Evaluation of the Accuracy of Implementation of Obstetric Referral Cases to the Emergency in the Jaminan Kesehatan Nasional (JKN) Era

Abstract

Evaluation of the Accuracy of Implementation of Obstetric Referral Cases to the Emergency in the Jaminan Kesehatan Nasional (JKN) Era Evaluasi Ketepatan Pelaksanaan Rujukan Kasus Gawat Darurat Obstetri ke Instalasi Gawat Darurat dalam Era Jaminan Kesehatan Nasional Omo A. Madjid, Arietta R.D. Pusponegoro, Immanuel S. Margatan Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia Dr. Cipto Mangunkusumo General Hospital Jakarta Abstract Abstrak Objective : To investigate the circumstances of the obstetric referral case at the emergency department of the Dr.Cipto Mangunkusumo Hospital as well as the accuracy of the referral implementation. Tujuan : Mengetahui gambaran kasus rujukan obstetri di IGD RSCM dan ketepatan pelaksanaan rujukan. Metode : Deskriptif desain studi potong lintang. Data diambil dari rekam medis pasien obstetri di IGD RSCM pada bulan Januari 2013 hingga Desember 2014, kemudian informasi mengenai data dan karakteristik pasien dikumpulkan. Ketepatan pelaksanaan rujukan kasus gawat darurat obstetri berdasarkan Krietria gawat darurat bagian kebidanan menurut ketentuan BPJS Kesehatan. Methods : We used cross-sectional study. Medical records of obstetric patients at Emergency department in RSCM in January 2013-July 2014 were obtained, then information about patients and their characteristic were collected. The accuracy of referral cases is based on emergency obstetric criteria by BPJS rules. Results : Primary Health Care became the leading referrer. Inappropriate diagnostic referral cases amounted to 21.2%when JKN fi rst began to be implemented in 2014. Cases with improper diagnoses were more referred when JKN was implemented which amounted to 16.8% and nonemergency referral cases of 6.9% in 2014. Hasil : Perujuk terbanyak adalah Puskesmas (FKTP). Kasus rujukan dengan ketidaksesuaian diagnosis lebih banyak jumlahnya pada saat JKN mulai diterapkan pada tahun 2014 sebesar 21.2%. Kasus dengan diagnosis yang tidak tepat rujuk lebih banyak pada saat JKN di laksanakan yaitu sebesar 16.8% dan kasus rujukan yang bukan gawat darurat sebesar 6.9% pada tahun 2014. Conclusions : Referral implementation has not been effi cient and effective, the number of obstetric referral cases to emergency department of RSCM that can actually be handled in the secondary advanced health services after the application of JKN is still high. Monitoring and evaluation is needed by the Local Health Offi ce to improve the quality of the referral system that applied in the newly JKN era. Kesimpulan : Pelaksanaan rujukan belum efi sien dan efektif, jumlah rujukan obstetri ke IGD RSCM yang sebenarnya dapat ditangani di fasilitas kesehatan tingkat lanjutan sekunder setelah penerapan JKN masih tinggi. Dibutuhkan monitoring dan evaluasi oleh Dinas Kesehatan setempat untuk meningkatkan kualitas sistem rujukan yang berlaku di era JKN yang baru diterapkan. Keywords : accuracy of referrals, BPJS, JKN, obstetric emergencies, referral system. Kata kunci : BPJS, gawat darurat obstetri, JKN, ketepatan rujukan, sistem rujukan.