Pengaruh Pelatihan Crew Resources Management Metode TeamSTEPPS Registered Trade Mark 2.0 Terhadap Performa Tim Medis dan Kualitas Pelayanan Obstetri di Rumah Sakit Pendidikan

SHINTA PRAWITASARI, Prof. dr. Adi Utarini, MSc, MPH, PhD; Prof. dr. Moch. Hakimi, Sp.OG (K), Ph.D ; dr.Widyandana, MHPE, Ph.D, Sp.M (K)

2021 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar Belakang: Keberhasilan pelayanan obstetri emegensi merupakan kolaborasi interprofessional antara dokter obstetri dan ginekologi, tim perinatologi, anestesi, bidan dan perawat yang bertugas di kamar bersalin, unit gawat emergensi dan ruang operasi. Systematic review membuktikan bahwa Crew Resource Management (CRM) metode TeamSTEPPS Registered Trade Mark 2.0 meningkatkan kinerja tim dan penelitian uji klinik acak memperbaiki DII (Decision to Incision Inteval) seksio sesaria (SC) emergensi. Pelatihan TeamSTEPPS Registered Trade Mark 2.0 belum pernah dilakukan di RS Pendidikan di Indonesia. Tujuan: Mengetahui pengaruh pelatihan crew resources management metode TeamSTEPPS Registered Trade Mark 2.0 terhadap performa tim medis dan kualitas pelayanan obstetri emergensi di RSUP Dr. Sardjito dan RSUP dr. Soeradji Tirtonegoro Metode: Rancangan penelitian yang digunakan adalah eksperimen kuasi dengan pendekatan pre and post test design yang dilengkapi dengan studi kualitatif untuk menilai secara lebih mendalam fakto-faktor yang menjadi penghalang dan pendukung implementasi TeamSTEPPS Registered Trade Mark 2.0. Luaran yang dinilai untuk penelitian kuantitatif adalah perubahan pengetahuan, sikap, kinerja tim obstetri emergensi di Instalasi Gawat Darurat (IGD), Decision to Delivery Interval (DDI) SC Kategori 1 dan 2 dan luaran bayi dan ibu pada SC Kategori 1 dan 2. Cara pengumpulan data kuantitatif adalah dengan penigisian kuisioner dan observasi 24 jam sedangkan pengumpulan data kualitatif dilakukan dengan in-depth interview (i-DI). Hasil: Pelatihan TeamSTEPPS Registered Trade Mark 2.0 dinilai efektif oleh peserta pelatihan dalam mengajarkan kompetensi TeamSTEPPS Registered Trade Mark 2.0. Pengetahuan mengenai TeamSTEPPS Registered Trade Mark 2.0 tidak meningkat sesudah pelatihan. Skor Safety Attitude Questionnaire (SAQ) untuk domain kerjasama tim, iklim keselamatan, suasana kerja, persepsi terhadap manajemen dan skor total SAQ meningkat setelah pelatihan di RSUP Dr. Sardjito tetapi tidak meningkat di RSUP dr. Soeradji Tirtonegoro. Kinerja Tim Obstetri Emergensi di IGD meningkat setelah pelatihan di semua kompetensi yang diajarkan dalam TeamSTEPPS Registered Trade Mark 2.0 di RSUP dr. Soeradji dan meningkat pada 4 dari 5 kompetensi yang diajarkan. Proporsi DDI SC Kategori 1 kurang atau sama dengan 30 menit untuk SC Kategori 1 dan DDI kurang atau sama dengan 75 menit untuk SC Kategori 2 di kedua RSUP tidak terjadi perbaikan sesudah pelatihan. Luaran bayi dengan indikator skor APGAR menit ke-5 < 7 dan meninggal selama perawatan serta proporsi perawatan di ICU untuk ibu pada SC Kategori 1 dan 2 sesudah pelatihan di kedua RS tidak terjadi perbaikan. Kesimpulan: Pelatihan TeamSTEPPS Registered Trade Mark 2.0 dinilai efektif oleh peserta pelatihan di kedua RSUP, menigkatkan sikap keselamatan yang dinilai dengan SAQ di RSUP Dr. Sardjito, dan meningkatkan kinerja tim obstetri emergensi di kedua RSUP. Pelatihan TeamSTEPPS Registered Trade Mark tidak menunjukkan pengaruh yang signifikan terhadap DDI SC Kategori 1 dan 2 serta luaran bayi dan ibu di kedua RSUP. Kata kunci: CRM TeamSTEPPS Registered Trade Mark 2.0, pengetahuan, sikap, kinerja tim obstetri emergensi di IGD, DDI SC Kategori 1 dan 2, skor APGAR menit ke 5, bayi meninggal saat perawatan dan perawatan ICU untuk Ibu

Background: Successful emergency obstetrics care depends on interprofessional collaboration between obstetricians, the perinatology team, anesthesiologists, midwives, nurses in the delivery room, emergency room and, operating theatre. Based on the systematic review, Crew Resource Management (CRM) such as TeamSTEPPS Registered Trade Mark 2.0 proved to increase team performance and a randomized clinical trial also proved that decision to incision interval in the emergency cesarean section was shorter after TeamSTEPPS Registered Trade Mark 2.0 training. TeamSTEPPS Registered Trade Mark 2.0 Training in Academic hospitals in Indonesia has never been done before. Objective: To understand the influence of TeamSTEPPS Registered Trade Mark 2.0 Training on team performance and emergency obstetrics care quality in Sardjito Hospital and Soeradji Tirtonegoro Hospital Method: A quasi-experimental with pre and post-test design was used. This study is supplemented with a qualitative study to understand more about team performance in the emergency room before and after training and barrier and enabling factors for the achievement of the standard decision to delivery interval in CS grade 1 and grade 2. The outcome of quantitative study being measured is knowledge improvement on TeamSTEPPS Registered Trade Mark 2.0 competencies, patient safety attitude using Safety Attitude Questionnaire (SAQ), the performance of emergency obstetrics team in the emergency room, and the decision to delivery Interval (DDI) for grade 1 and grade 2 C section and fetal and maternal outcomes in grade 1 and grade 2 C section. The qualitative study was done. Data collection for the quantitative study was done with questionnaires and 24 hrs direct observation while the qualitative study was done with the in-depth interview (i-DI). Result: TeamSTEPPS Registered Trade Mark 2.0 training was appraised as effective and very effective in teaching about TeamSTEPPS Registered Trade Mark competencies. The knowledge about TeamSTEPPS Registered Trade Mark was not improved after training. Safety Attitude Questionnaire (SAQ) scores for teamwork, safety climates, working condition, perception about management domains, and total SAQ score were improved after training in Sardjito Hospital, but the same results were not seen in Soeradji Tirtonegoro hospital. Emergency Obstetrics Team Performance was improved after training in all TeamSTEPPS Registered Trade Mark 2.0 competencies in Sardjito hospital and 4 out of 5 competencies in Soeradji Tirtonegoro hospital. The proportion of grade 1 C section with DDI within 30 minutes and grade 2 C section with DDI within 75 minutes were not improved after training in both hospitals. The fetal outcome with indicator APGAR score 5 minutes less than 5 and death during hospital care in grade 1 and grade 2 C section and maternal outcome with indicator ICU care in grade 1 and grade2 C section were not improved either. Conclusion: TeamSTEPPS Registered Trade Mark 2.0 training was appraised as effective by training participants, improved safety attitude measured by SAQ in Sardjito hospital, improved emergency obstetrics team in Sardjito hospital but didnot showed any significant influence on DDI for grade 1 and grade 2 and fetal-maternal outcome in grade 1 and grade 2 C section in both hospitals. Keyword: CRM TeamSTEPPS Registered Trade Mark 2.0, knowledge, attitude, emergency obstetrics team performance in the emergency room, DDI in grade 1 and grade C section, APGAR score 5 minutes, neonatal death during hospital care, and maternal ICU care

Kata Kunci : CRM TeamSTEPPS Registered Trade Mark 2.0, pengetahuan, sikap, kinerja tim obstetri emergensi di IGD, DDI SC Kategori 1 dan 2, skor APGAR menit ke 5, bayi meninggal saat perawatan dan perawatan ICU ibu