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"Latar Belakang:Keterlambatan penanganan pasien STElevation Myocardial Infarction(STEMI)menjadi penyebab tingginya mortalitas dan kejadian MACE (Major Adverse Cardiac Events). Di Indonesia, pasien pasien STEMI sering mengalami keterlambatan penanganan. Upaya yang dapat dilakukan di fasilitas kesehatan dengan kemampuan Primary Percutaneous Coronary Intervention(PCI) adalah mencapai reperfusi tepat waktu pasien STEMI. Berbagai strategi dilakukan untuk mencapai reperfusi tepat waktu diantaranya dengan menerapkan program CODE STEMI. Program CODE STEMI merupakan notifikasi STEMI melalui sistem panggilan tunggal yang dapat mempercepat waktu reperfusi pasien STEMI di rumah sakit.Tujuan:Mengetahui pengaruh penerapan program CODE STEMI terhadap Door to Balloon Time (D2BT) dan MACE pasien STEMI yang menjalani PrimaryPCI di RSUPN Cipto Mangunkusumo Jakarta.Metode:Penelitian ini merupakan studi kohort retrospektif pada 255 rekam medis pasien STEMI yang menjalani PrimaryPCI di RSUPN Cipto Mangunkusumo sebelum penerapan program CODE STEMI (2015-2016) dan sesudah penerapan program CODE STEMI (2017-2018). Analisis data dilakukan secara kuantitatif dengan uji Mann whitney untuk D2BT dan chi square untuk MACE.Hasil:Terdapat 111 pasien pada kelompok Non CODE STEMI dan 144 pasien pada kelompok CODE STEMI. D2BT berkurang bermakna 110 menit dari 275 (99-2356) menit pada kelompok Non CODE STEMI menjadi 165 (67-1165) menit pada kelompok CODE STEMI (p <0.001). Kejadian MACE (48,4% vs 51,6%; p = 0,120), gagal jantung (46,6% vs 42 %; p = 0,288), syok kardiogenik (27% vs 19,4%; p = 0,152), aritmia (12,6% vs 6,2%; p = 0,079), stroke (4,5% vs 5,6%; p = 0,705) dan angka mortalitas (7,2% vs 3,5%; p = 0,179) sama antara kedua kelompok.Kejadian infark berulang dan PCI ulang berkurang bermakna pada kelompok CODE STEMI (4,5% vs 0,7%; p = 0.047, 2,7% vs 0,0%; p = 0.047).Simpulan:Program CODE STEMI memperbaiki D2BT. Program CODE STEMI tidak menurunkan kejadian MACE.

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Background: Delay in the management of ST Elevation Myocardial Infarction (STEMI)patients is a cause of high mortality and the incidence of Major Adverse Cardiac Events (MACE).In Indonesia, STEMI patients often experience delays in treatment. Efforts that can be made in health facilities with Primary PercutaneousCoronary Intervention(PCI)capability are achieving timely reperfusion of STEMI patients. Various strategies were carried out to achieve timely reperfusion including implementationthe CODE STEMI program. The CODE STEMI program is a STEMI notification through a single call system that can speed up the reperfusion time of STEMI patients in the hospital.

Objective:To determine the effect of the implementation of the CODE STEMI program on Door to Balloon Time (D2BT) and MACE of STEMI patients undergoing Primary PCI at Cipto Mangunkusumo National Central General Hospital Jakarta.

Methods: This was a retrospectivecohort study on 255 medical records of STEMI patients undergoing Primary PCI at Cipto Mangunkusumo National Central General Hospital before the application of the CODE STEMI program (2015-2016) and after the application of the CODE STEMI program (2017-2018). Data analysis was performed quantitatively by Mann Whitney test for D2BT and chi square for MACE

Results:There were 111 patients in the Non CODE STEMI group and 144 patients in the CODE STEMI group. D2BT decreased significantly 110 minutes from 275 (99-2356) minutes in the Non CODE STEMI group to 165 (67-1165) minutes in the CODE STEMI group (p <0.001). MACE events (48.4% vs 51.6%; p= 0.120), heart failure (46.6% vs 42%; p = 0.288), cardiogenic shock (27% vs 19.4%; p = 0.152), arrhythmia (12.6% vs 6.2%; p = 0.079), stroke (4.5% vs 5.6%; p = 0.705) and mortality rate (7.2% vs 3.5%; p = 0.179 ) were similar between the two groups. The incidence of reinfarction and repeated PCI was significantly reduced in the CODE STEMI group (4.5% vs 0.7%; p = 0.047, 2.7% vs 0.0%; p = 0.047).C

onclusions:The CODE STEMI program reduces D2BT. The CODE STEMI program did not reduce the overall MACE incidence but reduced the incidence of reinfarction and repeated PCI of STEMI patients undergoing Primary PCI at Cipto Mangunkusumo National Central General Hospital. "

"Sindrom koroner akut berkontribusi pada tingginya angka morbiditas dan mortalitas terkait kasus penyakit kardiovaskular, dengan salah satu penyebab mortalitas tertinggi yaitu STEMI(ST Elevation Myocardial Infarction). Keterlambatan penanganan pasien STEMI menjadi penyebab tingginya mortalitas dan kejadian MACE (Major Adverse Cardiac Event), serta berpengaruh terhadap kualitas pelayanan kesehatan.Program CODE STEMI diciptakan dengan harapan dapat menyelesaikan keterlambatan ini serta meningkatkan kualitas pelayanan terhadap pasien. Penelitian ini bertujuan untuk mengetahui pengaruh pelaksanaan program CODE STEMI terhadap kualitas pelayanan pasien dengan STEMI di RSUPN Dr. Cipto Mangunkusumo.Metode yang digunakan adalah metode operasional secara kuantitatif dan kualitatif dengan desain kohort retrospektif. Data kuantitatif didapatkan dari telaah dokumen dengan jumlah sampel 207 pasien (135 kelompok CODE STEMI, 72 kelompok Non CODE STEMI), sedangkan data kualitatif didapatkan dari wawancara mendalam dengan sepuluh informan penelitian. Analisis data dilakukan secara kuantitatif dengan uji Mann whitney (Door to balloon time, total biaya RS, lama rawat) dan chi square (kejadian Mortalitas dan MACE). Hasil penelitian menunjukan terdapat perbaikan yang bermakna untuk door to balloon time, total biaya dan lama rawat pasien STEMI pada pasien yang ditangani dengan CODE STEMI. Selain itu terdapat kecenderungan penurunan angka kejadian MACE dan mortalitas setelah diterapkan program CODE STEMI. Baik pihak rumah sakit maupun pasien mengaku puas dengan program CODE STEMI tersebut. Program ini terbukti memiliki efikasi, efektivitas, optimalitas, akseptibilitas, legitimasi, dan ekuitas yang baik serta memenuhi prinsip-prinsip manajemen yang baik untuk sebuah program pelayanan. Kesimpulan penelitian ini adalah program CODE STEMI berpengaruh baik terhadap kualitas pelayanan pasien dengan STEMI di RSUPN Dr. Cipto Mangunkusumo.

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Acute coronary syndrome contributes to high rates of morbidity and mortality associated with cardiovascular disease, with one of the highest causes of mortality is STEMI (ST Elevation Myocardial Infarction). Delay in the management of STEMI patients is a cause of high mortality and the incidence of MACE (Major Adverse Cardiac Event), as well as affecting healthcare quality. This delay may be solved by the CODE STEMI program. This study aims to determine the effect of the implementation of the CODE STEMI program on the quality of healthcare services with patients with STEMI at Dr. Cipto Mangunkusumo Hospital. The method used was an observational method using quantitative and qualitative approach with a cross sectional design. Quantitative data were obtained from a medical records with a sample of 207 patients (135 CODE STEMI groups, 72 Non-CODE STEMI groups), while qualitative data were obtained from in-depth interviews with ten research informants. Data analysis was performed quantitatively by Mann Whitney test (Door to balloon time, total hospital costs, length of stay) and chi square test (Mortality and MACE events). The results of the study shows a significant reduction in terms of door to balloon time, total cost, and length of stay of STEMI patients treated with CODE STEMI. In addition, there is a decreasing tendency of the incidence of MACE and mortality after the application of the CODE STEMI program. Both the hospital and the patient said they were satisfied with the CODE STEMI program. This program is proven to have a good efficacy, effectivity, optimality, acceptability, legitimation, and equity. It also met the required principles of good management for healthcare program. The conclusion of this study is that the CODE STEMI program has a good impact on the healthcare quality of patients with STEMI in Dr. Cipto Mangunkusumo National Central General Hospital. "