HUBUNGAN MANAJEMEN KEGAWATDARURATAN MATERNAL DAN FAKTOR MEDIK TERHADAP CLINICAL OUTCOME PASIEN DAN PEMENUHAN HAK PASIEN RUJUKAN MATERNAL DI RSUD DR. DRADJAT PRAWIRANEGARA

DYAH S NUGRAHANDINI, dr. Ari Natalia Probandari,MPH,PhD.; dr. Hanevi Djasri,MARS

2016 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Tingginya Angka Kematian Ibu di dunia maupun di Indonesia, menunjukkan rendahnya kualitas pelayanan kesehatan ibu. Terdapat dua faktor yang berpengaruh terhadap clinical outcome pasien rujukan obstetri, yaitu faktor medik dan faktor non-medik. Penilaian faktor non-medik seperti manajemen kegawatdaruratan obstetri dan faktor medik seperti usia maupun paritas pada pasien rujukan yang akhirnya masuk ruang rawat intensif, dianggap dapat memberikan gambaran pelayanan kesehatan pasien rujukan obstetri. Peningkatan kualitas pelayanan kegawatdaruratan obstetri mencakup kesiapan tenaga medis untuk merespon secara cepat dan tepat dengan memperhatikan pemenuhan hak pasien. Tujuan: Penelitian ini bertujuan menganalisis hubungan manajemen kegawatdaruratan maternal serta faktor medik terhadap clinical outcome dan menganalisa pemenuhan hak pasien emergensi obstetri. Metode: Penelitian ini merupakan penelitian mixed-method parallel kombinasi dari studi kasus kontrol dan penelitian kuantitatif. Sampel penelitian penelitian kasus kontrol diambil dari kasus rujukan obstetri ke RSUD dr. Dradjat Prawiranegara bulan Juni 2014 sampai bulan Juni 2016 dengan menggunakan systematic random sampling. Sampel penelitian kualitatif berupa 10 kasus rujukan obstetri dengan menggunakan purposive sampling. Pengumpulan data kuantitatif dengan pengambilan data sekunder dari buku register dan buku rekam medis. Pengumpulan data kualitatif dilakukan dengan observasi dan wawancara. Analisis data kuantitatif dilakukan dengan analisis regresi logistik, sedangkan analisis data kualitatif dilakukan dengan content-analysis Hasil: Faktor yang berhubungan dengan clinical outcome pasien rujukan kegawatdaruratan maternal, yaitu: respon time di FKTL (OR=1,786;CI 95%OR=1,247-2,559)), tatalaksana kasus emergensi di FKTL (OR=1,735 (1,1882,535)) dan paritas ibu (Cl 95%:OR:2,420 (0,795-7,368)). Faktor yang paling berhubungan dengan clinical outcome yaitu respon time di FKTL (OR=1,720). Pemenuhan hak pasien di RSUD dr. Dradjat Prawiranegara sudah tercapai dengan baik dilihat dari pemberian informasi yang jelas dan lengkap, pelayananan berkualitas sesuai standar, dan diperlakukannya pasien secara tidak diskriminatif.

Background: The high number of maternal death in Indonesia, and globally, indicates the low quality of the maternal health service. There are two factors that influence the clinical outcome of obstetric emergency patient; these are: medical and non-medical factors. Assessment on the non-medical factors (i.e. management of obstetric emergency on patient that eventually treated in ICU&HCU) can provide insight on the health service quality to obstetric emergency patient. This assessment will also include medical factors; namely the patients age and parity (number of birth given). Quality improvement in Emergency Obstetric Care (EmOC) include medical personnel readiness to fast and correct response with due regard to the fulfillment of the patients rights. Objective: In general, this research aimed to analyze the relation between the management of maternal emergency (and medical factors) with the clinical outcome of obstetric emergency patient. In specific, this research aimed to study the relation between response time, the emergency obstetric cares conformity with SOP (standard operational procedure), the usage of information and communication technology in patient referral system, patient age and patient parity on the patients clinical outcome. This research also analyzed the fulfillment of the patients rights. Method: This research applied a parallel mixed methods design that combine qualitative and case control study. Samples of a case-control study were obstetric referral cases in the RSUD dr.Dradjat Prawiranegara between June 2014 and June 2016, which selected by systematic random sampling. Informant for the qualitative study was 10 obstetric referral case taken by purposive sampling. Data on the samples were collected from the medical register and medical record book of the hospital. Bivariat analysis, namely logistic regression analysis, was conducted to study the collected quantitative data. Qualitative data was analyzed using content-analysis. Result: Factors related to the clinical outcome of (obstetric emergecy) referral patients including: respond time in hospital (Cl 95%:OR:1,786 (1,247-2,559)), conformity with SOP of obstetric emergency in hospital (Cl 95%:OR: 1,735 (1,188-2,535)) and parity (Cl 95%:OR:2,420 (0,795-7,368)); with respon time in FKTL (OR:1,720) emerged as the most influential factor. The fulfilment of the patients rights has been achieved at RSUD dr. Dradjat Prawiranegara. This was observed through the provision of clear and comprehensive information on patients medical status, and provision of health care which are both undiscriminating and according to standard.

Kata Kunci : emergensi obstetri, kegawatdaruratan obstetri, clinical outcome, respon time, ruang rawat intensif, hak pasien, Obstetric emergency, respond time, referral patients, intensive care, patients rights