Latar Belakang: Koordinasi asuhan pasien masih bermasalah di RS UGM khususnya dalam perencanaan perawatan dan proses transisi. RS UGM menerapkan case management system untuk memperbaiki koordinasi asuhan kasus kompleks salah satunya stroke. Evaluasi dilakukan terhadap sistem baru tersebut. Tujuan: Mengevaluasi fidelity case management pasien stroke rawat inap dan mengidentifikasi faktor-faktor implementasinya Metode: Penelitian implementasi, desain concurrent mixed method, dilaksanakan November 2016 – Januari 2017 di RS UGM. Pengambilan data dengan wawancara mendalam terhadap case manager, diskusi kelompok terarah paramedis, dan observasi proses koordinasi. Fidelity yang dinilai meliputi kepatuhan terhadap cakupan dan konten. Evaluasi luaran dibatasi pada lama hari rawat dan angka kematian. Hasil dan Pembahasan: Kepatuhan konten alur case management masih rendah yaitu sebesar 2%. Alur skrining dan follow up post discharge belum sesuai karena kepatuhan dan pemahaman pelaksana serta belum lengkapnya petunjuk teknis. Ketidaksesuaian skrining mempengaruhi rendahnya cakupan kasus yaitu 19%. Faktor pendukung implementasi adalah ketersediaan panduan, pelatihan, dukungan pimpinan, dan respon tim. Kendala implementasi adalah kurangnya petunjuk teknis, kendala waktu koordinasi, dan kendala sosial edukasi pasien. Evaluasi luaran menunjukkan angka kematian menurun, rerata lama hari rawat memanjang. Responden merasakan manfaat case management dalam memperbaiki koordinasi tim. Kesimpulan dan Saran: Fidelity implementasi case management system di RS UGM rendah ditandai dengan rendahnya kepatuhan konten dan cakupan kasus. Rerata lama hari rawat memanjang, tetapi rentang hari rawat memendek. Angka kematian kasus lebih kecil. Respon partisipan adalah faktor pendukung implementasi tetapi strategi fasilitasi belum dilakukan dengan optimal sehingga mempengaruhi fidelity yang rendah. Strategi fasilitasi perlu ditingkatkan dengan kebijakan dan petunjuk teknis yang komprehensif terutama pada alur skrining dan follow up post discharge, pelatihan case manager, sosialisasi, dan monitoring evaluasi berkelanjutan Kata kunci: fidelity, stroke, case management system
Background: Management of medical treatment is a very complex multi-disciplinary process with many stages. During patient care at Universitas Gadjah Mada Academic Hospital (UGM Academic Hospital) incidents involving patient safety either go unreported or are accidentally found. According to some public health research only about 10-20% of incidents were reported. The purpose of this research aimed to provide data to the management about the level of patient safety and make recommendations to improve service quality, especially to reduce injury and increase patient safety.Methods: Our study was conducted by doing a review of patient medical records of hospitalized adults (n = 60) treated in September 2015 to detect trigger and adverse events using the IHI Global Trigger Tool for Measuring Adverse Events. Group Cares was designed to reflect the adverse events that occurred anywhere in UGM Academic Hopitaltal so that all samples should be reviewed by both modules. All three remaining modules were used if necessary depending on the unit where patients were treated. Technical analysis used in this research was descriptive statistics.Results: The study found 69 incidents / triggers that occurred in 27 patients (n = 60) consisting of 47 incidents in the treatment group, 16 incidents in the surgery group, one incident in intensive care, and 5 incidents at the Emergency Department. Based on the level of injury, the incidents which happened demanded extended day care, requiring more intervention and assistance of disability. No cases of death were reported due to the incidents.Conclusions: The incidence found in all categories according to the modules with the highest incidence was the incidence of treatment and the smallest was in intensive care. Most incidents resulted in extending the duration of treatment and require more intervention. No fatal cases were reported to have resulted in the studied sample.
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