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"[Instalasi gawat darurat (IGD) rumah sakit adalah bagian dari rumah sakit yang memberikan layanan terdepan. Di Rumah Sakit dr. Mohammad Hoesin (RSMH) Palembang sudah terdapat IGD berdasarkan SK Direktur Utama Rumah Sakit yang menetapkan struktur organisasi, tugas dan tanggung jawab, visi dan misi, dan prosedur tetap pelayanan gawat darurat. IGD RSMH Palembang dikepalai oleh seorang dokter spesialis bedah urologi dibantu oleh dua orang kepala ruangan.Standar pelayanan di IGD sudah menerapkan standar layanan sesuai dengan standar akreditasi KARS 2012. IGD keberadaannya di rumah sakit diatur oleh Kepmenkes RI No. 856/Menkes/SK/IX/2009 tentang Standar IGD. Kepemenkes ini mengatur tentang standarisasi pelayanan gawat darurat di rumah sakit, dalam Kepmenkes tersebutdiatur standar organisasi, sumber daya manusia, pelayanan, kelengkapan sarana prasarana di IGD. Di RSMH Palembang telah dilaksanakan dokter spesialis jaga on site di IGD sejak 30 Januari 2014 sebagai tindak lanjut Kepmenkes RI tersebut. Sejak dilaksanakan kebijakan dokter spesialis jaga on site di IGD masih dijumpai kepatuhan para dokter masih belum optimal dan walaupun mutu layananan semakin membaik sejalan dengan telah terakreditasi paripurna rumah sakit versi KARS 2012. Penelitian ini bertujuan untuk mengetahui bagaimana implementasi kebijakan dokter spesialis jaga on site di IGD sudah dilaksanakan sesuai dengan tujuan yang diharapkan sesuai dengan Kepmenkes. Penelitian dilakukan dengan metode kualitatif melalui wawancara mendalam pada informan. Informan yang diwawancarai adalah jajaran Direktur RSMH Palembang, Ketua Komite Medik, Kabag. Keuangan, Kepala ruangan IGD dan para dokter spesialis. Penilaian hasil wawancara menggunakan kerangka fikir model implementasi kebijakan George Edward III dengan variabelsumber daya, komunikasi, disposisi dan struktur organisasi.Dari hasil penelitian ini didapatkan implementasi kebijakan dokter spesialis jaga on site belum berjalan dengan baik, disebabkan karena faktor komunikasi, disposisi dan struktur organisasi belum berjalan baik dan masih banyak perlu dukungan sumber daya. Usulan yang diberikan adalah penambahan dan kompetensi tenaga sesuai standar, revisi SOP, penyediaan media komunikasi, perbaikan fasilitas,meningkatkan koordinasi dan fungsi pengawasan secara berkala, advokasi ke Kemenkes RI.;Emergency department (ED) is a part of hospital which giving advanced services. In dr. Mohammad Hoesin (RSMH) Palembang hospital already own an emergency department based on SK director of the hospital whom establishes the organizational structure, duties and responsibilities, vision and mission, and standard operating procedures emergency services. ED RSMH Palembang is lead by a specialist urology and assisted by two heads of the room. Standard service of ED has implementing service standards according to accreditation standards KARS 2012. ED in the hospital arranged Indonesian health minister No. 865/Menkes/SK/IX/2009 about ED standards. The head of health minister regulates the standardization of emergency services at the hospital, which managing standard organizations, human resources, services, completeness infrastructure in ED. RSMH Palembang has been implemented specialist doctors duty on site in the ER since January, 30th 2014 as a follow-up of the head of the Indonesian health minister. Ever since implemented a policy specialist on duty in the ER site still found the compliance of the doctors are still not optimal and although the quality of service has improved in line with acreditation hospital KARS version 2012. This research aims to determine how the implementation of policy specialists doctors on site in the ER has been implemented in accordance with the expected goals in accordance with the head of health minister. Research done with qualitative method by performing in-depth interviews on informants. Informants interviewed are RSMH Palembang board of directors, chairman of the medical committee, chief financial officer, head of the ED room and specialist doctors. Assessment interview results are using logical framework policy implementation model George Edward III with variable resources, communications, disposition and organizational structure. From the results of this study, the implementation of policy specialist doctorson site guard has not run well, due to the communication factor, disposition and organizational structure has not been going well and much needed resource support. The given proposal is the addition of appropriate power and competence standards, the revised SOP, provision of communication media, improvement of facilities,improving the coordination and monitoring functions regularly, advocacy to the head of the Indonesian health minister, Emergency department (ED) is a part of hospital which giving advancedservices. In dr. Mohammad Hoesin (RSMH) Palembang hospital already own anemergency department based on SK director of the hospital whom establishes theorganizational structure, duties and responsibilities, vision and mission, and standardoperating procedures emergency services. ED RSMH Palembang is lead by aspecialist urology and assisted by two heads of the room. Standard service of ED hasimplementing service standards according to accreditation standards KARS 2012.ED in the hospital arranged Indonesian health minister No.865/Menkes/SK/IX/2009 about ED standards. The head of health minister regulatesthe standardization of emergency services at the hospital, which managing standardorganizations, human resources, services, completeness infrastructure in ED. RSMHPalembang has been implemented specialist doctors duty on site in the ER sinceJanuary, 30th 2014 as a follow-up of the head of the Indonesian health minister. Eversince implemented a policy specialist on duty in the ER site still found thecompliance of the doctors are still not optimal and although the quality of service hasimproved in line with acreditation hospital KARS version 2012.This research aims to determine how the implementation of policy specialistsdoctors on site in the ER has been implemented in accordance with the expectedgoals in accordance with the head of health minister. Research done with qualitativemethod by performing in-depth interviews on informants. Informants interviewed areRSMH Palembang board of directors, chairman of the medical committee, chieffinancial officer, head of the ED room and specialist doctors. Assessment interviewresults are using logical framework policy implementation model George Edward IIIwith variable resources, communications, disposition and organizational structure.From the results of this study, the implementation of policy specialist doctorson site guard has not run well, due to the communication factor, disposition andorganizational structure has not been going well and much needed resource support.The given proposal is the addition of appropriate power and competence standards,the revised SOP, provision of communication media, improvement of facilities,improving the coordination and monitoring functions regularly, advocacy to the headof the Indonesian health minister]"

"Pelayanan Instalasi Gawat Darurat (IGD) adalah salah satu instalasi Rumah Sakit yang melayani pasien 24 jam dengan tujuan memberikan pertolongan segera agar tidak terjadi kematian, kecacatan. Hal yang paling penting dari pelayanan IGD adalah respon time, berbagai kondisi dan banyaknya pasien yang datang secara bersamaan untuk segera mendapatkan pelayanan secara cepat dan tepat, sehingga dapat memberikan kepuasan pasien salah satunya. Tujuan dari penelitian ini untuk melihat hubungan antara response time perawat dengan tingkat kepuasan pasien di zona kuning Instalasi Gawat Darurat (IGD). Desain penelitian menggunakan pendekatan kuantitatif dengan metode cross sectional. Responden dipilih dengan metode consecutive sampling dengan jumlah 108 responden. Cara untuk mendapatkan hasil dengan pengamatan menggunakan stopwatch digital, lembar observasi respon time dan kuesioner kepuasan pasien dengan CECSS (Consumer Emergency Care Satisfaction Scale). Pada penelitian ini ditemukan tidak adanya hubungan antara response time perawat dengan tingkat kepuasan pasien di zona kuning Instalasi Gawat Darurat (IGD) dengan p value 0,410. Kesimpulan dari penelitian ini menjadi sebagai dasar untuk penelitian lebih lanjut. Sehingga dapat menganalisis faktor-faktor yang dapat berhubungan terhadap variabel-variabel yang telah diteliti.

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Emergency Department (ED) is one of the hospital installations that serves patients 24 hours with the aim of providing immediate assistance to prevent death, disability. The most important thing from the emergency services is the response time, various conditions and the number of patients who come together to immediately get services quickly and precisely, so that one can provide patient satisfaction. The purpose of this study was to examine the relationship between nurse response time and level of patient satisfaction in the yellow zone of the Emergency Department. The research design was a quantitative approach with cross sectional method. 108 respondents were recruited using consecutive sampling method. Response time was measured using a digital stopwatch and filled in the observation sheet and patient satisfaction was measured Consumer Emergency Care Satisfaction Scale (CECSS). The result found no relationship between nurse response time with patient satisfaction in the yellow zone of the Emergency Department (ED) with p value 0,410. The conclusions of this study serve as the basis for further research. So that it can analyze the factors that can be related to the variables that have been studied."

"Hal yang pertama kali dilakukan oleh perawat ketika pasien dengan kondisi gawat darurat datang ke instalasi gawat darurat yaitu melakukan triase. Pengetahuan dan persepsi keterampilan triase perawat memiliki pengaruh besar dalam efisiensi fungsional instalasi gawat darurat. Tujuan penelitian ini yaitu untuk mengetahui gambaran pengetahuan dan persepsi keterampilan triase pada perawat di instalasi gawat darurat. Penelitian ini menggunakan desain deskriptif cross-sectional dengan metode purposive sampling sebanyak 62 perawat instalasi gawat darurat rumah sakit di Kota Depok. Variabel yang diteliti dalam penelitian ini yaitu umur, jenis kelamin, tingkat pendidikan, lama bekerja, pelatihan kegawatdaruratan, pengetahuan triase, dan persepsi keterampilan triase. data dianalisis menggunakan analisis univariat. Hasil penelitian ini menunjukkan bahwa sebagian besar responden memiliki tingkat pengetahuan (58,1%) dan persepsi keterampilan triase (67,7%) kategori cukup. Oleh karena itu, pihak Rumah Sakit dapat melakukan evaluasi terhadap kemampuan triase perawat dan memfasilitasi para perawat untuk mendapatkan pelatihan kegawatdaruratan secara berkala untuk meningkatkan mutu pelayanan keperawatan.

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The first action taken by nurses when a patient come with an emergent issue to the emergency unit is triage. Nurse's triage knowledge and skill perception have a significant impact to the functional efficiency of emergency unit. The purpose of this study is to determine the description of triage knowledge and skill perception among nurses in emergency unit. This study used descriptive cross-sectional design with a purposive sampling method to 62 emergency unit nurses in Depok. The variables examined in this study were age, gender, level of education, length of work, emergency training, triage knowledge, and perception of triage skills. Data were analyzed using univariate analysis. The results of this study indicate that the majority of respondents have a sufficient level in both of knowledge (58.1%) and triage skills perception (67.7%). Therefore, the Hospital can evaluate the ability of triage nurses and facilitate nurses to get emergency training on a regular basis to improve the quality of nursing services."

"Instalasi Gawat Darurat (IGD) Rumah Sakit RK Charitas dituntut untuk segera meningkatan kualitas karena masih menghadapi berbagai permasalahan seperti terjadinya penumpukan pasien, lamanya waktu pelayanan, dan tingginya keluhan pasien. Lean thinking telah berkembang menjadi metode yang banyak digunakan di rumah sakit untuk mengatasi berbagai masalah. Penelitian ini bertujuan untuk (1) mengevaluasi arus pasien IGD saat ini, (2) untuk mengidentifikasi dan menghilangkan proses yang tidak bernilai, dan (3) mengusulkan future state value stream map (VSM). Penelitian ini dilakukan dengan pendekatan action research. Pengambilan data dilakukan dengan observasi langsung keseluruhan aktivitas di IGD untuk memetakan current state VSM, dan mengidentifikasi waste serta menentukan value added dan non value added activity. Simulasi dilakukan untuk mengurangi aktivitas non value added yang dapat dihindari sebagai dasar pengajuan future state VSM. Hasil penelitian ini menemukan 38 aktivitas yang dilakukan oleh pasien di IGD RS RK Charitas, rata-rata waktu yang dibutuhkan pasien adalah 405 menit dan kegiatan yang paling memakan waktu adalah menunggu transfer ke rawat inap. Setelah waste dieliminasi, seluruh proses aktivitas di IGD turun dari 38 menjadi 29 aktivitas saja serta terjadi peningkatan value added sebesar 17,97%. Keseluruhan hasil tersebut menjadi dasar untuk menyimpulkan bahwa penerapan lean thinking di IGD RS Charitas telah terbukti mereduksi waste dan meningkatkan value added. Penerapan future state VSM dalam jangka pendek, menengah dan panjang meliputi antara lain aplikasi 5S, membuat sistem informasi emergensi di unit radiologi dan mengubah layout triase adalah rekomendasi yang diajukan dari penelitian ini.

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Emergency department (ED) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called "lean thinking". This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to propose a future state value stream map (VSM). It was a qualitative study. The first step is we observe the whole activity in ED and make a current state VSM, than we apply lean thinking to find waste and identify value added and non value added activity. The last step is to eliminate the avoidable non value added activity and propose the future VSM Among all the processes carried out in ED at RK Charitas Hospital, the most time consuming processes were to wait for an admission bed (boarding). After the waste is eliminated, the entire process of activity in the ER drops from 38 to 29 activities only. Value added activity increased by 17.97%. The application of lean thinking hopefully can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction. "

"Bagian Gawat Darurat merupakan pintu gerbang dan cermirmya suatu rumah sakit yang memberikan pelayanan cepat, tepat, profesional tanpa mengabaikan keamanan pasien. Dengan kompleksnya permasalahan yang ada maka perlu diadakan penelitian untuk mengetahui gambaran pengelolaan pelayanan serta faktor input dan faktor proses yang mempengaruhi pengelolaan pelayanan di Bagian Gawat Darurat R S RK. Cbaritas Palembang. Penelitian ini merupakan penelitian kualitatif dengan pendekatan pemecahan masalah yang di!akuk.an di BGD RS RK Cbaritas pada bulan Maret sampai April 2008 melalui wawaneara mendalarn, observasi langsung, dan telaah dokumen. Hasil penelitian dengan mempergunakan problem priority matrix untuk memprioritaskan pemecahan masalah berdasarkan besarnya manfaat yang diperoleh dengan usaha yang dibutuhkan maka didapatkan lima permasalahan yang menduduki tiga rangking pertama yaitu lamanya waktu penjemputan pasien rawat inap, kualitas dokter jaga dan perawat BGD yang kurang jumlah perawat BGD kurang, pelaksanaan triase belum baik di BGD RS RK Charitas Palembang. Disarankan adanya kordinasi antara direktorat medis dan keperawatan untuk mempercepat proses penjemputan pasien rawat inap, memberikan pendidikan dan pelatihan untuk dokter jaga dan perawat BGD, menambah tenaga perawat BGD mempertegas pelaksanaan triase dan membuka poli insidentil dekat BGD pada saat poli rawat jalan tutup.

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The Emergency Department (ED) has already known as the gateway and the reflection of services given by the hospital which is suppose to be fast accurate and qualified without neglecting the pntient's safety. As the problem is more and more complicated regarding to services at the ED, therefore, a study is needed in order to explore how the quality of the service management is, as well as the input and process factors influenced at the ED of RK Charitas Hospital of Palembang. The research is a qualitative study with the Problem Solving Approach as the strategy of the study. The study is carried out at the ED of RK Charitas Hospital from March to April 2008 with an in-depth interview, direct observation and documents assessment (secondary data exploration), as the method of infonnation eolleetion.

The study is using the Problem Priority Matrix in order to find the problem solving prioritizing base on the magnitude of benefit yielded from effort required. There are five problems in the three first order, namely ; time for picking-up inpatient care at the ED still too long, inadequate quality of doctor and nurse at the ED, in adequate amount of nurses, and inadequancy on triase implementation at the ED of RK Charitas Hospital of Palembang.

It was suggested the existence of coordination between medical directorates and nursing to minimize time of patient?s transfer from ED to inpatient care unit, giving education and training for doctor and nurse at ED, adding nurse worker at ED, assuring triase implementation and opening an incidental unit near ED at the time of outpatient unit is closed."

"Kesiapan Instalasi Gawat Darurat di RSUP Dr. Kariadi sebagai rujukan Sistem Gawat Darurat Terpadu Sehari-Hari sangat dipengaruhi oleh faktor input : Sumber Daya Manusia dan pengaturan jaganya, tersedianya ambulan 24 jam, melalui call center, sarana fisik bangunan, sarana medik dan non medik, ketersediaan obat alat kesehatan dan bahan habis pakai di ruang tindakan, Standar prosedur pelayanan pasien, serta faktor proses pelayanan pasien meliputi alur pasien, triase, pelayanan gawat darurat di label merah, pemeriksaan penunjang laboratorium dan radiologi dan ketersediaan obat di farmasi 24 jam.Hasil penelitian ini dengan membandingkan Kepmenkes No 856/Menkes/SK/IX/2009 tentang standar Instalasi Gawat Darurat (IGD) rumah sakit didapatkan bahwa mampu memberikan semua jenis pelayanan 100%, tersedianya SDM sesuai dengan kualifikasi dan pendidikan serta dokter jaga spesialis anak, bedah, penyakit dalam, obstetrik dan kandungan serta anesthesi 24 jam 100%, terpenuhinya syarat fisik bangunan di ruang tindakan, operasi dan observasi 100%, tersedianya obat, prasarana medik di ruang tindakan berupa obat, bahan habis pakai dan peralatan medik 100%, tersedianya layanan ambulan 24 100%, tersedianya pemeriksaan penunjang laboratorium, radiologi dan farmasi 24 jam 100% dan belum berfungsinya call center.

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Preparedness of Emergency Department Kariadi Hospital Semarang as a referral Emergency Comprehensive Services System Daily influenced by input factors, human resources and distribution services, 24 hour ambulance services, call center ,physical building , medical and non medical equipment, drugs and single used material in service area standard operating procedure for patients services, and process factor as patient flow through an emergency department, triage, true emergency services (red label), supporting services as laboratory, radiology and pharmacies 24 hours.

Result of this study compare with the Kepmenkes No 856/Menkes/SK/IX/2009 tentang Standar Instalasi Gawat Darurat (IGD) Rumah Sakit, is prepared for all services case, qualification and education of human resources and prepared of special doctor on site pediatrician, surgeon, internist, obstetric and gynecologist also anesthesiologist 24 hours, prepared of physical building in services area, operation room, and observation room 100%, prepared of medication, medical equipment and material single used 100%, ambulance services 24 hours, prepared of supporting services as laboratory, radiology and pharmacies 24 hour and call center is not well done."

"Latar Belakang: Dalam pemberian pelayanan kesehatan dan non kesehatan dituntut untuk melakukan sebaik mungkin. Proses peningkatan kesehatan dapat dilakukan dengan melakukan penguatan terhadap pelayanan kesehatan, yaitu Rumah Sakit. Tujuan: Tujuan dari penelitian melakukan analisis implementasi indikator SPM IGD pada KMK No. 129 tahun 2008 di IGD Rumah Sakit “Sehat” Depok. Metode Penelitian: Desain pada penelitian menggunakan penelitian kualitatif dengan Jenis Penelitian Rapid Assesment Procedure. Hasil: Pada komponen input, pengambilan kebijakan melalui proses multi pimpinan, SDM masih belum pernah diadakan pelatihan kegawatdaruratan yang tersertifikasi, SOP keperawatan dan medis di IGD berjumlah 116. Sarana dan prasarana IGD masih belum sesuai dengan Permenkes RI No.47 tahun 2018. Pada komponen proses terdiri dari perencanaan dan pengambilan keputusan, pengorganisasian, kepemimpinan, dan pengendalian. Pada komponen output terdapat indikator yang belum sesuai dengan SPM, pada indikator pemberi pelayanan gawat darurat yang bersertifikat yang masih berlaku BLS/PPGD/GELS/ALS hasil capaian 71%, keterserdian tim penanggulangan bencana tersedia satu tim, namun belum ada SK dari pimpinan. Kesimpulan: Belum tercapainya keseluruhan indikator pada SPM mengindikasikan bahwasanya mutu pelayanan dasar pada IGD Rumah Sakit “Sehat” Depok belum maksimal dalam implementasi dan pelaksanaanya. Saran: Melakukan optimalisisi pada SPM dengan mengadakan pelatihan dan penurunan SK untuk tim bencana di IGD.

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Background: In the term of providing both health and non-health services, we are required to do our best. The process of improving public health can be undertaken by strengthening health services in the hospitals. Objectives: The purpose of this research is to analyze the implementation of the indicators of SPM IGD in KMK No. 129 of 2008 in the emergency room of Sehat Hospital in Depok. Research Methods: The design of this study uses a qualitative approach with Rapid Assessment Procedure. Results: Based on the input component, the hospital’s policy-making through a multi-leader process, the hospital’s human resources have never been held a certified emergency training while nursing and medical SOPs in the emergency room is 116. The emergency room facilities are still not following the Minister of Health Regulation No. 47 of 2018. Based on the process component, it consists of planning, decision making, organizing, leadership, and controlling. Based on the output component, the indicators are not following the SPM, the indicators of certified emergency service providers still use BLS/PPGD/GELS/ALS, which results in 71% (standard 100%), the disaster management team is only one team and there is no a decree from the director. Conclusion: The lack of positive results of all indicators in SPM indicates that the quality of basic services in Depok Sehat Hospital’s emergency room has not been maximally implemented. Suggestion: The hospitals’ stakeholder optimizes the SPM through certified training and the director signs the decree for the disaster management team in the emergency room.

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"Instalasi Gawat Darurat IGD adalah gerbang utama masuknya pasien gawat darurat,sehingga dibutuhkan pelayanan yang cepat, tepat, cermat dan alur proses yang lancardan bebas hambatan. Yang menjadi hambatan pelayanan pasien IGD adalah adanyabottleneck proses mulai dari pasien datang sampai dengan pasien keluar sehinggaberdampak pada turn arround time TAT melebihi dari standar yang dtetapkan olehrumah sakit yaitu le; 8 jam. Penelitian ini bertujuan untuk melakukan analisis alurproses pelayanan pasien gawat darurat dengan menggunakan lean six sigma tools.Desain penelitian ini adalah analisa kualitatif dengan metode observational actionprocess research dan kerangka acuan DMAI Define, Measure, Analyse, Improve .Pengambilan data dengan observasi alur proses pelayanan pasien, telaah dokumen danwawancara mendalam di Instalasi Gawat Darurat RSUP Nasional Dr. CiptoMangunkusumo. Hasil penelitian dari 369 pasien terdapat 166 44.98 memilikiTAT > 8 jam dengan rata ndash; rata waktu pelayanan pada saat datang 5.30 menit, triage4.09 menit, registrasi 7.10 menit, evaluasi dan tatalaksana awal 60.10 menit, zonapelayanan 535.14 menit, permintaan obat ke satelit farmasi 34 menit, pemeriksaanlaboratorium 66.47 menit, pemeriksaan radiologi 98 menit, dan pasien pulang 20.24menit, rawat 50.30 menit, rujuk 110 menit dan meninggal 72.50 menit. Persentase NonValue Added 59 dan perhitungan Six Sigma berada di level sigma 3 yangmemungkinkan terdapat 66.807 melebihi TAT dari 1 juta kesempatan. Hasil analis fishbone menunjukkan adanya bottelneck di setiap proses terutama di zona pelayanandengan penyebab yaitu menunggu diperiksa, menunggu hasil pemeriksaan penunjang,menunggu alat, obat dan alat kesehatan, menunggu disposisi, menunggu discharge danmenunggu ruang rawat. Penelitian ini menyimpulkan bahwa alur proses pelayananpasien IGD tergolong un-lean dan berada di level sigma 3 sehingga diperlukan upayaperbaikan terus menerus Kaizen dengan desain ulang pelayanan mulai dari pro aktiftriage, mengaktifkan zona hijau, advanced patient tracking, ruang intermediate warduntuk pasien boarding dan layanan ambulans melalui anggota tim gerak Lean SixSigma.

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Emergency Room ER is the main gate of emergency patients that required a fast,precise, and careful service. One of challenges in ER is bottleneck process start frompatients arrived until patients discharged. This may cause to the Turn Around Time TAT exceeds the standard of 8 hours.

This research aimed to analyse the flowprocess of patient's care in ER using Lean Six Sigma Tools. Design used in this studyis qualitative analysis by method of observational action process research andreference of DMAI Define, Measure, Analyze, and Improve. Data were collected byobservation to process of patient's care, document review and in depth interview inER of National Referral Hospital of Dr. Cipto Mangunkusumo.

Results of this study,166 44,98 from 369 patients have TAT 8 hours with average service time patients arrived 5.30 minutes, triage 4.09 minutes, registration 7.10 minutes,evaluation and initial treatment 60.10 minutes, service zone 535.14 minutes, takingmedicines to pharmacy 34 minutes, laboratory check 66.47 minutes, radiologyexamination 98 minutes, patients discharge 20.24 minutes, to be admission 50.30minutes, refer to another hospital 110 minutes, death 72.50 minutes. Percentage ofNon Value Added is 59 and calculation of Six Sigma is in Level Sigma 3 thatallows there to be 66,807 over TAT of 1 million occasions.

Fishbone analysis shows that there is bottleneck in each process, especially in service zone with varietiescauses of waiting to be checked assessed, waiting for laboratory check or radiologyexamination, waiting for medicines and medical devices, waiting for disposition,waiting to be discharged and waiting for admission.

This study concludes that theflow processes of patient's care in ER is classified as un lean and stand in level sigma3. Therefore it is required continuous improvement Kaizen by re design of servicesstart from pro active triage, green zone activation, advanced patient tracking, intermediate ward for boarding patients and ambulance service through Lean SixSigma team.Keyword Flow Process, Emergency Room, Lean Six Sigma."

"Pendahuluan: Instalasi gawat darurat (IGD) sebagai unit yang sangat penting di rumah sakit memiliki banyak masalah terkait indikator mutu antara lain peningkatan 20,9% length of stay (LOS), adanya 2,2% pasien yang tidak mendapatkan triase, 8,6% pasien yang mendapatkan kejadian medis yang dapat dicegah dan angka kematian sebesar 14,6%. Permasalahan ini harus diselesaikan agar tidak menganggu kinerja IGD dan rumah sakit, salah satu caranya adalah menggunakan lean thinking. Oleh karena itu, penelitian ini bertujuan untuk mengetahui lean tools yang paling banyak digunakan dan dampaknya pada indikator mutu di IGD. Metode: Penelitian ini menggunakan metode literature review dengan penelusuran studi melalui database PubMed, Scopus dan EBSCO yang menghasilkan 19 studi terinklusi dari tahun 2011-2021. Hasil: Penelitian ini menemukan sebagian besar IGD di studi terinklusi berhasil meningkatkan indikator mutunya melalui implementasi lean thinking. Lean tools yang paling banyak digunakan adalah Value Stream Mapping (VSM) pada fase define dan kaizen pada fase improve, sedangkan indikator mutu yang paling banyak digunakan adalah door to doctor time sebagai luaran primer dan length of stay (LOS) sebagai luaran sekunder.

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Introduction: The emergency department (ED) as a very important unit in the hospital has many problems related to quality indicators, including an increase of 20.9% length of stay (LOS), 2.2% of patients who did not receive triage, 8.6% of patients who get preventable medical events and the mortality rate is 14.6%. This problem must be resolved so as not to interfere with the performance of the ED and hospital, one of the solutions is to use lean thinking. Therefore, this study aims to determine the most widely used lean tools and their impact on quality indicators in the ED.

Methods: This study used a literature review method by tracing studies through the PubMed, Scopus and EBSCO databases which resulted in 19 included studies from 2011-2021.

Results: This study found that most of the ED in the included study succeeded in improving their quality indicators through the implementation of lean thinking. The most widely used lean tools are Value Stream Mapping (VSM) in the define phase and kaizen in the improve phase, while the most widely used quality indicators are door to doctor time as the primary outcome and length of stay (LOS) as the secondary outcome."

"Data Base Plan for Emergency Installation is part of Hospital Management Information System, in special case we are studying of Management Information System for data registration in Emergency Installation for support activity. Dr. M. Djamil Padang Hospital's Company Emergency Installation which still use manual registration procedures and reporting system will be effect to losing patient information.

Objectives of this research are to develop computerized registration information system Dr. M. Djamil Padang Hospital's Company Emergency Installation. To development system we have 2 (two) stages, manual stage by DFD and Flowchart and automation stage by data input, process and output. To support developing automation or computerized system we use Microsoft Access 2000 and Microsoft Visual Basic Version 6.

Regarding to the analyse result at Dr. M. Djamil Padang Hospital's Company Emergency Installation especially in registration and reporting process we found inefficient system as follows :

- Data input use repeat manual system

- Reporting activity use manual report system with collecting data by recapitulation from activity manual forms.

- Raw data report still necessary to process for get Emergency Installation information Consequently the above inefficient system is data input and process inclined data false, in reporting manual process will be effect disinformation data patient.

Therefore, is necessary planed of data base application program that have more effective and efficient with implemented hospital computerize system. This system plan expected to increase service quality for patient. Because this system able to create report relation with health indicator.

Complicity of this systems is high affectivity and efficiently, accurate, easy to operated because relevant with user needed and able to expand in order to develop system that have more complicity in the future time."