SITUASI KERJA TIM MEDIS INTENSIVE CARE UNIT BERFOKUS PADA 4S (SPACE, STUFF, STAFF, SYSTEM) DALAM MENGHADAPI LONJAKAN JUMLAH PASIEN KRITIS COVID-19

MOCHAMAT HELMI, Prof. dr. Laksono Trisnantoro, MSc, PhD

2022 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar Belakang: Pandemi COVID-19 merupakan tantangan bagi tim medis ICU, sehingga memerlukan manajemen kesiapan space, stuff, staff, dan system (4S) untuk menghadapi lonjakan jumlah pasien. Penelitian ini dilakukan untuk mendokumentasikan situasi kerja ICU dalam menghadapi lonjakan jumlah pasien COVID-19 dengan pendekatan �4S� di ICU yang berdampak terhadap kesiapan tim medis dari bulan Maret s/d September 2020 yang merupakan awal dari pandemi di Indonesia. Metode: Mixed method dengan wawancara kepada tim medis ICU di RS rujukan nasional COVID-19 di Jakarta dan Yogyakarta. Kemudian dilakukan focused group discussion (FGD) yang menghadirkan tim pakar, dan survei daring kepada tim medis ICU dari berbagai RS di Indonesia. Data kualitatif dianalisis dengan content analysis melalui traskrip, coding, reduce coding, kategorisasi dan penentuan tema, sedangkan data kuantitatif dilakukan analisis deskriptif. Data hasil analisis diintegrasikan dalam bentuk kajian narasi untuk dilakukan interpretasi permasalahan sehingga dapat disusun rekomendasi. Hasil penelitian: Penelitian ini mendapatkan permasalahan tim medis pemberi pelayanan COVID-19 di ICU, yang terkait dengan 4S: 1) Space, keterbatasan kualitas dan kuantitas ruang isolasi ICU COVID-19 yang terstandar, 2) Stuff, kurangnya dukungan alat pelindung diri, obat dan bahan medis habis pakai, dan alat kesehatan, 3) Staff, kurangnya jumlah dan sebaran dokter ahli, proses skrining tim medis untuk memberikan pelayanan, pengetahuan terkait dengan tata kelola pelayanan pasien dan manajemen ICU COVID-19. 4) System, (a) Jaminan kesehatan, perhitungan beban kerja yang belum tertata dengan baik berpotensi terjadi burn-out, (b) Jaminan hukum, kurang baiknya dasar hukum untuk memberikan pelayanan pada bencana yang berlangsung lama, (c) Skema insentif, kurang transparan untuk beberapa rumah sakit, tidak sesuai dengan beban dan risiko kerja, keterlambatan pengiriman, (d) Sistem komando; banyaknya area yang tidak memiliki kecukupan dokter ahli dan fasilitas yang kurang. Kesimpulan: Dengan pendekatan 4S, ditemukan data bahwa tim medis ICU di berbagai RS tidak siap menghadapi surge capacity pada awal pandemi COVID-19. Rekomendasi-rekomendasi untuk meningkatkan kesiapan perlu dilakukan dengan lebih baik untuk dapat lebih siap apabila terjadi lonjakan kembali jumlah pasien COVD-19.

Background: The COVID-19 pandemic poses a challenge for the ICU's medical team in preparing management of space, stuff, staff, and system (4S) to deal with the increase in the number of patients. This study was conducted to document the ICU work situation in dealing with the surge in the number of COVID-19 patients with the "4S (space, stuff, staff, system)" approach in the ICU which has an impact on the readiness of the Medical Team from March to September 2020 which is the beginning of Pandemic in Indonesia. Methods: A mixed method was conducted using interviews with the ICU's medical team at the National Referral Hospital for COVID-19 in Jakarta and Yogyakarta. Subsequently, a series of focused group discussion (FGD) was performed which invites a Team of Experts, and an online survey to the ICU Medical Team from various hospitals in Indonesia was conducted. Qualitative data were analyzed using content analysis through transcripts, coding, reduce coding, data categorization, and determining themes. Meanwhile, the quantitative data were analyzed for distribution and frequency. The data was then integrated into a narrative study to interpret the problems to formulate recommendations. Results: This study found the 4S-related issues faced by the ICU's medical team in providing COVID-19 services involve are: 1) Space, limited quality and quantity of standardized isolation ICU rooms for COVID-19 patients; 2) Stuff, lack of support for personal protective equipment, medicines and consumable medical materials, and medical devices; 3). Staff, lack of number and distribution of expert doctors, the proper screening process for the medical team to provide services, limited knowledge about patient care management and ICU COVID-19 management; 4). System: (a) Health Insurance, a workload that has not been properly calculated can lead to burn-out. (b) Legal protection, lack of proper legal basis for providing services for a prolonging disaster; (c) Incentive schemes, lack of transparency for some hospitals, incompatible with workloads and risks, late delivery, and possible hospital fraud; (d) Command System, many areas do not have sufficient Expert Doctors with poor facilities. Conclusion: Using the 4S approach, it was found that the ICU's medical team in various hospitals has not been well prepared to face the COVID-19 Pandemic. Hence, recommendations need to be performed in order to prepare for a possibility of an upcoming surge capacity.

Kata Kunci : COVID-19, pandemi, tim medis, ICU