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Amal C. Sjaaf
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Department of Health and Policy, Building F Floor 1, Faculty of Public Health Universitas Indonesia, Kampus Baru UI Depok 16424, Depok City, West Java Province, Indonesia
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INDONESIA
Jurnal ARSI : Administrasi Rumah Sakit Indonesia
Published by Universitas Indonesia
ISSN : 24069108     EISSN : 2476986X     DOI : https://doi.org/10.7454/arsi
Core Subject : Health, Science, Social,
Decision Sciences, Operations Research & Management Public Health Social Sciences
Jurnal ARSI (Administrasi Rumah Sakit Indonesia) was initiated by the Center for Health Administration and Policy Studies (CHAMPS) Faculty of Public Health, University of Indonesia (FKM UI) and is currently managed by the Department of Health Administration and Policy, Faculty of Public Health, University Indonesia . Jurnal ARSI (Administrasi Rumah Sakit Indonesia) was published with the Indonesian Hospital Association (PERSI) and the FKM UI Hospital Management Association (IKAMARS). Jurnal ARSI (Administrasi Rumah Sakit Indonesia) is a peer-reviewed journal that focuses on service administration and management in hospitals in Indonesia. The articles or scientific manuscripts published in the Jurnal ARSI (Administrasi Rumah Sakit Indonesia) include original research, case studies, and reviews supporting corporate governance, clinical governance, or both (bridging). This journal is published electronically, featuring articles in either Bahasa or English. Printed versions are produced only by request. This journal also provides direct open access to its content with the principle that research publications are freely available to the public for broad benefit.
Arjuna Subject : Umum - Umum
Articles 201 Documents
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Towards The Four-Hour Rule: Impact of Observation Units and Emergency Medicine Specialists in an Indonesian Tertiary Hospital Sulistio, Septo; Gani, Ascobat
Jurnal ARSI : Administrasi Rumah Sakit Indonesia Vol. 11, No. 3
Publisher : UI Scholars Hub

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Abstract

Emergency Department (ED) overcrowding is a global challenge. In response, the government of Indonesia mandates an ED Length of Stay (LOS) of ≤4 hours. This study aims to evaluate the impact of implementing an Emergency Department Observation Unit (EDOU) combined with an Emergency Medicine (EM) specialist-led disposition process on ED LOS at a national referral hospital in Indonesia. This was a retrospective, pre-post analysis comparing all ED visits in 2023 (pre-intervention, n = 26,282) with all visits in 2024 (post-intervention, n = 31,483). The primary outcome was the proportion of patients with an ED LOS ≤4 hours. Secondary outcomes included median ED LOS and the odds ratios (OR) for yellow zone patients achieving the ≤4-hour target based on the intervention period and the deciding physician's specialty. Following the intervention, the median ED LOS decreased from 16.4 hours to 8.0 hours (p-value = <0.05). Yellow zone patients in the post-intervention period had 6.37 times the odds of achieving a ≤4-hour LOS compared to the pre-intervention period (95% CI [5.72–7.09]). When the decision to admit to the EDOU was made by an EM specialist, the odds of achieving the target were 1.86 times higher than for other specialists (95% CI [1.43–2.42]). The combined implementation of an EDOU and EM specialists-led disposition significantly reduced ED LOS and dramatically increased the odds of meeting national performance targets. The success was driven by both increased downstream bed capacity and streamlined, specialist-led disposition processes.

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