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Pelaksanaan Sistem Code Blue di RSA UGM dan Dampaknya Terhadap Pembiayaan Ratna Dewi Puspita; Agit Seno Adisetiadi; Purwadi Sujalmo; Renni Pusposari
The Journal of Hospital Accreditation Vol 3 No 01 (2021): Pembelajaran dari Kegiatan Akreditasi dan Peningkatan Mutu
Publisher : Komisi Akreditasi Rumah Sakit (KARS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35727/jha.v3i01.68

Latar Belakang: Code blue adalah sistem manajemen darurat yang dibentuk untuk kasus-kasus yang membutuhkan intervensi medis darurat, baik itu pasien, kerabat/keluarga pasien, maupun staf rumah sakit. Selama ini belum ada evaluasi pelaksanaan panggilan code blue terhadap outcome pasien (survival rate) dan pembiayaan pasien di Rumah Sakit Akademik Universitas Gadjah Mada (RSA UGM).Tujuan: Penelitian bertujuan untuk mengevaluasi pelaksanaan code blue di RSA UGM terhadap outcome pasien yang mendapat pelayanan tersebut serta efisiensi pembiayaan rumah sakit dengan ketepatan pelaksanaan sistem code blue.Metode: Penelitian ini menggunakan penelitian deskriptif. Peneliti mengambil data dengan metode total sampling. Data diperoleh dari lembar code blue dan rekam medis pasien yang memperoleh tindakan code blue pada periode Januari–Desember 2018. Data dikumpulkan, ditelaah, dan disajikan dalam bentuk tabel sebagai gambaran pelaksaanaan sistem code blue. Peneliti melakukan simulasi diagnosis (diagnosis penelitian) dengan melengkapi diagnosis cardiac arrest dan respiratory arrest ke dalam sistem Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan secara offline. Hasil simulasi kemudian dibandingkan antara klaim BPJS Kesehatan yang sudah ada.Hasil: Dari total 86 pasien yang dilakukan panggilan code blue di RSA UGM, diperoleh 36% pasien mampu dicegah kegawatannya dan dikembalikan sirkulasi darahnya, hal ini melebihi konsensus American Heart Assosiation (AHA) sebesar 18%. Dari data diperoleh bahwa dari pasien yang mendapatkan pelayanan tim code blue, didapatkan bahwa 100% pasien tidak tertulis diagnosis cardiac arrest (I46.9) atau respiratory arrest (R09.2) sebagai landasan diagnosis diaktifkannya tim code blue. Terdapat efisiensi klaim pembiayaan pada beberapa pasien yang mengalami perbaikan setelah dilakukan simulasi diagnosis dengan ditambahkan diagnosis cardiac arrest (I46.9) dan atau respiratory arrest (R09.2).Kesimpulan: Tim code blue RSA UGM mampu mencegah kegawatan dan mampu mengembalikan sirkulasi darah pasien secara spontan sudah melebihi konsensus AHA. Kesuksesan penanganan tim code blue dalam menangani pasien henti jantung dan henti nafas mampu meningkatkan efektifitas pembiayaan terutama pasien dengan Jaminan Kesehatan Nasional (JKN) dengan disertai kelengkapan rekam medis sesuai dengan diagnosis.

Survival Study of D-dimer, Lactic Acid and BGA on COVID-19 Patients Purwadi Sujalmo; Rosita Yunanda Purwanto; Clarista Ardelia Rahardjo; Yanasta Yudo Pratama; Rochmi Isnaini Rismawanti; Wandira Lalitya; Afridhia Bidari Fachrudin
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 29, No 1 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i1.2084

The value of D-dimer value, lactic acid levels, and the results of blood gas analysis (PaO2, PCO2, PH, and PaO2/FiO2) are prognostic factors for COVID-19 patients, although there is no agreement on the optimum cut-off point for specificity and sensitivity. The aim of this study is to examine D-dimer value, lactic acid levels, and the results of blood gas analysis as a prognosis for patients with severe or critical COVID-19. This was a retrospective study of the medical records of the UGM Academic Hospital. Overall survival was assessed by the Kaplan-Meier curve. Determination of the cut-off for D-dimer, lactic acid, and BGA variables was carried out using the ROC followed by calculating the Youden index. Then the hazard ratio was determined by Cox regression. The cut-off value to determine the group of patients on the D-dimer and lactic acid variable was 881 ng/mL (sensitivity 77.23%, specificity 32.31%) (p=0.040) and 21 ng/mL, patients with lactic acid values above the cut-off had a higher risk of death (p=0.391). The cut-off of pH, PaO2, and PaCO2 were 7.43, 72.2 mmHg, and 33.9, respectively. D-dimer levels, lactic acid, and PaCO2 values in blood gas analysis above the cut-off value had a worse survival rate, while patients also had a worse survival rate if the PaO2 and PH values were below the cut-off value.

Survival Study of D-dimer, Lactic Acid and BGA on COVID-19 Patients Purwadi Sujalmo; Rosita Purwanto; Clarista Rahardjo; Yanasta Yudo Pratama; Rochmi Rismawanti; Wandira Lalitya
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 29, No 1 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i1.1966

The value of D-dimer value, lactic acid levels, and the results of blood gas analysis (PaO2, PCO2, PH, and PaO2/FiO2) are prognostic factors for COVID-19 patients, although there is no agreement on the optimum cut-off point for specificity and sensitivity. The aim of this study is to examine D-dimer value, lactic acid levels, and the results of blood gas analysis as a prognosis for patients with severe or critical COVID-19. This was a retrospective study of the medical records of the UGM Academic Hospital. Overall survival was assessed by the Kaplan-Meier curve. Determination of the cut-off for D-dimer, lactic acid, and BGA variables was carried out using the ROC followed by calculating the Youden index. Then the hazard ratio was determined by Cox regression. The cut-off value to determine the group of patients on the D-dimer and lactic acid variable was 881 ng/mL (sensitivity 77.23%, specificity 32.31%) (p=0.040) and 21 ng/mL, patients with lactic acid values above the cut-off had a higher risk of death (p=0.391). The cut-off of pH, PaO2, and PaCO2 were 7.43, 72.2 mmHg, and 33.9, respectively. D-dimer levels, lactic acid, and PaCO2 values in blood gas analysis above the cut-off value had a worse survival rate, while patients also had a worse survival rate if the PaO2 and PH values were below the cut-off value.

Survival Study of D-dimer, Lactic Acid and BGA on COVID-19 Patients Purwadi Sujalmo; Rosita Yunanda Purwanto; Clarista Ardelia Rahardjo; Yanasta Yudo Pratama; Rochmi Isnaini Rismawanti; Wandira Lalitya; Afridhia Bidari Fachrudin
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 1 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i1.1966

The value of D-dimer value, lactic acid levels, and the results of blood gas analysis (PaO2, PCO2, PH, and PaO2/FiO2) are prognostic factors for COVID-19 patients, although there is no agreement on the optimum cut-off point for specificity and sensitivity. The aim of this study is to examine D-dimer value, lactic acid levels, and the results of blood gas analysis as a prognosis for patients with severe or critical COVID-19. This was a retrospective study of the medical records of the UGM Academic Hospital. Overall survival was assessed by the Kaplan-Meier curve. Determination of the cut-off for D-dimer, lactic acid, and BGA variables was carried out using the ROC followed by calculating the Youden index. Then the hazard ratio was determined by Cox regression. The cut-off value to determine the group of patients on the D-dimer and lactic acid variable was 881 ng/mL (sensitivity 77.23%, specificity 32.31%) (p=0.040) and 21 ng/mL, patients with lactic acid values above the cut-off had a higher risk of death (p=0.391). The cut-off of pH, PaO2, and PaCO2 were 7.43, 72.2 mmHg, and 33.9, respectively. D-dimer levels, lactic acid, and PaCO2 values in blood gas analysis above the cut-off value had a worse survival rate, while patients also had a worse survival rate if the PaO2 and PH values were below the cut-off value.

Study of Survival of COVID19 Patients with Severe or Critical Symptoms: Study of D-dimer on Survival of COVID19 Patients with Severe or Critical Degrees in ICU COVID, Academic Hospital, Gadjah Mada University, Yogyakarta Purwadi Sujalmo; Rosita Yunanda Purwanto; Rochmi Isnaini Rismawanti; Yanasta Yudo Pratama; Wandira Lalitya; Afridhia Bidari Fachrudin
Academic Hospital Journal Vol 4, No 1 (2022)
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v4i1.71798

The SARS-CoV 2 virus pandemic has been a scourge since 2020. The number of cases that continues to increase, both mild, moderate, severe-critical confirmed cases are directly proportional to the need for treatment rooms, both ordinary wards and intensive care units (ICU), which is inversely proportional to the available capacity. room. Based on research, the high mortality and morbidity rate due to COVID 19 is due to the incidence of patient sepsis. Research abroad states that the value of D-dimer is a prognostic factor for COVID-19 patients, although there is no agreement on the best cut-off point for specificity and sensitivity. hypercoagulability conditions and increased lactic acid in patients with severe sepsis. It is necessary to evaluate the role of this laboratory result in estimating the prognosis of COVID-19 patients in Indonesia. There is no study that examines the relationship between the incidence of sepsis and the characteristics of hypercoagulability with the dominance of the thrombotic process in COVID19 patients in Indonesia. The purpose of this study was to provide information to health workers about the role of D-dimer value as a prognostic factor for severe-critical COVID-19 patients. This quantitative retrospective research data in the form of proportions were collected for 12 months from the medical records of the UGM Academic Hospital of patients with confirmed severe-critical COVID-19. Overall survival was assessed by the Kaplan-Meier curve. The cut-off determination for the D-dimer variable was carried out using the Receiver Operating Curve (ROC) followed by the calculation of the Youden index. Then the hazard ratio was determined by cox regression with a p value of <0.05 which was considered significant. Statistical analysis with SPSS version 26 software.

Modified COVID-19 Mortality Scoring as a Mortality Prognostic in COVID-19 Patients Rahmadani Puji Lestari; Benedictus Hangga Harinawantara; Khoironi Rachmad Damarjati; Purwadi Sujalmo
Academic Hospital Journal Vol 4, No 1 (2022)
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v4i1.72845

Background: The number of patients infected with COVID-19 was increasing. The COVID-19 clinical presentation varies from asymptomatic, mild, moderate, severe, and critical. Mortality rates increase with morbidity and disease severity. This study aimed to develop a prognostic intrahospital mortality scoring named "Modified COVID-19 Mortality Scoring".Methods: A retrospective cohort study was conducted on COVID-19 inpatients at the UGM Academic Hospital during November 2020-March 2021. Data were obtained from electronic medical records. Clinical and laboratory parameters were taken at the time of admission.Results: The study involved 413 patients, including 50 subjects who died from COVID-19 and 363 survivors. The final stage of multivariate analysis resulted in some variables; age≥55 years, history of stroke, qSOFA score≥2, d-dimer≥1500 ng/mL, absolute neutrophil count (ANC)≥5,000 cells/uL, and absolute lymphocyte count (ALC)<1,000 cells /uL affected intrahospital mortality (p<0.050). In the scoring model, the d-dimer≥1500 ng/mL was worth 2 points, and each remaining variable was worth 1 point. The score had a strong predictive ability with an area under the ROC curve, 0.814(95%CI=0.757–0.871). The sensitivity and specificity of the score was 76%, with a cutoff point score of 3, an OR of 10,357 (95%CI=5.179-20,710, p=0.000). Moreover, the probability scores of 3, 4,5,6,7 were 18%, 33%, 53%, 72%, and 85%.Conclusion: The existence of a scoring system is expected to help identify COVID-19 inpatients who have a higher risk of death so that stricter monitoring and early intervention can be carried out.

Nurses’ perception on Initial Implementation of Early Warning System: A Mixed Method Study Sujalmo, Purwadi; Setiyarini, Sri; Walsh, Kenneth; Greenwood, Melanie
Jurnal Keperawatan Soedirman Vol 17 No 1 (2022): Jurnal Keperawatan Soedirman (JKS)
Publisher : Fakultas Ilmu-ilmu Kesehatan

The early warning system (EWS) has been decided as a new standard for Indonesian hospitals. The main objective of EWS implementation is to help nurses quickly recognize and react to deteriorating patients. This study explores how EWS contributes to nurses’ clinical decisions around patient deterioration. The research design for this study was mixed-method sequential explanatory. A purposive sampling approach was used to recruit the participants. Closed and open-ended questionnaires were distributed (n = 53) to adult unit nurses and the data was analyzed by using descriptive statistics. Focus group discussions were conducted to evaluate the implementation process and the results obtained were analyzed by using thematic analysis. Both data were integrated by using a joint display table. We found that 79% of nurses indicated that they needed education about how to use the EWS and 92% of nurses required education on physiology and management of the deteriorating patient. Three themes emerged: (1) the nurses’ experience of EWS Implementation, (2) the impact of EWS implementation, and (3) ameliorating the EWS Implementation. The participants showed that the EWS has been used for the assessment, documentation, and communication process of deteriorating patient management. The EWS is a complex tool for nurses, and they need support from stakeholders to maintain and optimize the advantages.

The Relationship between Virtual Visits and Family Satisfaction of ICU Patients at UGM Academic Hospital Hidayanto, Muhammad Nur; Pitajeng, Mutik Sri; Sujalmo, Purwadi; Ratnasari, Etika
Academic Hospital Journal Vol 7, No 1 (2025)
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v7i1.102151

Background: The visiting policy to the hospital changed following the pandemic situation. There was a restriction to ICU patients getting visits from their relatives or families during their admission. This policy aimed to prevent transmission and optimize care for patients. An online visit was implemented to provide a visit experience to patients and their families during ICU hospitalization. Visitation was associated with family satisfaction of ICU patients but an analysis of the relationships between virtual visits and family satisfaction in ICU has not been conducted. Identify relationships between online visit and patient’s family satisfaction with ICU.Materials and methods: An online survey of ICU patients' family members who were admitted to ICU Arjuna 5 RSA UGM in 2020-2022 was done.Results: 34 of 36 family members of ICU patients completed the online survey questionnaire. Most participants experienced online visits (85.3%) and had high levels of satisfaction with the ICU. The average score of their satisfaction with the ICU was (68.6±21,1). However, the Fisher test between online visits andthe patient’s family satisfaction with ICU resulted in a p-value of=0.56. P value >0.05 meant no significant relationship between both variables.Conclusion: there was no significant relationship between online visits and patient family satisfaction with the ICU. A high level of family satisfaction in the ICU might be influenced by other factors that are required to be studied.

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