Penerapan Lean Thinking untuk Mereduksi Waktu Boarding Pasien IGD ke Rawat Inap di RSUD Koja Tahun 2017

Theryoto Theryoto, Mardiati Nadjib

Abstract


ABSTRAK

Pelaksanaan Program Jaminan Kesehatan Nasional (JKN) menyebabkan peningkatan kunjungan pasien IGD dan angka pasien boarding sehingga terjadi penumpukan (stagnasi) pasien di IGD. RSUD Koja telah menerapkan manajemen tempat tidur dalam rangka mereduksi waktu boarding pasien IGD tetapi belum optimal, sehingga dilakukan upaya untuk membantu mereduksi waktu boarding pasien IGD ke rawat inap dalam rangka perbaikan yang berkelanjutan sesuai prinsip lean thinking. Penelitian operasional ini mencakup intervensi dengan siklus PDCA (plan, do, check, action). Hasil penelitian menunjukkan  penerapan lean thinking dapat mereduksi waktu boarding pasien IGD ke rawat inap dari rata-rata 4 jam 45 menit 18 detik (34,92 %) menjadi 3 jam 25 menit 59 detik (68,25 %) dan menurunkan aktivitas non value added sebesar 2,02% (dari 93,16% menjadi 91,14%). Delapan jenis waste yang teridentifikasi dapat dieliminasi kecuali waste jenis waiting. Dalam rangka perbaikan yang berkelanjutan selanjutnya manajemen tempat tidur perlu ditetapkan sebagai persyaratan standard kerja untuk menuju waktu boarding rata-rata menjadi 1 jam 45 menit 45 detik dengan aktivitas non value added kurang dari 89,83% di masa mendatang.

 

ABSTRACT

The implementation of the National Health Insurance Program (Program JKN) affects the increased number of patients to emergency unit and boarding patients that resulting crowding in the emergency unit. Koja Hospital has implemented bed management in order to reduce the boarding time of emergency unit patients but has not succeeded, so an effort to help reducing the boarding time of  emergency unit  patients to inpatient in order to continuous improvement was done using the lean thinking principle. This research uses operational research method and intervention with PDCA (Plan, Do, Check, Action) cycle. The study revealed that lean thinking approach could reduce the boarding time of emergency unit patients  to hospitalization from the average of 4 hours 45 minutes 18 seconds (34.92%) to 3 hours 25 minutes 59 seconds (68.25%) and decrease the activity of non value added at 2.02% (from 93.16% to 91.14%). Eight types of waste identified can be eliminated except waiting. In order to continuous improvement, bed management should be set as standardized work for the goal of average boarding time of 1 hour 45 minutes 45 seconds with non value added activities less than 89.83% in the future.


Keywords


boarding time; bed management; lean thinking

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References


(1) Proudlove, N.C., et.al., 2003, Can good bed management solve the overcrowding in accident and emergency departments? Emerg.Med.J.;20:149155, doi:10.1136/emj.20.2.149

(2) Boyle A., et.al., 2012, Review Article Emergency Department Crowding : Time for Interventions and Policy Evaluations, Emergency Medicine International, Volume 2012, Article ID 838610, 8 pages, doi:10.1155/2012/838610, Hindawi Publishing Corporation

(3) The Canadian Association of Emergency Physicians, Position Statement on Emergency Department Overcrowding, Board Approved June 2009

(4) Joint Commission Perspectives, 2012, Volume 32, Issue 7,, Joint Commission on Accreditation of Healthcare Organizations, APPROVED: Standards Revisions Addressing Patient Flow Through theEmergency Department

(5) Toussaint,J.S., et.al., 2013, The Promise of Lean in Health Care, Mayo Clin Proc.; 88(1):74-82




DOI: http://dx.doi.org/10.7454/arsi.v4i1.3206

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