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"Pelayanan kamar operasi merupakan salah satu bentuk pelayanan yang sangat mempengaruhi tampilan suatu rumah sakit. Seiring dengan ilmu pengetahuan dan teknologi, kegiatan bedah menjadi bentuk pelayanan kesehatan spesialistik yang mahal, jadi harus efisien pengelolaannya.Instalasi Kamar Operasi RSUD Pasar Rebo mempunyai 4 kamar operasi yang melayani bedah cito dan elektif. Dengan disatukannya pelayanan tindakan bedah cito dan elektif di instalasi kamar operasi ini, tindakan bedah elektif sering diundur pelaksanaannya karena harus mendahulukan pelaksanaan tindakan bedah cito yang mendapat prioritas utama dan adakalanya bedah elektif terpaksa ditunda/dibatalkan pelaksanaannya. Kapasitas waktu yang tersedia dari jam 8.00 pagi s.d 14.00 siang juga pada kenyataannya tidak dimanfaatkan seefisien karena belum adanya sistem penjadwalan operasi yang baik, pemakaian kamar operasi selalu dimulai diatas jam 8.00 pagi sehingga waktu kerja yang terbuang dimasing-masing kamar operasi rata-rata 32,87% perhari.Penelitian ini bertujuan untuk mengetahui gambaran/karakteristik sistem pelayanan tindakan bedah di Instalasi Kamar Operasi di RSUD Pasar Rebo dan membuat tehnik penjadwalan yang sesuai sehingga produk yang dihasilkan dapat efisien dan optimal. Penelitian ini merupakan penelitian cross sectional dan melakukan analisa kuantitatif terhadap data sekunder untuk membuat model kuantitatif dan analisa deskriptif.Dari hasil penelitian diketahui utilisasi kamar operasi sebesar 46,66% pada saat bedah cito masih dilakukan bersama-sama dengan bedah elektif. Lalu dari simulasi diperoleh besar utilisasi kamar operasi untuk bedah elektif (tanpa bedah cito) rata-rata sebesar 39,25% di setiap kamar operasi dengan 9 kasus perhari. Dengan simulasi juga dapat diketahui kapasitas optimal kamar operasi untuk mengerjakan bedah elektif sebanyak 18 kasus per hari. Dengan mengetahui kapasitas optimal masing-masing kamar operasi dan lama waktu operasi untuk masing-masing tindakan bedah dapat dibuat sistem penjadwalan yang sesuai untuk Instalasi kamar Operasi RSUD Pasar Rebo.Dengan adanya penjadwalan dapat diketahui berapa besar kapasitas yang berlebih setiap hari dan disarankan membuat perencanaan untuk pemanfaatannya sehingga Instalasi Kamar Operasi dapat sebagai salah satu revenue center rumah sakit.

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Developing a Model for Scheduling of Elective Surgery Service for The Surgery Theatre Installation of The Pasar Rebo HospitalSugery theatre service is one of the hospital services that make an image to the hospital performance. In line with advanced knowledge and technology, surgical operation become more expensive specialistic health service and need to be managed efficiently.

The Surgery Theatre Installation of The Pasar Rebo Hospital have four surgical theatres which serve surgical operations both emergency and elective surgery. As The Surgery Theatre Installation served surgical operations both emergency and elective surgery, resulting in postponement or cancellation of elective surgical operations. Allocated time to serve surgical operations is from 8.00 a.m to 2.00 p.m daily. This allocated time had not been utilized effectively because of unmanaged scheduling for surgical operations resulting in lost of worktime about 32,87% for each surgical theatre daily.

The purpose of this study was to describe characteristic of surgical service acheduling system of The Pasar Rebo Hospital and subsequently to develop a model to manage better through scheduling technique. This study was a cross sectional study with quantitative model related to scheduling of surgery services.

The result of this study showed that each surgical theatre utilization rate was about 46,6% when both emergency and elective surgical operations performed in those surgical theatres.

After performing simulation, utilization rate of elective surgery without emergency surgery was about 39,25% with 9 cases for each surgical theatre daily. In addition, optimal capacity of Sugery Theatre Installation was 18 cases daily. After knowing optimal capacity for each surgical theatre and average time for each surgical operation, a model of well managed scheduling system can be developed for The Surgery Theatre Installation of The Pasar Rebo Hospital.

After implementing well managed scheduling system, The Surgery Installation of The Pasar Rebo Hospital would be able to know daily capacity for each surgery theatre and develop a plan to utilize effectively each surgery theatre daily resulting in increasing revenue for The Pasar Rebo Hospital."

"ABSTRACTLatar belakang: Efek samping tindakan odontektomi yang sering terjadi adalah pembengkakan dan rasa nyeri.Banyak praktisitelah menggunakan terapi dingin untuk mengurangi pembengkakan dan rasa nyeri pasca odontektomi, namun masih sedikit dokter gigi yang menggunakan terapi dingin berupa larutan irigasi bersuhu dingin saat tindakan odontektomi. Tujuan: Mengevaluasi efek pemberian irigasi bersuhu dingin terhadap pembengkakan dan rasa nyeri pasca odontektomi. Metode penelitian:Studi prospektif pada pasien RSKGM FKG UI dengan gigi impaksi dan menjalani tindakan odontektomi. Pasien dibagi menjadi 2 kelompok, yaitu kelompok pasien yang mendapat perlakuan larutan irigasi bersuhu dingin dan kelompok kontrol larutan irigasi bersuhu kamar. Pembengkakan dan intensitas nyeri pasien pada kedua kelompok diukur dan dibandingkan pada hari H, ke-3, dan ke-7. Hasil: Terdapat perbedaan bermakna (p<0.05) antarapembengkakan pada kelompok pasien yang diberikan larutan irigasi bersuhu dingin dengan kelompok pasien yang diberikan larutan irigasi bersuhu kamar, namun tidak terdapat perbedaan bermakna (p>0.05) antara rasa nyeri pada kelompok pasien yang diberikan larutan irigasi bersuhu dingin dengan kelompok pasien yang diberikan larutan irigasi bersuhu kamar. Kesimpulan: Larutan irigasi bersuhu dingin berpengaruh terhadap pembengkakan, namun tidak berpengaruh pada rasa nyeri pasca odontektomi. Background: Side effects of mandibular third molar surgery that happen occur are swelling and pain. Many practitioners have used cold therapy to reduce swelling and pain after third molar surgery, but the use of cold irrigation solution by dentist is still rare. Objective: To evaluate the effect of cold irrigation solution on swelling and pain after third molar surgery. Methods:  Prospective study on patients in RSKGM FKG UI with impacted teeth and underwent third molar surgery. Patients were divided into two groups; intervention group with cold irrigation solution and control group with room temperature irrigation solution. Swelling and pain intensity on both groups were measured and compared on operative day, days 3 and 7 post operative. Result: There was significant swelling difference between both group, but there was no significant pain difference between both group. Conclusion: Cold irrigation solution effects swelling after third molar surgery, but doesnt effect the pain."

"Latar belakang: Cedera duktus bilier sewaktu operasi laparoskopi kolesistektomi berpotensi menimbulkan masalah untuk pasien dan ahli bedahnya. Rekonstruksi duktus bilier cukuplah sulit dimana diagnosis dini dan tatalaksana yang tepat diperlukan untuk mencegah morbiditas lanjut dan komplikasi yang mengancam jiwa. Operasi koreksi oleh ahli bedah hepatobilier yang berpengalaman di rumah sakit pusat rujukan penting untuk menjamin keberhasilan rekonstruksi.Metode: Sepanjang Juni 2010 hingga Juni 2015 terdapat 7 kasus cedera saluran bilier. Dilakukan penelitian secera retrospektif, mengevaluasi karakteristik, tindakan dan keluaran dari operasi rekonstruksi.Hasil: Satu dari 7 kasus cedera duktus bilier ditangani secara endoskopi, selebihnya menjalani pembedahan. Lima kasus (83,3%) menjalani operasi koreksi yang ditunda. Mean interval dari waktu terjadinya cedera hingga saat rujukan adalah 45 hari (median 45 hari). Mean interval dari waktu terjadinya cedera hingga operasi rekonstruksi adalah 182 hari (median 65 hari). Semua pasien mengalami biloma, dua pasien telah dilakukan drainase sebelum dirujuk. Satu pasien datang dengan ikterus dan 3 pasien mengalami peningkatan kadar bilirubin. Berdasarkan kolangiografi pra operasi; dua pasien dengan cedera Strassberg E3 dan satu pasien dengan cedera Strassberg E1. Dua pasien lain masing-masing mengalami cedera Strassberg C dan D. Pada semua pasien dilakukan rekonstruksi hepatikoyeyunostomi Roux en Y dan stent internal dipasang pada 2 pasien. Stent internal ini dilepas masing-masing pada hari post operatif ke-18 dan ke-20. Rerata durasi operasi adalah 4 jam 42 menit. Rerata durasi rawat inap adalah 38,2 hari. Hanya satu pasien yang mengalami morbiditas pasca operasi. Pasien ini memerlukan tindakan operasi untuk memperbaiki luka operasi yang terbuka. Dilakukan pemantauan pasca operasi selama 6-24 bulan. Semua pasein tidak ada yang mengalami ikterus maupun kolangitis pada periode tersebut.Simpulan: Tindakan koreksi operatif pada cedera duktus bilier akan menunjukkan hasil yang baik bila dilakukan oleh ahli bedah hepatobilier yang berpengalaman. Hepatikoyeyunostomi merupakan tindakan yang terbaik untuk mengembalikan kontinuitas aliran bilier. Follow up jangka panjang tetap dibutuhkan untuk melihat keluaran pada seluruh pasien. ......Background: Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) procedure bears problem for the patients and the surgeon. Biliary reconstruction is often challenging while prompt diagnosis and proper treatment are needed to prevent long term morbidity and life threatenting complications. Surgical repair by an experienced hepatobiliary surgeon in a tertiary care is important to ensure the success of the reconstruction.Methods: From June 2010 to June 2015 there are 7 BDI. We conduct a retrospective study by evaluating the characteristic, type of surgery and the outcome.Results: One out of 7 BDI cases were managed endoscopically. The rest had surgical reconstruction. Five cases (83.3%) had a late surgical repair. The mean interval from the time of BDI to referral was 45 days (median 45 days). The mean interval from the time of BDI to the reconstruction surgery was 182 days (median 65 days). All of the patients had biloma, two patients had drainage prior of the referral. One patient had clinical jaundice, three patients with slightly elevated bilirubin level. Based on the cholangiography studies prior of the surgery, two patients had Strassberg E3 injury and 1 patient had Strassberg E1 injury. Two other patients each had Strassberg C and D injury . All of the patients had a hepaticojejunostomy Roux en Y reconstruction; an internal stent was placed in two patients. The internal stent were removed on POD 18 and POD 20. Mean operative time was 4 hours 42 minutes. Mean hospital stay was 38.2 days. Only one patient developed a post operative morbidity. She needed another surgery to repair the burst abdomen. The follow up period range from 6-24 months. All patients did not develop jaundice or cholangitis during that period.Conclusion: Surgical repair for BDI will show a better outcome when being done by an experienced hepatobilliary surgeon. Hepaticojejunostomy offers the best chance to restore the continuity of the biliary flow. A long term follow up still needed to see the overall result on these patients."

"ABSTRAKFistel enterokutan (FEK) mengakibatkan sepsis, malnutrisi, ketidakseimbangan cairan dan elektrolit. Tujuan penelitian ini supaya diketahuinya faktor risiko yang mempengaruhi penyembuhan FEK. Penelitian ini dirancang secara potong lhe purpose of this study be discovered the risk factors that affect ECF healing. The study was designed as a cross-sectional retrospective analytic, by recording medical records for the period January 2007 - December 2011 at Cipto Mangunkusumo Public Hospital. Obtained 69 cases, the appropriate inclusion criteria 57 cases, aged 17-76 years, the highest in the group 31-45 years, male 37 cases, 54 cases of post-operative, 3 cases of spontaneous. Factors that affect healing is albumin levels> 3.0 mg / dl 3.8 times, low output fistula 2.9 times, colon fistula site 2.9 times, Subjective Global Assessment A and B 1.6 times. Factors that affect healing is good nutrition, low output fistula, colon fistula site.intang retrospektif analitik, dengan mencatat rekam medis penderita pada periode Januari 2007 - Desember 2011 di RSUPN Cipto Mangunkusumo. Didapatkan 69 kasus, yang sesuai kriteria inklusi 57 kasus, usia 17–76 tahun, terbanyak pada kelompok 31–45 tahun, laki-laki 37 kasus, 54 kasus pasca operatif, 3 kasus spontan. Faktor yang memengaruhi penyembuhan adalah kadar albumin >3,0 mg/dl 3,8 kali, fistel low output 2,9 kali, lokasi fistel kolon 2,9 kali, Subjective Global Assessment A dan B 1,6 kali. Faktor yang memengaruhi penyembuhan adalah nutrisi baik, fistel low output, lokasi fistel kolon.

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ABSTRACTEnterocutaneous fistula (ECF) resulting in sepsis, malnutrition, fluid and electrolyte imbalance. The purpose of this study be discovered the risk factors that affect ECF healing. The study was designed as a cross-sectional retrospective analytic, by recording medical records for the period January 2007 - December 2011 at Cipto Mangunkusumo Public Hospital. Obtained 69 cases, the appropriate inclusion criteria 57 cases, aged 17-76 years, the highest in the group 31-45 years, male 37 cases, 54 cases of post-operative, 3 cases of spontaneous. Factors that affect healing is albumin levels> 3.0 mg / dl 3.8 times, low output fistula 2.9 times, colon fistula site 2.9 times, Subjective Global Assessment A and B 1.6 times. Factors that affect healing is good nutrition, low output fistula, colon fistula site."

"ABSTRAKNama : Patiyus Agustiansyah/NPM 1506706023Program Studi : Kajian Administrasi Rumah SakitJudul : Analisis dan Implementasi Lean pada Persiapan OperasiKanker Ginekologi di RSUP dr. Mohammad HoesinPalembangIndonesia saat ini memiliki beban kanker ginekologi besar yaitu insidensi,morbiditas dan mortalitasnya. Salah satu penanganan kanker ginekologi adalahpembedahan yang akan membantu kesintasan pasien. Waktu tunggu penjadwalanoperasi kanker ginekologi hendaklah memperhatikan progresifitas kankersehingga waktu tunggu operasinya tidak melebihi 2 minggu. Waktu tungguoperasi menggambarkan mutu pelayanan rumah sakit.Tujuan penelitian ini adalah,untuk menganalisis waktu tunggu penjadwalan operasi kanker ginekologi diRSUP dr. Moehammad Hoesin Palembang dengan menggunakan prinsip Lean.Hasil penelitian menunjukan penegakan diagnosis selama 43.844 menit dan waktutunggu operasi selama 66.700 menit, dengan menerapkan prinsip lean makapenegakan diagnosis 10.328,5 menit dan waktu tunggu operasi 10.325 menit.Kesimpulan penelitian, pada current state terdapat 26 aktifitas; 12 aktifitas VA value added ratio / VAR waktu 0,46 ; VAR jarak 89,6 dan 14 aktifitas NVA waste pasien dan 4 waste aktifitas petugas. Aliran proses yang menghambat bottle neck terdapat di pendaftaran, di poliklinik, di pemeriksaan penunjang dandi bagian praoperatif waktu tunggu paling lama . Future State memiliki 15aktifitas VA VAR waktu 33 ; VAR jarak 95,8 dengan 8 aktifitas NVA waste aktifitas pasien dan 0 waste aktifitas petugas, dengan waktu tunggudiagnosis 10.328,5 menit sedangkan waktu tunggu penjadwalan operasi 10.325menit. Hasil perbandingan current state dengan future state didapatkanpeningkatan aktifitas value added sebanyak 7,7 dengan penurunan waktutunggu 81,3 dan penurunan jarak tempuh 0,42 . Analisis akar masalahpenyebab waktu tunggu lama penjadwalan operasi kanker ginekologi di RSMHdikarenakan kekurangan SDM registrasi, rekam medis, DPJP dan keterbatasaninfrastruktur CT scan, kamar operasi dan instrumen dan kelemahan mengelolaproses penjadwalan operasi tersebut. Saran peneliti adalah peningkatan kinerjadan penambahan SDM, membuat regulasi untuk memprioritaskan pelayananpasien kanker ginekologi, serta integrasi Sistem Informasi Manajemen RumahSakit di setiap unit pelayanan.Kata Kunci : prinsip lean, value added VA , non value added NVA , waste,waktu tunggu penegakan diagnosis, waktu tunggu operasi, kanker ginekologi

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ABSTRACTName Patiyus Agustiansyah NPM 1506706023Program Studi Hospital Administration StudyTitle Lean Analysis and Implementation of Gynecology CancerOperative Scheduling in General Hospital dr. MohammadHoesin RSMH PalembangIndonesia currently has gynecologic cancer burden in the incidence, morbidityand mortality. One of gynecological cancer treatment is surgery which will helpthe survival rate of patients. The waiting time of gynecological cancer surgeryscheduling should bu focused to cancer progression so the waiting time should notexceed 2 weeks. The waiting time operation illustrates the quality of hospitalservices.The purpose of this study was to analyze the waiting time of gynecologiccancer surgery scheduling in RSMH by using the principles of Lean. The resultsshowed that establishing diagnosed need 43,844 minutes and the waiting timeoperation was 66,700 minutes. By applying Lean then the diagnosis establishing10,328.5 minutes, and operations waiting times 10,325 minutes. The studyconclusion showing for 26 activities of current state with 12 VA activities VARtime 0.46 VAR range for 89.6 and 14 NVA activities with 14 patient rsquo swastes activities and 4 employee wastes activities. The process flow whichinhibits bottle neck were lies in the stage of registration, at the outpatient clinic,at the laboratory examination and at the preoperative division the longest waitingtime . The waiting time for diagnosis process were 43.844 minutes, while thewaiting time scheduling of operation process were 66.700 minutes. Future Statehas 15 VA VAR time of 33 VAR range of 95.8 with 8 NVA activities and 8patients waste activity and 0 employee waste activities. The waiting time for adiagnosis process were 10328.5 minutes, while the waiting time for operationscheduling process were 10.325 minutes. The comparison between the currentstate to the future state resulted increasement of the VA activity for 7.7 with areduction in waiting time for 81.3 and mileage decrease of 0.42 . Analysis ofroot problems revealed that the long waiting times for scheduling process ofgynecologic cancer surgery in RSMH were due to lack of human resourcesquantity registration, medical records, doctor in charge and the lack ofinfrastructure CT scan, operating rooms and instruments and managerialweaknesses in managing the process of scheduling the surgery. Researcherssuggest to improve the performance of existing recruitment human resources,make regulations of a priority of gynecologic cancer patients, as well as theintegration of Hospital Management Information System in each unit.Keywords lean principles, values added VA , non value added NVA , waste,value added ratio, waiting time for establishing diagnosis, surgery waiting times,gynecological cancer"

"ABSTRAKAnalisis Efisiensi Penggunaan Labu Darah Dalam Tindakan Operasi di RSUP Fatmawati Tahun 2017Penelitian ini bertujuan untuk menganalisis gambaran dan efisiensipenggunaan labu darah dalam tindakan operasi di RSUP Fatmawati. Jenispenelitian ini adalah kuantitatif dengan cara mengumpulkan data pasien diinstalasi bedah sentral dan unit transfusi darah rumah sakit 709 pasien dankualitatif dengan melakukan wawancara mendalam terhadap dokter bedah dandokter obstetric gynecology, penelitian ini menggunakan pendekatan retrospektif.Menilai nilai efisiensi penggunaan labu darah dengan melihat nilai CrossmatchedTransfusion Rate CTR , Transfusion Probability TP , Transfusion Index TI ,dan Nonusage Probability NUP . Penelitian ini menunjukan bahwa nilai CTRsebanyak 2,6, TP sebanyak 44 , TI 0,95, dan NUP 0,59. Faktor-faktor penyebabpemborosan dalam penelitian ini dikarenakan antisipasi dokter dalam pemesanandarah, jenis operasi, kadar haemoglobin, faktor pengalaman dan perkiraan dokterdalam menentukan kebutuhan kantong darah.Kata kunci: Crossmatch Transfusion Rate, Transfusion Probability, TransfusionIndex, Nonusage Probability.

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ABSTRACTAnalysis of the Efficiency of the Use Of Blood Bags in theOperative Action At RSUP Fatmawati In 2017This study aims to analyze the use of blood vials for transfusion in theoperation at Fatmawati Hospital. This research applied quantitative with reportfrom the operating theater and hospital blood transfusion unit as the source of data 709 patiens and qualitative methode by interview surgeon and obstetrician andgynecologist, this research using a retrospective approach. Assess the efficiencyof the use of blood bags by looking at the values of Crossmatched TransfusionRate CTR , Transfusion Probability TP , Transfusion Index TI , and NonusageProbability NUP . This study shows CTR value as much as 2.6, TP as much as44 , TI 0.95, and NUP 0.59. Factors causing blood waste are higher anticipationof doctors in ordering blood, the type of surgery, haemoglobin rate, experienceand the speed of doctors in determining the needs of blood bags.Keywords Crossmatch Transfusion Rate, Transfusion Probability, TransfusionIndex, Nonusage Probability"

"Pendahuluan:perforasi ileum merupakan suatu kegawatdaruratan dalam sistem gastrointestinal. Perforasi ileum terjadi akibat tumor ileum. Tujuan:untuk menampilkan asuhan keperawatan, penerapan evidence based nursing dan proyek inovasi. Peran perawat spesialis sebagai pemberi asuhan keperawatan lanjut, edukator, advokat, konselor, kolaborator, pembaharu dan peneliti. Metode:karya ilmiah ini menggunakan pendekatan studi kasus. Hasil: ada 1 kasus utama yaitu perforasi massa ileum dan 30 kasus resume sistem gastrointestinal dan hepatobilier. Ada 2 pasien dilakukan penerapan evidence based nursing practice mengunyah permen karet. Adanya efektifitas dari pemberian mengunyah permen karet untuk meningkatkan motilitas usus. Program inovasi kelompok berupa panduan peningkatan pemulihan setelah operasi enhanced after recovery surgery pada pasien yang menjalani pembedahan sistem pencernaan berupa pemberian maltodekstri sebelum operasi yaitu berjumlah 2 pasien, dan mobilisasi dini post operasi berjumlah 4 orang serta mengunyah permen karet setelah operasi berjumlah 2 orang. Kesimpulan: perilaku maladaptif pasien Tn.SMS yaitu gangguan body image. Mengunyah permen karet dapat meningkatkan motilitas usus, pemberian maltodektsrin pre operasi dapat mengurangi mual dan muntah serta nyeri post operasi dan mobilisasi dini 2 jam post operasi dapat mengurangi nyeri bahu pasien. ......Analysis of Medical Surgical Nursing Residency Practice and Case Study of Nursing Care Delivery on Patient with Perforated Ileal Mass Using Roy Adaptation Model RohmaniJuly 2018 Introduction: ileal perforation is an emergency in the gastrointestinal system. Perforation of ileum occurs due to ileal tumors. Purpose: to present nursing care, the application of evidence-based nursing and innovation projects. The role of specialist nurse as a nursing care nurse, educator, advocate, counselor, collaborator, reformer and researcher. Method: This paper uses a case study approach. Results: There were 1 major cases of ileal mass perforation and 30 cases of gastrointestinal and hepatobilier resume systems. There were 2 patients conducted the application of evidence based nursing practice chewing gum. The effectiveness of chewing gum to increase bowel motility. The group innovation program is an enhanced after recovery surgery guideline for patients undergoing gastrointestinal surgery in the form of preoperative maltodextrine, 2 patients, and postoperative early mobilization of 4 people and chewing gum after surgery of 2 people. Conclusion: maladaptive behavior of patient of Mr.SMS are body image disorder. Chewing gum can improve bowel motility, preoperative maltodextrine administration may reduce nausea and vomiting and postoperative pain and early mobilization 2 hours postoperatively may reduce shoulder pain of the patient. Key words: Roy adaptation model, Tumour of Ileum, Chewing Gum, Maltodextrin, D early mobilization, Enhanced recovery After Surgery. "