WASTE DI INSTALASI GAWAT DARURAT RSI PKU MUHAMMADIYAH TEGAL

NURHIDAYAT, Prof. dr. Adi Utarini, M.Sc.,MPH., Ph.D; Dr. Firman, SE., S.Kep.,MPH

2019 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar belakang: Jaminan Kesehatan Nasional (JKN) dengan penerapan cakupan kesehatan semesta mempunyai dampak meningkatnya jumlah kunjungan pasien ke rumah sakit, termasuk pasien di instalasi gawat darurat (IGD). Peningkatan jumlah kunjungan IGD ini menyebabkan lama waktu tunggu pemindahan pasien dari IGD ke ruang rawat inap pun menjadi panjang. Metode yang dapat digunakan dalam perbaikan proses pelayanan ini adalah lean management, yaitu dengan mengurangi waste lama waktu tunggu pemindahan pasien dari IGD ke ruang rawat inap. Tujuan: Tujuan penelitian ini adalah menurunkan lama waktu tunggu pemindahan pasien dari IGD ke ruang rawat inap dengan cara mengidentifikasi waste waktu tunggu, melakukan perbaikan faktor-faktor penyebab waste dan melakukan perbaikan cepat. Metode: Penelitian ini merupakan penelitian action research: Diagnosing Action: pengumpulan data, Planning action: Analisa data, identifikasi penyebab waste dan solusi, Taking action: Sosialisasi rencana implementasi, update ketersediaan ruang rawat inap,perakitan rekam medis di ruang rawat inap, penulisan resep dokter hanya untuk untuk obat penggunaan di IGD, dan uji coba selama 12 hari kerja, Evaluating action: evaluasi dan tindak lanjut implementasi. Hasil: Terdapat delapan tahapan utama dalam alur proses pelayanan pasien IGD hingga dikirim ke rawat inap.Waste yang umum ditemukan dalam proses tersebut: waste of overprocessing, waste of motion, dan waste of waiting. Beberapa penyebab waste adalah banyaknya kasus false emergency, kekurangan sumber daya (ruang tunggu dan SDM, papan/petunjuk informasi), pemetaan dengan Value Stream Mapping mengidentifikasi rerata lead time: 69,9 menit, Waiting time: 39,9 menit dan Cycle Time: 30 menit. Setelah dilakukan intervensi/taking action, rerata lama waktu tunggu pemindahan pasien dari IGD ke ruang rawat inap berkurang dari 69,9 menit menjadi 51,5 menit (18.4 menit atau 26%). Kesimpulan: Dengan lean management RS mampu mengidentifikasi waste dan penyebabnya pada alur proses pasien sejak di IGD hingga dikirim rawat inap. Dengan menghilangkan/mengurangi waste mampu menurunkan lama waktu proses pemindahan pasien IGD ke ruang rawat inap.

Background: The National Health Insurance (JKN) with the application of universal health coverage has the effect of increasing the number of patient visits to hospitals, including patients in emergency departments (ED). The increase in the number of emergency visits led to a long waiting period for the transfer of patients from the emergency room to the inpatient room. The method that can be used in the improvement of this service process is lean management, which is by reducing the waste of the waiting time for moving patients from the emergency room to the inpatient room. Objective: The purpose of this study was to reduce the waiting time for transferring patients from the emergency room to the inpatient ward by identifying waste waiting time, making improvements to the factors that cause waste and making rapid repairs. Method: This research is an action research study: Diagnosing Action; data collection, planning action; Data analysis, identification of causes of waste and solutions, Taking action; Dissemination of the implementation plan, update the availability of inpatient rooms, assembling medical records in the inpatient room, writing prescription only for drug use in the emergency room, and testing for 12 working days, evaluating action, evaluation and follow-up implementation. Results: There are eight main stages in the flow of the service process of ED patients to be sent to hospitalization. Waste is commonly found in the process: waste of overprocessing, waste of motion, and waste of waiting. Some causes of waste are the many cases of false emergencies, lack of resources (waiting room and HR, information boards / instructions), mapping with Value Stream Mapping identifying average lead time: 69.9 minutes, Waiting time: 39.9 and Cycle Time: 30 minute. After taking action, the average length of waiting time for moving patients from the emergency room to the inpatient room decreased from 69.9 minutes to 51.5 minutes (18.4 minutes or 26%) Conclusion: With lean management, the Hospital is able to manage waste and cause it to process patients since the emergency room until it is sent to hospitalization. By reducing / reducing the process time for the transfer of ED patients to the inpatient room.

Kata Kunci : lean management, waste, waktu tunggu, emergensi, lean management, waste, waiting time, emergency