Analisis Faktor yang Memengaruhi Mortalitas Pasien Rawat Inap di RS Akademik UGM

Diasa Ayu Raharni, Dr. dr. Hanevi Djasri, MARS, FISQua

2023 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar belakang: Data kematian atau indikator mortalitas rumah sakit merupakan elemen penting dari program pemantauan keselamatan pasien rumah sakit. Pada tahun 2022, rekapitulasi kinerja rawat inap di RSA UGM menunjukkan nilai NDR 34,1‰, angka ini belum mencapai standar ideal yaitu <25>

Tujuan : Mengidentifikasi faktor yang memengaruhi angka kematian pasien dewasa ?48 jam di rawat inap dan menyusun rencana program penurunan kematian rumah sakit di RSA UGM.

Metode: Penelitian ini menggunakan jenis penelitian mix method dengan pendekatan sequential explanatory. Data kuantitatif dari rekam medis pasien dewasa bulan Oktober – Desember 2022. Data kualitatif didapatkan dari diskusi kelompok terarah dengan 3 kelompok terpisah yaitu kelompok manajemen, dokter dan perawat. Analisis data kuantitatif menggunakan uji chi-square dan Fisher’s exact dan regresi logistik multivariat sedangkan data kualitatif dengan analisis tematik.

Hasil : Dari penelitian ini didapatkan 388 subyek dengan 18 orang (46.4‰) pasien meninggal selama perawatan ?48 jam. Secara independen, jenis ruang rawat inap (OR 10,799, CI 95 % 3,990 – 29,233), skor Early Warning System  (OR 15,644, CI 95 % 5,511 – 44,412)  dan jumlah komorbid (OR 8,603, CI 95 % 2,769 – 26,730) berpengaruh terhadap kejadian kematian pasien dewasa di rawat inap (p<0 p=0,018, p=0,016,>Early Warning System (EWS)

Kesimpulan : Skor EWS dan lokasi perawatan pasien dewasa di intensif berhubungan secara signifikan dengan kejadian kematian ?48 jam setelah rawat inap, maka penting bagi pihak manajemen untuk meningkatkan kualitas pelayanan RS Akademik UGM dengan melakukan srategi penurunan angka kematian rumah sakit guna memperbaiki net death rate sesuai dengan standar nasional Kemenkes RI.

Background: Hospital mortality indicators are important element of a hospital patient safety monitoring program. In 2022, net death rate (NDR) value of RSA UGM showed 34.1‰ which not yet reached the ideal standard, namely <25>

Objective: Identifying factors that influence the mortality rate of adult patients ?48 hours in inpatient care and developing a program plan to reduce hospital mortality at RSA UGM.

Methods: An explanatory sequential design of mixed methods research was used. The medical records of adult patients admitted to RS Akademik UGM from October 2022 to December 2022. Quantitative data analysis used chi-square and Fisher's exact tests and multivariate logistic regression. Qualitative data was obtained from focus group discussions with three separate groups, namely the managerial group, the doctor team and the nurse team, while qualitative data used thematic analysis.

Results: From this study, 388 subjects were obtained with 18 (4.64% or 46.4‰) patients died during treatment ?48 hours. Independently, ward type (OR 10,799, CI 95 % 3,990 – 29,233), Early Warning System (EWS) score (OR 15,644, CI 95 % 5,511 – 44,412) and number of comorbidities (OR 8,603, CI 95 % 2,769 – 26,730) associated with with ?48 hours in-hospital mortality (<0 p=0.018, p=0.016,>

Conclusion: The early warning system score >5 and the intensive care are significantly related to in-hospital mortality ?48 hours after hospitalization so it is important for management to improve the quality of services at the RS Akademik UGM by carry out a strategy to reduce hospital mortality rates in order to decrease the net mortality rate in accordance with the Indonesia Ministry of Health's national standards.

Kata Kunci : angka kematian di rumah sakit, net death rate, early warning system, ICU, penurunan angka kematian