FAKTOR-FAKTOR YANG MEMPENGARUHI UTILISASI KAMAR OPERASI DAN PENGARUHNYA TERHADAP LUARAN KLINIS PASIEN DI RSUD dr. ADJIDARMO KAB. LEBAK BANTEN

MOCH ANDRI FIRDAUS, Prof. dr. Iwan Dwiprahasto, M.Med.Sc. Ph.D; dr. Hanevi Djasri, MARS

2018 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar Belakang: Kamar operasi merupakan fasilitas yang penting di rumah sakit. Beberapa indikator mutu pelayanan instalasi bedah sentral adalah utilisasi kamar operasi, waktu tunggu operasi, dan pembatalan operasi. Indikator ini penting bagi rumah sakit karena dapat berdampak pada indikator luaran klinis, salah satunya adalah Length of Stay (LoS). Data menunjukkan bahwa Rumah Sakit Umum Daerah dr. Adjidarmo Kabupaten Lebak Banten pada tahun 2016 melaporkan terjadinya pembatalan operasi sebanyak 4,9% dari total 950 tindakan operasi. Tujuan: Penelitian ini bertujuan untuk mengidentifikasi fenomena pembatalan dan lamanya waktu tunggu tindakan operasi sekaligus faktor-faktor yang mempengaruhinya dan pengaruhnya terhadap luaran klinis di Instalasi Bedah Sentral RSUD dr. Ajidarmo Kabupaten Lebak Banten. Metode: Penelitian ini adalah penelitian kuantitatif dengan rancangan cross sectional. Penelitian ini dilakukan di Instalasi Bedah Sentral RSUD dr. Ajidarmo Kabupaten Lebak Banten pada bulan September - Oktober 2017. Variabel independen yang diteliti dalam penelitian ini yaitu usia, jenis kelamin, severity level, sumber pembiayaan, kategori operasi, dan jenis operasi dengan variabel dependen berupa pembatalan operasi dan waktu tunggu operasi serta length of stay (LoS). Hasil: Rata-rata utilisasi kamar operasi per hari adalah sekitar 25 tindakan. Operasi kebidanan merupakan jenis operasi terbanyak dilakukan yaitu mencapai angka 394 tindakan selama periode pengamatan (1 bulan). Setelah dilakukan proses adjustment, pasien umum (Non - JKN) dan kategori operasi elektif merupakan faktor prediktor kejadian pembatalan operasi (Prevalence Ratio / PR berturut-turut = 67,68; 95% CI = 24,92 - 183,80 dan 44,83; 95% CI = 4,88 - 412.05). Waktu tunggu operasi terlama di semua kamar operasi terjadi pada kasus bedah umum. Setelah dilakukan proses adjustment, faktor prediktor lamanya waktu tunggu operasi adalah usia pasien kurang dari 65 tahun (PR = 2,91; 95% CI = 1,16 - 7,33), kategori operasi elektif (PR = 1,96; 95% CI = 1,17 - 3,29), dan jenis operasi bedah umum (PR = 2,67; 95% CI = 1,62 - 4,40). Penelitian ini tidak menunjukkan adanya dampak waktu tunggu operasi terhadap LoS. Kesimpulan: Rata-rata utilisasi kamar operasi di RSUD dr. Adjidarmo melampaui standar yang disarankan. Sumber pembiayaan dan kategori operasi merupakan faktor yang mempengaruhi pembatalan operasi. Usia pasien, kategori operasi, dan jenis operasi merupakan faktor yang mempengaruhi waktu tunggu operasi. Waktu tunggu operasi tidak berdampak pada luaran klinis berupa length of stay (LoS).

Background: The operating room (OR) is an important facility in the hospital. Some indicators of quality of central surgical installation services are the utilization of OR, operating waiting times, and cancellations of operations. These indicators are important for the hospital because it may impact on clinical outcome indicators, one of which is Length of Stay (LoS). The data showed that the Regional General Hospital dr. Adjidarmo Lebak Banten in 2016 reported the cancellation of operations as much as 4.9 % out of a total of 950 operations. Objective: This study aims to identify the phenomenon of cancellation and the length of waiting time of surgery as well as the influencing factors and its effect on the clinical outcome in the Central Surgery Installation of Regional General Hospital dr. Ajidarmo Lebak Banten. Method: This research was a quantitative research with cross-sectional design. This study was conducted at the Central Surgery Installation of Regional General Hospital dr. Ajidarmo Lebak Banten in September - October 2017. Independent variables assessed in this study were age, gender, severity level, financing source, operation category and type of operation with the dependent variable were cancellation of operation, waiting time of operation, and length of stay (LoS). Result: Average OR utilization per day was about 25 cases. Obstetric surgery was the most common type of surgery that was reaching 394 cases during the observation period (1 month). After the adjustment process, the general patient and the elective surgery category were predictors of cancellation of operation (Prevalence Ratio/ PR respectively = 67.68; 95 % CI = 24.92 - 183.80 and 44.83 95 % CI = 4.88 - 412.05). The longest operating waiting time in all operating rooms occured in the case of general surgery. After adjustment, the predictors of waiting time were patient age less than 65 years (PR = 2,91; 95% CI = 1,16 - 7,33), elective surgery category (PR = 1,96; 95% CI = 1.17 - 3.29), and the type of general surgery (PR = 2.67; 95% CI = 1.62 - 4.40). This research did not show any effect of waiting time of operation on LoS. Conclusion: Average operating room utilization in the Regional General Hospital dr. Ajidarmo Lebak Banten exceeded the recommended standards. Financing sources and categories of operations were factors that affect cancellation of operations. Patient age, surgery category, and type of surgery were factors that affect surgical waiting times. Operation waiting time had no impact on LoS

Kata Kunci : Utilisasi kamar operasi, pembatalan operasi, waktu tunggu; Operating room utility, operation cancellation, waiting time