Mulyana, Radi Muharris
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Faktor-Faktor Penyebab Pengembalian Berkas Resume Medis IGD RSCM oleh Verifikator BPJS Kesehatan Habib, Hadiki; Mulyana, Radi Muharris; Albar, Imamul Aziz; Sulistio, Septo
Cermin Dunia Kedokteran Vol 45, No 4 (2018): Cidera Kepala
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (578.818 KB) | DOI: 10.55175/cdk.v45i4.198

Abstract

Pendahuluan: Sejak  dijalankan  tahun  2014,  program  Jaminan  Kesehatan  Nasional  (JKN)  yang  diselenggarakan  oleh  Badan  Penyelenggara Jaminan Sosial (BPJS) Kesehatan terus mengalami perbaikan. Penyebab klaim tidak dapat diproses perlu dianalisis, diidentifikasi, dan diperbaiki, oleh karena itu perlu didentifikasi. Penelitian dilaksanakan di RSCM bulan Januari sampai November 2017, atas data rekam medis, berupa resume medis, hasil koding, dan rincian biaya. Dari 855 resume medis yang gagal verifikasi, diambil sampel 270 berkas secara acak. Sebanyak 215 (79,6%) resume medis dapat dibaca dengan baik, sehingga memudahkan proses telaah. Sebanyak 206 (76,3%) resume medis lengkap. Hampir separuh (49%) kasus tidak gawat darurat. Dari resume medis yang memang melaporkan pengelolaan kasus gawat darurat, hanya 58% diagnosis yang menggambarkan kegawatdaruratan. Masih ada 22,6% koding yang tidak sesuai dengan diagnosis yang tertulis di resume medis.
Integration of Indonesian National Trauma Guideline into the Emergency Room System (Cipto Code Trauma System) Mulyana, Radi Muharris; Gani, Ascobat
Journal of Epidemiology and Public Health Vol. 10 No. 2 (2025)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/jepublichealth.2025.10.02.02

Abstract

Background: Indonesia has enacted the national trauma guideline since 2017 and Cipto Mangun-kusumo Hospital (CMH) has applied it since 2019 through the establishment of Cipto Code Trauma. This study aimed to describe the compliance, system adherence, performance and outcome associated with the Cipto Code Trauma system.Subjects and Method: This cross-sectional study was conducted at CMH Emergency Room (ER) using direct observations and data from electronic health records (EHRs). Observations were performed on 106 trauma cases by convenience sampling to map clinical and non-clinical components using a checklist. We compared the implemented ER components against the 2017 national trauma guidelines, assessing the system compliance. Total sampling from EHRs was performed on 4,317 trauma patients to assess performance and outcome of Cipto Code Trauma system. The data were analyzed descriptively.Results: Observations from 106 trauma cases indicate that the Cipto Code Trauma meets all criteria from the national trauma guidelines. Performance indicators from 840 patients were achieved, including trauma team activation (87.6%), on-site multidisciplinary consultation (87.6%), time to physician assessment within five minutes (84.4%), except for length of stay under 4 hours (18.5%) and time to operating theatre within two hours (45.5%). Among the 4,317 trauma cases, the mortality rate for patients in the resuscitation category was 0.4%, while 39% of these patients were discharged directly from the ER.Conclusion: The Cipto Code Trauma at CMH has successfully integrated the Indonesian national trauma guidelines, meeting all required standards. However, further improvements are needed to enhance system adherence and performance.
Integration of Indonesian National Trauma Guideline into the Emergency Room System (Cipto Code Trauma System) Mulyana, Radi Muharris; Gani, Ascobat
Journal of Epidemiology and Public Health Vol. 10 No. 2 (2025)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/jepublichealth.2025.10.02.02

Abstract

Background: Indonesia has enacted the national trauma guideline since 2017 and Cipto Mangun-kusumo Hospital (CMH) has applied it since 2019 through the establishment of Cipto Code Trauma. This study aimed to describe the compliance, system adherence, performance and outcome associated with the Cipto Code Trauma system.Subjects and Method: This cross-sectional study was conducted at CMH Emergency Room (ER) using direct observations and data from electronic health records (EHRs). Observations were performed on 106 trauma cases by convenience sampling to map clinical and non-clinical components using a checklist. We compared the implemented ER components against the 2017 national trauma guidelines, assessing the system compliance. Total sampling from EHRs was performed on 4,317 trauma patients to assess performance and outcome of Cipto Code Trauma system. The data were analyzed descriptively.Results: Observations from 106 trauma cases indicate that the Cipto Code Trauma meets all criteria from the national trauma guidelines. Performance indicators from 840 patients were achieved, including trauma team activation (87.6%), on-site multidisciplinary consultation (87.6%), time to physician assessment within five minutes (84.4%), except for length of stay under 4 hours (18.5%) and time to operating theatre within two hours (45.5%). Among the 4,317 trauma cases, the mortality rate for patients in the resuscitation category was 0.4%, while 39% of these patients were discharged directly from the ER.Conclusion: The Cipto Code Trauma at CMH has successfully integrated the Indonesian national trauma guidelines, meeting all required standards. However, further improvements are needed to enhance system adherence and performance.