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"ABSTRAKInstalasi gawat darurat merupakan unit terpenting dalam operasional di suaturumah sakit. Penelitian ini bertujuan untuk mengetahui gambaran kompetensiperawat dalam penanganan gangguan jalan nafas di instalasi gawat darurat disalah satu rumah sakit di Jakarta. Kompetensi tersebut terdiri dari pengetahuan,sikap dan keterampilan. Penelitian ini adalah penelitian deskriptif kategorik,dengan desain cross sectional dan melibatkan 22 perawat. Hasil penelitianmenunjukkan untuk kategori pengetahuan, perawat yang meiliki pengetahuankurang sebanyak 14 perawat, sedangkan pengetahuan baik sebanyak 8 perawat.Untuk kategori sikap, perawat yang memilik sikap baik sebanyak 20 perawat,sedangkan sikap kurang sebanyak 2 perawat. Untuk kategori keterampilan,perawat yang memiliki keterampilan baik sebanyak 15 perawat, sedangkanperawat dengan keterampilan kurang sebanyak 7 perawat. Penelitian inimenyarankan peningkatan kompetensi perawat khususnya pengetahuan, sikap danketerampilan dalam penanganan gangguan jalan nafas melalui pendidikan,pelatihan, seminar, dan workshop.

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ABSTRACTEmergency department is the most important unit in a hospital. This study aims todescribe nurses competences in handling airways disorder in emergency room, ina hospital in Jakarta. These competences consist of knowledge, attitude, an skills.This was a descriptive study with a cross sectional design. Involving 22 nursesworking in an emergency room as the sample. This study showed that in thecategory of knowledge 14 nurses had less knowledge, whereas 8 nurses had goodknowledge. In the attitude category, 20 nurses had good attitude, while 2 nurseshad poor attitude. In the skill category, there were 15 nurses had good skill, while7 nurses had less skill. This study suggests that knowledge, attitude, and skill ofnurses in the Emergency Department have to improve these competences throughtraining, seminars and workshop"

"Pendahuluan: Instalasi gawat darurat (IGD) sebagai unit yang sangat penting di rumah sakit memiliki banyak masalah terkait indikator mutu antara lain peningkatan 20,9% length of stay (LOS), adanya 2,2% pasien yang tidak mendapatkan triase, 8,6% pasien yang mendapatkan kejadian medis yang dapat dicegah dan angka kematian sebesar 14,6%. Permasalahan ini harus diselesaikan agar tidak menganggu kinerja IGD dan rumah sakit, salah satu caranya adalah menggunakan lean thinking. Oleh karena itu, penelitian ini bertujuan untuk mengetahui lean tools yang paling banyak digunakan dan dampaknya pada indikator mutu di IGD. Metode: Penelitian ini menggunakan metode literature review dengan penelusuran studi melalui database PubMed, Scopus dan EBSCO yang menghasilkan 19 studi terinklusi dari tahun 2011-2021. Hasil: Penelitian ini menemukan sebagian besar IGD di studi terinklusi berhasil meningkatkan indikator mutunya melalui implementasi lean thinking. Lean tools yang paling banyak digunakan adalah Value Stream Mapping (VSM) pada fase define dan kaizen pada fase improve, sedangkan indikator mutu yang paling banyak digunakan adalah door to doctor time sebagai luaran primer dan length of stay (LOS) sebagai luaran sekunder.

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Introduction: The emergency department (ED) as a very important unit in the hospital has many problems related to quality indicators, including an increase of 20.9% length of stay (LOS), 2.2% of patients who did not receive triage, 8.6% of patients who get preventable medical events and the mortality rate is 14.6%. This problem must be resolved so as not to interfere with the performance of the ED and hospital, one of the solutions is to use lean thinking. Therefore, this study aims to determine the most widely used lean tools and their impact on quality indicators in the ED.

Methods: This study used a literature review method by tracing studies through the PubMed, Scopus and EBSCO databases which resulted in 19 included studies from 2011-2021.

Results: This study found that most of the ED in the included study succeeded in improving their quality indicators through the implementation of lean thinking. The most widely used lean tools are Value Stream Mapping (VSM) in the define phase and kaizen in the improve phase, while the most widely used quality indicators are door to doctor time as the primary outcome and length of stay (LOS) as the secondary outcome."

"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. "

"Pelayanan Instalasi Gawat Darurat (IGD) adalah salah satu instalasi Rumah Sakit yang melayani pasien 24 jam dengan tujuan memberikan pertolongan segera agar tidak terjadi kematian, kecacatan. Hal yang paling penting dari pelayanan IGD adalah respon time, berbagai kondisi dan banyaknya pasien yang datang secara bersamaan untuk segera mendapatkan pelayanan secara cepat dan tepat, sehingga dapat memberikan kepuasan pasien salah satunya. Tujuan dari penelitian ini untuk melihat hubungan antara response time perawat dengan tingkat kepuasan pasien di zona kuning Instalasi Gawat Darurat (IGD). Desain penelitian menggunakan pendekatan kuantitatif dengan metode cross sectional. Responden dipilih dengan metode consecutive sampling dengan jumlah 108 responden. Cara untuk mendapatkan hasil dengan pengamatan menggunakan stopwatch digital, lembar observasi respon time dan kuesioner kepuasan pasien dengan CECSS (Consumer Emergency Care Satisfaction Scale). Pada penelitian ini ditemukan tidak adanya hubungan antara response time perawat dengan tingkat kepuasan pasien di zona kuning Instalasi Gawat Darurat (IGD) dengan p value 0,410. Kesimpulan dari penelitian ini menjadi sebagai dasar untuk penelitian lebih lanjut. Sehingga dapat menganalisis faktor-faktor yang dapat berhubungan terhadap variabel-variabel yang telah diteliti.

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Emergency Department (ED) is one of the hospital installations that serves patients 24 hours with the aim of providing immediate assistance to prevent death, disability. The most important thing from the emergency services is the response time, various conditions and the number of patients who come together to immediately get services quickly and precisely, so that one can provide patient satisfaction. The purpose of this study was to examine the relationship between nurse response time and level of patient satisfaction in the yellow zone of the Emergency Department. The research design was a quantitative approach with cross sectional method. 108 respondents were recruited using consecutive sampling method. Response time was measured using a digital stopwatch and filled in the observation sheet and patient satisfaction was measured Consumer Emergency Care Satisfaction Scale (CECSS). The result found no relationship between nurse response time with patient satisfaction in the yellow zone of the Emergency Department (ED) with p value 0,410. The conclusions of this study serve as the basis for further research. So that it can analyze the factors that can be related to the variables that have been studied."

"[Instalasi gawat darurat (IGD) rumah sakit adalah bagian dari rumah sakit yang memberikan layanan terdepan. Di Rumah Sakit dr. Mohammad Hoesin (RSMH) Palembang sudah terdapat IGD berdasarkan SK Direktur Utama Rumah Sakit yang menetapkan struktur organisasi, tugas dan tanggung jawab, visi dan misi, dan prosedur tetap pelayanan gawat darurat. IGD RSMH Palembang dikepalai oleh seorang dokter spesialis bedah urologi dibantu oleh dua orang kepala ruangan.Standar pelayanan di IGD sudah menerapkan standar layanan sesuai dengan standar akreditasi KARS 2012. IGD keberadaannya di rumah sakit diatur oleh Kepmenkes RI No. 856/Menkes/SK/IX/2009 tentang Standar IGD. Kepemenkes ini mengatur tentang standarisasi pelayanan gawat darurat di rumah sakit, dalam Kepmenkes tersebutdiatur standar organisasi, sumber daya manusia, pelayanan, kelengkapan sarana prasarana di IGD. Di RSMH Palembang telah dilaksanakan dokter spesialis jaga on site di IGD sejak 30 Januari 2014 sebagai tindak lanjut Kepmenkes RI tersebut. Sejak dilaksanakan kebijakan dokter spesialis jaga on site di IGD masih dijumpai kepatuhan para dokter masih belum optimal dan walaupun mutu layananan semakin membaik sejalan dengan telah terakreditasi paripurna rumah sakit versi KARS 2012. Penelitian ini bertujuan untuk mengetahui bagaimana implementasi kebijakan dokter spesialis jaga on site di IGD sudah dilaksanakan sesuai dengan tujuan yang diharapkan sesuai dengan Kepmenkes. Penelitian dilakukan dengan metode kualitatif melalui wawancara mendalam pada informan. Informan yang diwawancarai adalah jajaran Direktur RSMH Palembang, Ketua Komite Medik, Kabag. Keuangan, Kepala ruangan IGD dan para dokter spesialis. Penilaian hasil wawancara menggunakan kerangka fikir model implementasi kebijakan George Edward III dengan variabelsumber daya, komunikasi, disposisi dan struktur organisasi.Dari hasil penelitian ini didapatkan implementasi kebijakan dokter spesialis jaga on site belum berjalan dengan baik, disebabkan karena faktor komunikasi, disposisi dan struktur organisasi belum berjalan baik dan masih banyak perlu dukungan sumber daya. Usulan yang diberikan adalah penambahan dan kompetensi tenaga sesuai standar, revisi SOP, penyediaan media komunikasi, perbaikan fasilitas,meningkatkan koordinasi dan fungsi pengawasan secara berkala, advokasi ke Kemenkes RI.;Emergency department (ED) is a part of hospital which giving advanced services. In dr. Mohammad Hoesin (RSMH) Palembang hospital already own an emergency department based on SK director of the hospital whom establishes the organizational structure, duties and responsibilities, vision and mission, and standard operating procedures emergency services. ED RSMH Palembang is lead by a specialist urology and assisted by two heads of the room. Standard service of ED has implementing service standards according to accreditation standards KARS 2012. ED in the hospital arranged Indonesian health minister No. 865/Menkes/SK/IX/2009 about ED standards. The head of health minister regulates the standardization of emergency services at the hospital, which managing standard organizations, human resources, services, completeness infrastructure in ED. RSMH Palembang has been implemented specialist doctors duty on site in the ER since January, 30th 2014 as a follow-up of the head of the Indonesian health minister. Ever since implemented a policy specialist on duty in the ER site still found the compliance of the doctors are still not optimal and although the quality of service has improved in line with acreditation hospital KARS version 2012. This research aims to determine how the implementation of policy specialists doctors on site in the ER has been implemented in accordance with the expected goals in accordance with the head of health minister. Research done with qualitative method by performing in-depth interviews on informants. Informants interviewed are RSMH Palembang board of directors, chairman of the medical committee, chief financial officer, head of the ED room and specialist doctors. Assessment interview results are using logical framework policy implementation model George Edward III with variable resources, communications, disposition and organizational structure. From the results of this study, the implementation of policy specialist doctorson site guard has not run well, due to the communication factor, disposition and organizational structure has not been going well and much needed resource support. The given proposal is the addition of appropriate power and competence standards, the revised SOP, provision of communication media, improvement of facilities,improving the coordination and monitoring functions regularly, advocacy to the head of the Indonesian health minister, Emergency department (ED) is a part of hospital which giving advancedservices. In dr. Mohammad Hoesin (RSMH) Palembang hospital already own anemergency department based on SK director of the hospital whom establishes theorganizational structure, duties and responsibilities, vision and mission, and standardoperating procedures emergency services. ED RSMH Palembang is lead by aspecialist urology and assisted by two heads of the room. Standard service of ED hasimplementing service standards according to accreditation standards KARS 2012.ED in the hospital arranged Indonesian health minister No.865/Menkes/SK/IX/2009 about ED standards. The head of health minister regulatesthe standardization of emergency services at the hospital, which managing standardorganizations, human resources, services, completeness infrastructure in ED. RSMHPalembang has been implemented specialist doctors duty on site in the ER sinceJanuary, 30th 2014 as a follow-up of the head of the Indonesian health minister. Eversince implemented a policy specialist on duty in the ER site still found thecompliance of the doctors are still not optimal and although the quality of service hasimproved in line with acreditation hospital KARS version 2012.This research aims to determine how the implementation of policy specialistsdoctors on site in the ER has been implemented in accordance with the expectedgoals in accordance with the head of health minister. Research done with qualitativemethod by performing in-depth interviews on informants. Informants interviewed areRSMH Palembang board of directors, chairman of the medical committee, chieffinancial officer, head of the ED room and specialist doctors. Assessment interviewresults are using logical framework policy implementation model George Edward IIIwith variable resources, communications, disposition and organizational structure.From the results of this study, the implementation of policy specialist doctorson site guard has not run well, due to the communication factor, disposition andorganizational structure has not been going well and much needed resource support.The given proposal is the addition of appropriate power and competence standards,the revised SOP, provision of communication media, improvement of facilities,improving the coordination and monitoring functions regularly, advocacy to the headof the Indonesian health minister]"

"ABSTRAKLatar belakang : Kunjungan dan angka mortalitas pasien di Instalasi Gawat Darurat (IGD) semakin meningkat dengan kondisi penyakit yang bervariasi, sehingga deteksi yang cepat dan tepat pada pasien dengan risiko mortalitas tinggi sangat penting. Skor Hypotension, Oxygen Saturation, Low Temperature, ECG Changes, and Loss of Independence (HOTEL) sangat baik dan penting untuk diterapkan pada pasien gawat darurat karena menggunakan variabel-variabel yang mudah dan cepat diperoleh. Namun demikian skor tersebut belum divalidasi di Indonesia.Tujuan : untuk menilai performa skor HOTEL dalam memprediksi mortalitas 24 jam pasien non bedah di IGD Rumah Sakit Cipto Mangunkusumo (RSCM).Metode: Penelitian ini merupakan studi kohort retrospektif. Subjek penelitian adalah pasien non bedah yang masuk ke IGD RSCM pada bulan Oktober hingga November 2012. Variabel bebas yang dinilai adalah tekanan darah sistolik, saturasi oksigen perifer, suhu tubuh, perubahan elektrokardiogram (EKG), dan kemampuan berdiri tanpa bantuan. Luaran yang dinilai adalah mortalitas dalam 24 jam setelah masuk IGD. Performa kalibrasi dinilai dengan uji Hosmer-Lemeshow. Performa diskriminasi dinilai dengan area under the curve (AUC).Hasil: Terdapat 815 pasien non bedah yang datang ke IGD RSCM selama bulan Oktober hingga November 2012. Sebanyak 804 (98,7%) subjek memenuhi kriteria inklusi dengan mortalitas 24 jam sebesar 30 (3,7%) subjek. Performa kalibrasi HOTEL dengan uji Hosmer-Lemeshow menunjukkan p = 0,753. Performa diskriminasi ditunjukkan dengan nilai AUC 0,86 (IK 95% 0,781; 0,931).Simpulan: Skor HOTEL memiliki performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 24 jam pada pasien non bedah yang masuk ke IGD RSCM.

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ABSTRACT

Background: The number of visit and mortality rate of emergency patients at Emergency Department (ED) have been increasing from time to time. Those patients have wide spectrum conditions. Appropriate identification of the patients with high mortality risk is crucial. The Hypotension, Oxygen Saturation, Low Temperature, ECG changes, and Loss of Independence (HOTEL) score is easy and important to be applied in the ED, however, the score has not been validated in Indonesia.

Objective: to evaluate performance of HOTEL score in predicting the 24-hour mortality non-surgical patients in ED of Sakit Cipto Mangunkusumo hospital.

Method: This was a retrospective cohort study. The research subjects were the non-surgical patients who admitted to ED of RSCM between October-November 2012. We collected systolic blood pressure, peripheral oxygen saturation, body temperature, ECG changes, and loss of independence. Those data were evaluated based on the HOTEL scoring system. The outcome were evaluated in 24- hour after admission (alive or dead). The calibration was evaluated with the Hosmer-Lemeshow test. The discrimination performance was evaluated with area under the curve (AUC).

Results: There were 815 non-surgical patients admitted to the ED between October until November 2012. There were 804 (98,7%) subjects included. The 24-hour mortality rate was 30 subjects (3,7%). The calibration performance with the Hosmer-Lemeshow test showed p = 0,753. The discrimination performance was shown with the AUC score 0,86 (95% CI 0.781; 0.931).

Conclusion: The HOTEL score has a good calibration and discrimination performance in predicting the 24-hour mortality of the non-surgical patients in ED of Cipto Mangunkusumo hospital."

"Kesiapan Instalasi Gawat Darurat di RSUP Dr. Kariadi sebagai rujukan Sistem Gawat Darurat Terpadu Sehari-Hari sangat dipengaruhi oleh faktor input : Sumber Daya Manusia dan pengaturan jaganya, tersedianya ambulan 24 jam, melalui call center, sarana fisik bangunan, sarana medik dan non medik, ketersediaan obat alat kesehatan dan bahan habis pakai di ruang tindakan, Standar prosedur pelayanan pasien, serta faktor proses pelayanan pasien meliputi alur pasien, triase, pelayanan gawat darurat di label merah, pemeriksaan penunjang laboratorium dan radiologi dan ketersediaan obat di farmasi 24 jam.Hasil penelitian ini dengan membandingkan Kepmenkes No 856/Menkes/SK/IX/2009 tentang standar Instalasi Gawat Darurat (IGD) rumah sakit didapatkan bahwa mampu memberikan semua jenis pelayanan 100%, tersedianya SDM sesuai dengan kualifikasi dan pendidikan serta dokter jaga spesialis anak, bedah, penyakit dalam, obstetrik dan kandungan serta anesthesi 24 jam 100%, terpenuhinya syarat fisik bangunan di ruang tindakan, operasi dan observasi 100%, tersedianya obat, prasarana medik di ruang tindakan berupa obat, bahan habis pakai dan peralatan medik 100%, tersedianya layanan ambulan 24 100%, tersedianya pemeriksaan penunjang laboratorium, radiologi dan farmasi 24 jam 100% dan belum berfungsinya call center.

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Preparedness of Emergency Department Kariadi Hospital Semarang as a referral Emergency Comprehensive Services System Daily influenced by input factors, human resources and distribution services, 24 hour ambulance services, call center ,physical building , medical and non medical equipment, drugs and single used material in service area standard operating procedure for patients services, and process factor as patient flow through an emergency department, triage, true emergency services (red label), supporting services as laboratory, radiology and pharmacies 24 hours.

Result of this study compare with the Kepmenkes No 856/Menkes/SK/IX/2009 tentang Standar Instalasi Gawat Darurat (IGD) Rumah Sakit, is prepared for all services case, qualification and education of human resources and prepared of special doctor on site pediatrician, surgeon, internist, obstetric and gynecologist also anesthesiologist 24 hours, prepared of physical building in services area, operation room, and observation room 100%, prepared of medication, medical equipment and material single used 100%, ambulance services 24 hours, prepared of supporting services as laboratory, radiology and pharmacies 24 hour and call center is not well done."

"Hal yang pertama kali dilakukan oleh perawat ketika pasien dengan kondisi gawat darurat datang ke instalasi gawat darurat yaitu melakukan triase. Pengetahuan dan persepsi keterampilan triase perawat memiliki pengaruh besar dalam efisiensi fungsional instalasi gawat darurat. Tujuan penelitian ini yaitu untuk mengetahui gambaran pengetahuan dan persepsi keterampilan triase pada perawat di instalasi gawat darurat. Penelitian ini menggunakan desain deskriptif cross-sectional dengan metode purposive sampling sebanyak 62 perawat instalasi gawat darurat rumah sakit di Kota Depok. Variabel yang diteliti dalam penelitian ini yaitu umur, jenis kelamin, tingkat pendidikan, lama bekerja, pelatihan kegawatdaruratan, pengetahuan triase, dan persepsi keterampilan triase. data dianalisis menggunakan analisis univariat. Hasil penelitian ini menunjukkan bahwa sebagian besar responden memiliki tingkat pengetahuan (58,1%) dan persepsi keterampilan triase (67,7%) kategori cukup. Oleh karena itu, pihak Rumah Sakit dapat melakukan evaluasi terhadap kemampuan triase perawat dan memfasilitasi para perawat untuk mendapatkan pelatihan kegawatdaruratan secara berkala untuk meningkatkan mutu pelayanan keperawatan.

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The first action taken by nurses when a patient come with an emergent issue to the emergency unit is triage. Nurse's triage knowledge and skill perception have a significant impact to the functional efficiency of emergency unit. The purpose of this study is to determine the description of triage knowledge and skill perception among nurses in emergency unit. This study used descriptive cross-sectional design with a purposive sampling method to 62 emergency unit nurses in Depok. The variables examined in this study were age, gender, level of education, length of work, emergency training, triage knowledge, and perception of triage skills. Data were analyzed using univariate analysis. The results of this study indicate that the majority of respondents have a sufficient level in both of knowledge (58.1%) and triage skills perception (67.7%). Therefore, the Hospital can evaluate the ability of triage nurses and facilitate nurses to get emergency training on a regular basis to improve the quality of nursing services."

"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."

"Kondisi crowding di Instalasi Gawat Darurat (IGD) telah menjadi isu global di seluruh sistem pelayanan kesehatan di seluruh dunia lebih dari dua dekade. Hal ini disebabkan karena tingginya angka boarding time  yang menyebabkan penumpukan jumlah pasien yang ada di IGD. Tujuan dari penelitian ini adalah mengetahui faktor yang berhubungan dengan keterlambatan boarding time di instalasi gawat darurat. Metode yang digunakan adalah literature review dengan menggunakan database Pubmed, Scopus, Proquest, Google Scholar dan Library UI menghasilkan 15 artikel terinklusi yakni artikel yang terbit sepuluh tahun terakhir, membahas faktor yang berhubungan dengan keterlambatan boarding time di instalasi gawat darurat, dan artikel dengan metode kuantitatif, kualitatif, dan mix-method. Hasil studi terinklusi dari 15 artikel menghasilkan beberapa penyebab keterlambatan boarding time di IGD diantaranya yaitu ketersediaan tempat tidur yang disebabkan oleh kepulangan pasien yang tidak terencana dan membutuhkan waktu 118 menit (2 jam) lebih lama dibandingan kepulangan yang direncanakan. Keterbatasan jumlah tenaga kesehatan tidak hanya menyebabkan naiknya angka boarding time, namun juga menurunkan pelayanan kesehatan dan pasien safety. Waktu diagnosis pasien pada saat di IGD membutuhkan waktu lebih lama karena dokter perlu mengantongi data lebih banyak untuk memutuskan diagnosis pasien. Pasien yang masuk ke IGD merupakan pasien dengan kegawatdaruratan tinggi, semakin darurat membutuhkan diagnosis yang lebih lama pula dan menambah waktu boarding time di IGD. Ketersediaan bangsal khsusus memakan waktu banyak pada saat boarding time karena selain memerlukan treatment khusus, jumlah bangsal khusus ini juga terbatas. Tingkat kapasitas rumah sakit yang tinggi meningkatkan pula angka boarding time karena pasien harus menunggu pelayanan kesehatan akibat antri, sehingga meningkatkan angka boarding time. Konsultasi antara pasien dengan dokter terjadi di IGD pada pasien dengan kegawatdaruratan yang tinggi, sebab sebelum memberikan tindakan, dokter perlu mengetahui lebih dalam sakit yang dialami oleh pasien. Dapat disimpulkan bahwa faktor yang berhubungan dengan keterlambatan boarding time dirumah sakit ialah ketersediaan tempat tidur, keterbatasan jumlah tenaga kesehatan, waktu diagnosis pasien, tingkat kegawatdaruratan, ketersediaan bangsal khusus, tingkat kapasitas rumah sakit yang tinggi, dan jumlah konsul dengan dokter spesialis. Oleh karena itu, perlu dilakukan kajian mengenai standar waktu boarding time di instalasi gawat darurat yang ada pada rumah sakit.

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Crowding conditions in the Emergency Unit has become a global issue in all health care systems for more than two decades. This is due to a high number of boarding times which causes an accumulation number of patients in the ER. The purpose of this study sought was to determine the factors associated with boarding time delays in the emergency department. The researcher used a literature review as a method and used Pubmed, Scopus, Proquest, Google Scholar, and UI Library databases which produces 15 included articles, and articles published in the last ten years, discussing factors related to boarding time delays in the emergency department, and articles with quantitative methods. , qualitative, and mix-method. The results of the included study from 15 articles resulted in several causes of delays in boarding time in the ER, including the availability of beds caused by the patient's unplanned return and taking 118 minutes (2 hours) longer than the planned return. The limited number of health workers not only causes an increase in boarding time but also reduces health services and patient safety. The patient's diagnosis time in the ER takes longer because doctors need to collect more data to make a patient's diagnosis. Patients who enter the ER are patients with high emergencies, the more emergency requires a longer diagnosis and increases the boarding time in the ER. The availability of special wards takes a lot of time at boarding time because apart from requiring special treatment, the number of special wards is also limited. The high level of hospital capacity also increases the number of boarding times because patients have to wait for health services due to queuing, thereby increasing the number of boarding times. Consultations between patients and doctors occur in the ER for patients with high emergencies, because before taking action, doctors need to know more about the pain experienced by the patient. It can be concluded that the factors related to the delay in boarding time at hospital are availability of beds, limited number of health workers, time of patient diagnosis, level of emergency, availability of special wards, high level hospital capacity, and number of consuls with specialist doctors. Therefore, it is necessary to conduct a study on the standard boarding time in the emergency department at the hospital."