian kuantitatif untukmencari angka response tim disertai wawancara untuk mengetahui faktor-faktor apa yang mempengaruhi response time tersebut. Sebanyak 207 operasi bedah sesar emergensi dilakukan evaluasi.Didapatkan angka response time 54 menit.Tidak tercapainya standar nasional response tim berkaitan dengan belum adanya standar prosedur operasional tentang persiapan operasi bedah sesar emergensi. Sehingga disarankan untuk segera dibuat standar prosedur operasional yang melibatkan tim multidisiplin.

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According to national standards, obstetric services must be able to perform emergency cesarean section within 30 minutes of the decision made (response time). Evaluation in 2012, Doctor Kariadi General Hospital was unable to meet this standards. This study aims to determine the response time of emergency cesarean section and the factors that lead to failure to achieve this standards. Quantitative research conducted to find the response time and interview to determine what factors affect the response time. A total of 207 emergency cesarean section evaluated during the study. The mean response time was 54 minutes. Failure to achieve the national standard response time is related to the lack of standard operating procedures on the preparation of emergency cesarean section. So it is advisable to immediately create a standard operating procedure that involves a multidisciplinary team."

"Instalasi Gawat Darurat (IGD) Rumah Sakit RK Charitas dituntut untuk segera meningkatan kualitas karena masih menghadapi berbagai permasalahan seperti terjadinya penumpukan pasien, lamanya waktu pelayanan, dan tingginya keluhan pasien. Lean thinking telah berkembang menjadi metode yang banyak digunakan di rumah sakit untuk mengatasi berbagai masalah. Penelitian ini bertujuan untuk (1) mengevaluasi arus pasien IGD saat ini, (2) untuk mengidentifikasi dan menghilangkan proses yang tidak bernilai, dan (3) mengusulkan future state value stream map (VSM). Penelitian ini dilakukan dengan pendekatan action research. Pengambilan data dilakukan dengan observasi langsung keseluruhan aktivitas di IGD untuk memetakan current state VSM, dan mengidentifikasi waste serta menentukan value added dan non value added activity. Simulasi dilakukan untuk mengurangi aktivitas non value added yang dapat dihindari sebagai dasar pengajuan future state VSM. Hasil penelitian ini menemukan 38 aktivitas yang dilakukan oleh pasien di IGD RS RK Charitas, rata-rata waktu yang dibutuhkan pasien adalah 405 menit dan kegiatan yang paling memakan waktu adalah menunggu transfer ke rawat inap. Setelah waste dieliminasi, seluruh proses aktivitas di IGD turun dari 38 menjadi 29 aktivitas saja serta terjadi peningkatan value added sebesar 17,97%. Keseluruhan hasil tersebut menjadi dasar untuk menyimpulkan bahwa penerapan lean thinking di IGD RS Charitas telah terbukti mereduksi waste dan meningkatkan value added. Penerapan future state VSM dalam jangka pendek, menengah dan panjang meliputi antara lain aplikasi 5S, membuat sistem informasi emergensi di unit radiologi dan mengubah layout triase adalah rekomendasi yang diajukan dari penelitian ini.

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Emergency department (ED) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called "lean thinking". This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to propose a future state value stream map (VSM). It was a qualitative study. The first step is we observe the whole activity in ED and make a current state VSM, than we apply lean thinking to find waste and identify value added and non value added activity. The last step is to eliminate the avoidable non value added activity and propose the future VSM Among all the processes carried out in ED at RK Charitas Hospital, the most time consuming processes were to wait for an admission bed (boarding). After the waste is eliminated, the entire process of activity in the ER drops from 38 to 29 activities only. Value added activity increased by 17.97%. The application of lean thinking hopefully can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction. "

"Penanganan kasus gawat janin dengan sistem code green bertujuan mempercepat response time evakuasi janin ke luar rahim. Sistem code green telah dilaksanakan sejak tahun 2007 di Instalasi Rawat Darurat RSUP Sanglah Denpasar. Namun demikian belum pernah dilakukan evaluasi untuk mengukur keberhasilan penerapan sistem tersebut. Penelitian ini bertujuan untuk mengevaluasi penerapan sistem code green dengan pendekatan kualitatif dan disain studi kasus. Pengumpulan data primer dan sekunder didapat melalui wawancara mendalam dan observasi partisipatif. Dasar teori yang digunakan dalam penelitian ini adalah Theory of Constraints yang memandang sistem sebagai kesatuan mata rantai. Evaluasi juga dilakukan dengan menganalisis enam variabel pada diagram Ishikawa (fishbone diagram) meliputi man, method, material, machine, management dan milieu. Penelitian ini menemukan pemanjangan response time dalam sistem code green pada tahap penegakan diagnosis sampai menghubungi announcer sebagai the weakest link dari penerapan sistem. Variabel yang menyebabkan the weakest link dari sistem ini adalah sumber daya manusia yakni ketiadaan dokter penanggungjawab pelayanan (DPJP) di tempat kerja Ketiadaan DPJP (tidak on site) dalam penerapan sistem code green, terutama pada tahap pelayanan pertama yaitu penegakan diagnosis sampai menghubungi announcer berakibat fatal mengingat adanya keharusan bagi dokter residen kebidanan melaporkan dan meminta ijin terlebih dahulu kepada DPJP. Penelitian ini menyarankan agar pihak manajemen RSUP Sanglah Denpasar mengupayakan keberadaan DPJP di tempat tugas (on site), melakukan kajian standard opersional prosedur, dan melaksanakan monitoring penerapan sistem code green secara berkesinambungan.

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Code green system in management of fetal distress cases have purposes to improve response time on unborn baby evacuation process. Code green system have been implemented since 2007 in Emergency Department of Denpasar Sanglah General Hospital. However, there was no any evaluation process which was performed to assess the successes of implementation of code green system. The aim of this study is to evaluate the implementation of code green system with qualitative approach and case study design. Primary and secondary data were collected by a numbers efforts (by a few methods) such as in-depth interview, and observation participative. The theory of constraints (TOC) which postulate system as a chain was used as a based theory in this study. This study analyzed six variables of Ishikawa's diagram (Fishbone diagram) such as man, method, material, machine, management, and milieu.

This study found delay response time in code green system at the step of process from diagnosis to contact the announcer as a weakest link on the implementation of code green system. The cause of this weakest link was human resources. Obstetrician who in charge was not present during implementation of the code green system especially in the first step which the services was started from diagnosis until announcer informed when obstetric and gynecology resident reported and request approval from obstetrician who in charge in that critical moment. This study give recommendation such as to present an obstetrician who in-charge in field of services, to conduct a regular standard operational procedure review, and to perform continuing monitors and evaluations of code green system was needed."