Emergency services utilization in Jakarta (Indonesia): a cross-sectional study of patients attending hospital emergency departments

Abstract

Background Pre-hospital and emergency services in Indonesia are still developing. Despite recent improvements in the Indonesian healthcare system, issues with the provision of pre-hospital and emergency services persist. The demand for pre-hospital and emergency services has not been the subject of previous research and, therefore, has not been fully understood. Our research explored the utilization of emergency medical services by patients attending hospital emergency departments in Jakarta, Indonesia. Methods The study used a cross-sectional survey design involving five general hospitals (four government-funded and one private). Each patient’s demographic profile, medical conditions, time to treatment, and mode of transport to reach the hospital were analysed using descriptive statistics. Results A total of 1964 (62%) patients were surveyed. The median age of patients was 44 years with an interquartile range (IQR) of 26 to 58 years. Life-threatening conditions such as trauma and cardiovascular disease were found in 8.6 and 6.6% of patients, respectively. The majority of patients with trauma travelled to the hospital using a motorcycle or car (59.8%). An ambulance was used by only 9.3% of all patients and 38% of patients reported that they were not aware of the availability of ambulances. Ambulance response time was longer as compared to other modes of transportation (median: 24 minutes and IQR: 12 to 54 minutes). The longest time to treatment was experienced by patients with neurological disease, with a median time of 120 minutes (IQR: 78 to 270 minutes). Patients who used ambulances incurred higher costs as compared to those patients who did not use ambulances. Conclusion The low utilization of emergency ambulances in Jakarta could be contributed to patients’ lack of awareness of medical symptoms and the existence of ambulance services, and patients’ disinclination to use ambulances due to high costs and long response times. The emergency ambulance services can be improved by increasing population awareness on symptoms that warrant the use of ambulances and reducing the cost burden related to ambulance use.

Urban–sub-urban–rural variation in the supply and demand of emergency medical services

“…Tianjin is a coastal megacity, administratively equivalent to a province, in the North China Plain, with a population of approximately 14 million people and an area of 11,947 km 2 . Tianjin has a single EMS provider, namely, the Tianjin Medical Emergency Center, operated by the Tianjin Health Commission; the Tianjin Medical Emergency Center is a publicly funded system and covers all emergency medical calls within the city.…”

“…Emergency medical services (EMSs) are integral to immediate critical care, stabilization of life-threatening diseases, timely triage, and transportation in prehospital settings (1)(2)(3). Most countries attach great importance to meeting EMS demand, and comprehensive healthcare reform policies have been initiated successively by national legislatures in several countries (4)(5)(6)(7)(8)(9)(10).…”

Survey on emergency care utilization in tertiary care hospitals in Indonesia

“…Such variation in the use of taxi or ambulance has also been reported in earlier studies. 6,7 For example, in Jakarta, taxi (including ride-sharing services) was the most common method of ED visits (33.5%) while ambulances were used infrequently (9.3%), 6 whereas 36.7% of ED patients used ambulances in Yogyakarta. 7 This regional variation in transportation mode can be attributed to several geographic differences.…”

“…One possible reason for the low awareness of PSC is that PSC is a relatively new service and has not yet been installed in some areas, and awareness is not fully spread among citizens. 6 Patients often lack knowledge about the appropriate means of transportation to the hospital, leading to the assumption that private cars or ride-sharing services are commonly utilized. However, in the event of a clearly emergent accident, raising awareness about the availability of Prehospital Emergency Medical Services (PSC) may promote the appropriate utilization of this service.…”

“…The details of questionnaires are shown in Supplemental Table . The questionnaire was estimated to take approximately 15 minutes to complete, and the questions were based on a previous study. 6…”