scholarly journals Analysis of Cesarean Section Clinical Pathway Compliance at a Private Hospital in Yogyakarta

2019 ◽  
Vol 9 (1) ◽  
pp. 38
Author(s):  
Beta Haninditya ◽  
Tri Murti Andayani ◽  
Nanang Munif Yasin
Keyword(s):  
Length Of Stay ◽  
Cesarean Section ◽  
Pain Intensity ◽  
Clinical Pathway ◽  
Private Hospital ◽  
Clinical Pathways ◽  
P Value ◽  
Type C ◽  
The Relationship ◽  
Real Costs

This study aims to analyze the relationship between the compliance with the implementation of clinical pathways to therapeutic outcomes (ILO events, length of stay, pain intensity) and the total real cost of cesarean section patients. The study was conducted at a type C private hospital in Yogyakarta. This study is a non-experimental analytical study (observational analytic) with a cross sectional design using a retrospective data collection method and analyzed using Chi square test and non parametric regression test. Descriptive analysis for compliance with the implementation of clinical pathways was carried out by assessing the compliance of each care point contained in the clinical pathway section of the cesarean consisting of 12 points of care and will be grouped into two categories namely low compliance category with the average compliance value for clinical pathway <85% and good compliance with the average compliance value for clinical pathway ≥85%. Descriptions of adherence to the implementation of clinical pathway cesarean section each patient showed that as many as 686 patients (98%) had a good average compliance score and 14 patients (2%) had a low average compliance score. Outcome description 700 patients with cesarean section were found 1 patient experienced ILO, LOS according to clinical pathway (≤3 days) as many as 620 patients and 700 patients with pain scale ≤3. The results of the analysis of the relationship between the compliance and the implementation of the clinical pathway to the outcome of therapy (ILO events, length of stay, and pain intensity) showed the existence of a compliance relationship to the implementation of the clinical pathway with a value of p<0.05. The analysis of the relationship between the compliance to the implementation of the clinical pathway and the total real costs shows the relationship between the compliance   with   the   implementation   of  the  caesarean  section  clinical  pathway  at  a  type  C  private hospitals in Yogyakarta with the total real costs with p value of 0,000 and r value of 0.014.

scholarly journals Penerapan Clinical Pathways sebagai Instrumen Pengendalian Biaya Pelayanan : Studi Penelitian Tindakan Penderita BPJS yang Menjalani Operasi Caesar dengan Sistem Pembayaran INA-CBG

2021 ◽  
Vol 4 (2) ◽  
pp. 593-599
Author(s):  
Annisa Fitria ◽  
Andri Sofa Armani ◽  
Thinni Nurul Rochmah ◽  
Bangun Trapsila Purwaka ◽  
Widodo Jatim Pudjirahardjo
Keyword(s):  
Action Research ◽  
Caesarean Section ◽  
Length Of Stay ◽  
Cesarean Section ◽  
Clinical Pathway ◽  
Average Length ◽  
Clinical Pathways ◽  
Hospital Costs ◽  
Average Length Of Stay ◽  
Length Of Hospitalization

This study aims to determine the effect of using clinical pathways to control total actual hospital costs for BPJS patients who undergo a cesarean section. The method used in this research is action research. The results showed that the average actual hospital costs were significantly higher after the application of CP with p = 0.019. The average length of stay, service costs, and hospital costs were significantly lower in the entire CP form group with p = 0.012, p = 0.013, and p = 0.012. In conclusion, this study shows that the application of clinical pathways can reduce the length of hospitalization and actual hospital costs for cesarean section patients and indicates that clinical pathways can make services more efficient.   Keywords: Hospital Costs, Clinical Pathway, Caesarean Section

Improvement In Acute Management of Vaso-Occlusive Pain In Pediatric Sickle Cell Disease with Use of a Clinical Pathway

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2660-2660
Author(s):  
Katherine Ender ◽  
Jennifer Freed ◽  
John Babineau ◽  
Mary Tresgallo ◽  
William Schechter ◽  
...  
Keyword(s):  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
Capture Rate ◽  
Tertiary Care ◽  
P Value ◽  
Time Interval ◽  
Cell Disease

Abstract Abstract 2660 Background: Sickle cell disease causes considerable morbidity and mortality. Three guidelines exist for the management of vaso-occlusive pain, although studies have shown that these guidelines are not well followed and that there is considerable variation in care. Investigations of clinical pathways for pediatric sickle cell pain have not been published to our knowledge, but research in other pediatric conditions has shown that the implementation of clinical pathways can improve medical care. We initiated an investigation of the effects of a pain management pathway for sickle cell vaso-occlusive crisis in the emergency department (ED) with the hypothesis that the introduction of a clinical pathway would improve the efficiency and efficacy of acute pain management. Methods: We conducted a prospective, cohort study from February 2009 to March 2010 in an urban, tertiary care ED. We collected data from patients aged 3–18 years old with sickle cell disease who presented to the ED with vaso-occlusive crisis (VOC) pain. Baseline data was collected for five months prior to the introduction of the clinical pathway, followed by a four-week time interval in which the ED physicians and nurses were in-serviced on the pathway, followed by six months in which data was collected with the clinical pathway in place. Our pathway, which is in checklist format with instructions for triage, monitoring, medication administration, and timing of assessments and interventions, was developed by representatives from the divisions of Pediatric Hematology, Pediatric Emergency Medicine, and Pediatric Pain Medicine, Symptom Management and Palliative Care and based upon current standard-of-care guidelines. Results: Over the eleven month study period, 68 patients were enrolled. Random chart audits revealed a 75% capture rate. Significant improvement was demonstrated in time interval to first analgesic from 74 minutes to 42 minutes (p value 0.02), time interval to first opioid from 94 minutes to 46 minutes (p value < 0.01), and time interval to subsequent assessment of pain score from 110 minutes to 72 minutes (p value 0.02). The percentage of patients who received ketorolac also increased from 57% to 82% (p value 0.03). Change in pain scores was not significantly different, nor was admission rate. Conclusions: Implementation of a pain management pathway for sickle cell VOC led to an improvement in the time interval to administration of first analgesic and time interval to pain re-assessment, bringing these aspects of patient management closer to accepted guidelines. Whether improvement can be made in admission rates, change in pain ratings, and patient satisfaction will require further study. Disclosures: No relevant conflicts of interest to declare.

scholarly journals PERBANDINGAN ANTARA PEMBERIAN ANTIBIOTIKA PROFILAKSIS PADA SEKSIO SESAR SESUAI ALUR KLINIS RSUP DR SARDJITO DENGAN ANTIBIOTIKA DOSIS MULTIPEL TERHADAP KEJADIAN INFEKSI LUKA OPERASI

2016 ◽  
Vol 3 (2) ◽  
pp. 75
Author(s):  
Ardian Rahmansyah ◽  
Mohammad Hakimi ◽  
Rukmono Siswishanto
Keyword(s):  
Length Of Stay ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Clinical Pathway ◽  
Intervention Group ◽  
Group Versus ◽  
Control Group ◽  
Site Infection ◽  
Short Term

Background: Clinical pathway recommend the use of short-term prophylaxis antibiotics for cesarean section. Long-term antibiotics or multiple doses was found in clinical practice. There are differences in the mode of administration and the number of doses administered at sardjito hospital.Objective: To determine the effectiveness of short-term antibiotic prophylaxis in cesarean section appropriate to clinical pathway in the prevention of surgical site infection (ssi), the incidence of fever, dysuria events, length of stay.Method: The study used randomized clinical trial. The study subjects who underwent cesarean section and meet the inclusion and exclusion criteria in the period July 2013 to January 2014 divided into an intervention group (n = 52) who received ampicillin 2 gram pre and post-cesarean section, and a control group (n = 54) who received ampicillin 2 gram pre cesarean section and 1 gram every 8 hours for 6 times. Observed on days 3 and 10 post-cesarean section. The primary outcomes assessed were the incidence of surgical wound infection based on the criteria of surgical site infection from Centers for Disease Controland Prevention. Secondary outcomes assessed were the incidence of fever, dysuria events, length of stay. Homogeneity analysis were conducted on subject. Outcome analysis performed bivariate with t test and chi squared test.Results and Discussion : A total of 106 subjects can be analyzed. SSI events in the intervention group at day 3 was 3.8% (n = 52) and control group was 1.84% (n = 54) with p>0.05 RR 2.077 (95% CI 0.194 to 22.219). SSI on day 10 of 7.7% (n = 52) in the intervention group versus 9.3% (n = 54) in controls with p<0.05 RR 0.831 (CI 95%, 0.236 to 2.924). Fever events on day 3 by 5.8% in the intervention group versus 3.7% incontrols with p>0.05 RR 1.558 (95% CI 0.271 to 8.948) and on day 10 was 3.8% versus 3.7 % with p>0.05 RR 1.038 (95% CI 0.152 to 7.102). Dysuria not found on day 3 and but on 10 found 5.8% in the intervention group versus 11.1% with p>0.05 RR 0.519 (IK95% 0.137 to 1.968). Length of stay after cesarean section for 3.21 ± 0.412 days in the intervention group and 3.26 ± 0.442 days in the control group with p>0.05 (95% CI -0.213 - 0.117).Conclusion: There is no significant difference in the incidence of surgical wound infections, the incidence of fever, dysuria, length of stay between short-term prophylaxis antibiotics ampicillin appropriate to clinical pathway and long-term or multiple doses prophylaxis antibiotics. Short term antibiotics prophylaxis are more efficiently with the same effectiveness in preventing outcomes research.Keywords: prophylaxis antibiotics, ampicillin, short term regimen, long term regimen, cesarean section, surgical site infection. 

scholarly journals Outcomes of a Clinical Pathway for Pleural Disease Management: “Pleural Pathway”

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Srinivas R. Mummadi ◽  
Peter Y. Hahn
Keyword(s):  
Length Of Stay ◽  
Clinical Pathway ◽  
Average Length ◽  
Clinical Pathways ◽  
Administrative Database ◽  
British Thoracic Society ◽  
Pleural Disease ◽  
Average Case ◽  
Community Healthcare ◽  
Pleural Diseases

Background and Objectives. Clinical pathways are evidence based multidisciplinary team approaches to optimize patient care. Pleural diseases are common and accounted for 3.4 billion US $ in 2014 US inpatient aggregate charges (HCUPnet data). An institutional clinical pathway (“pleural pathway”) was implemented in conjunction with a dedicated pleural service. Design, implementation, and outcomes of the pleural pathway (from August 1, 2014, to July 31, 2015) in comparison to a previous era (from August 1, 2013, to July 31, 2014) are described. Methods. Tuality Healthcare is a 215-bed community healthcare system in Hillsboro, OR, USA. With the objective of standardizing pleural disease care, locally adapted British Thoracic Society guidelines and a centralized pleural service were implemented in the “pathway” era. System-wide consensus regarding institutional guidelines for care of pleural disease was achieved. Preimplementation activities included training, acquisition of ultrasound equipment, and system-wide education. An audit database was set up with the intent of prospective audits. An administrative database was used for harvesting outcomes data and comparing them with the “prior to pathway” era. Results. 54 unique consults were performed. A total of 55 ultrasound examinations and 60 pleural procedures were performed. All-cause inpatient pleural admissions were lower in the “pathway” era (n=9) compared to the “prior to pathway” era (n=17). Gains in average case charges (21,737$ versus 18,818.2$/case) and average length of stay (3.65 versus 2.78 days/case) were seen in the “pathway” era. Conclusion. A “pleural pathway” and a centralized pleural service are associated with reduction in case charges, inpatient admissions, and length of stay for pleural conditions.

scholarly journals INFLUENCE OF NURSING CLINICAL PATHWAY IMPLEMENTATION TO LENGTH OF STAY OF NON HEMORRHAGIC STROKE PATIENTS IN BUKITTINGGI ACHMAD MOCHTAR HOSPITAL

2018 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Fitrianola Rezkiki
Keyword(s):  
Length Of Stay ◽  
Nursing Care ◽  
Clinical Pathway ◽  
Hemorrhagic Stroke ◽  
Average Length ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Stroke Patients ◽  
Nursing Clinical

<p><em>Lenght of stay is indicator of serving quality and nursing care to measure hospital efficiency level. Neurology ward is one of the wards that experience increasing of length of stay from 5,91 to 7,38. The cause of length of stay increasing is nursing care management that according to Calhoun can be formulated to nursing clinical pathway. The purpose of this study is to analyze influence of nursing clinical pathway implementation to length of stay of non hemorrhagic stroke patients in neurology ward Bukitttinggi Achmad Mochtar Hospital. The designs of this study used non-equivalent post test only control group design approach. Sample of this study were taken by purposive sampling with total of 32 samples consist of 16 sample as intervention group and another 16 samples as control group. Data analyzing used t-test independent. The result shows that there is significant influence for average length of stay of stroke non hemorrhagic patients that were given nursing clinical pathway compared to the group that is not given nursing clinical pathway with p value 0,001 (p value ≤ 0,05. According to this study, hospital should implement nursing clinical pathway when doing nursing care to patients in ward and also hospital should make policy related to nursing clinical payhway implementation..</em></p><p><em> </em></p>

scholarly journals IMPACT OF CLINICAL PATHWAYS COMPLIANCE FOR REDUCING LENGTH OF STAY

2020 ◽  
Vol 8 (1) ◽  
pp. 79
Author(s):  
Michael Siswanto ◽  
Djazuly Chalidyanto
Keyword(s):  
Length Of Stay ◽  
Clinical Pathway ◽  
Acute Gastroenteritis ◽  
Pediatric Patients ◽  
Average Length ◽  
Clinical Pathways ◽  
Multidisciplinary Care ◽  
Care Plan ◽  
Cross Sectional ◽  
Therapy Compliance

Background: Clinical pathway is multidisciplinary care plan based on the best clinical practice for a group of patients with a particular diagnosis, designed to minimize care delay as well as maximize the quality of care and clinical outcomes. In 2017, average length of stay for pediatric patient with acute gastroenteritis was prolonged even clinical pathways had been implemented.Aim: Thid study determined the diagnostic examination and therapy compliance of clinical pathway related to the length of stay.Method: This study was cross sectional research through simple random sampling. Researchers analyzed pediatric patients whose clinical pathway were filled completely by doctors. The inclusion criteria were pediatric patients, admitted to hospitals during January to December 2018 as acute gastroenteritis patients. The data were analyzed using multiple classification analysis.Results: There were 197 patients with clinical pathway filled completely. As much as 60.91% of cases were compiled for diagnostic examination and 88.32% for therapy. There was no statistically significant correlation between diagnostic examination compliance (p > 0.05) and therapy compliance (p > 0.05) of clinical pathway with patients’ length of stay (combined = p > 0.05).Conclusion: Many factors could be related with the length of stay especially patients’ condition itself. In this study, clinical pathway compliance has no impact in reducing length of stay. Keywords: clinical pathway, compliance, length of stay, pediatric. 

scholarly journals Relationship Between Pain Intensity, Pain Catastrophizing, Self-efficacy in Patients With a Frozen Shoulder

2021 ◽  
Author(s):  
Junya Hirata ◽  
Minori Tomiyama ◽  
Yasuhiro Koike ◽  
Manabu Yoshimura ◽  
Keiko Inoue
Keyword(s):  
Pain Intensity ◽  
Self Efficacy ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Catastrophizing ◽  
Frozen Shoulder ◽  
Estimation Method ◽  
P Value ◽  
Hypothesis Model ◽  
The Relationship

Abstract Background: The evaluation of pain catastrophizing and self-efficacy is useful for predicting pain and is also associated with shoulder pain. The purposes of our study were to examine the relationship between pain catastrophizing, self-efficacy, and pain intensity in patients with a frozen shoulder.Methods: Ninety-three patients who were diagnosed with frozen shoulder were included in this study. Pain intensity (Numerical Rating Scale: NRS), pain catastrophizing (Pain Catastrophizing Scale: PCS), and self-efficacy (Pain Self-Efficacy Questionnaire: PSEQ) were measured at the first examination, and the relationship was examined using Bayesian estimation method. We developed a hypothesis model in which self-efficacy affects pain catastrophizing and pain catastrophizing affects pain intensity.Results: The path coefficients from the PSEQ score to the PCS score and from the PCS score to the NRS score were significant. The convergence of the hypothesized model was confirmed and validated (posterior prediction p-value 0.35). Conclusion: Our results suggest that self-efficacy affects pain catastrophizing, and pain catastrophizing affects pain intensity.

scholarly journals Efektifitas Implementasi Clinical Pathway Terhadap Average Length Of Stay dan Outcomes Pasien DF-DHF Anak di RSUD Kota Yogyakarta

2018 ◽  
Vol 2 (2) ◽  
pp. 175
Author(s):  
Neri Faradina Nur Fadilah ◽  
Savitri Citra Budi
Keyword(s):  
Length Of Stay ◽  
Clinical Pathway ◽  
Average Length ◽  
P Value ◽  
Cross Sectional ◽  
Average Length Of Stay

Latar belakang: Clinical pathway digunakan sebagai kendali mutu dan biaya dalam pelayanan kesehatan. Mutu pelayanan salah satunya dapat dilihat dari average length of stay dan outcomes. Implementasi clinical pathway yang sudah diterapkan perlu diukur efektifitasnya dalam menurunkan rata-rata lama dirawat dan menghasilkan outcomes yang lebih baik. Kasus DF dan DHF masuk dalam daftar 10 besar penyakit rawat inap di RSUD Kota Yogyakarta.Tujuan: Mengukur perbedaan average length of stay dan outcomes pasien DF-DHF anak antara sebelum dan setelah implementasi clinical pathway di RSUD Kota Yogyakarta.Metode: Jenis penelitian ini adalah penelitian kuantitatif dengan metode survey analitik dan rancangan cross sectional. Pengumpulan data dilakukan dengan studi dokumentasi pada 146 berkas rekam medis dan formulir clinical pathway.Hasil: Persentase outcomes tertinggi pada pasien DF yaitu pada kategori membaik 71,4% sebelum CP dan 80,9% setelah CP. Persentase outcomes tertinggi pada pasien DHF yaitu pada kategori membaik 83,9% sebelum CP dan 90,3% setelah CP. Average length of stay setelah CP lebih kecil dibandingkan sebelum CP pada pasien DF-DHF anak, dengan p-value DF anak = 0,016 < α = 0,05 dan p-value DHF anak = 0,021 < α = 0,05. Tidak ada perbedaan outcomes pasien DF-DHF anak antara sebelum dan setelah implementasi clinical pathway, dengan p_value DF anak = 0,775 > α = 0,05 dan p-value DHF anak = 1 > α = 0,05.Kesimpulan: Implementasi clinical pathway dapat menurunkan average length of stay, namun belum mampu membuktikan adanya perbedaan pada outcomes pasien.

scholarly journals The Relationship between Workload and Nursing Job Satisfaction in One Private Hospital in The West Region of Indonesia

2020 ◽  
Vol 16 (2) ◽  
pp. 95
Author(s):  
Dora Irene Purimahua ◽  
Gita Martinaningtyas ◽  
Lenceria Girsang ◽  
Widia Astuti ◽  
Martina Pakpahan
Keyword(s):  
Job Satisfaction ◽  
Private Hospital ◽  
Sampling Technique ◽  
Nursing Workload ◽  
P Value ◽  
The West ◽  
Cross Sectional ◽  
West Region ◽  
High Workload ◽  
The Relationship

Nurse as a profession and caregiver who composed the large portion of healthcare service workers is required to have high expertise in carrying out nursing practice, the speed at work, and high work volume. With these important roles, the income earned by nurses is still in the low category as a healthcare provider that makes nurses feel dissatisfied in their work. The purpose of this study was to describe the workload of nurses, level of work satisfaction and to find out the relationship between the workloads in nursing and the job satisfaction in one private hospital in the west region of Indonesia. This study used a quantitative method with a cross-sectional approach. Data were collected using a questionnaire of nursing workload and nursing job satisfaction on 126 nurses in one private hospital in the west region of Indonesia with a total sampling technique. Univariate and bivariate were conducted to analyze the collected data. This study found that there were 55% of nurses with high workload and 52% of nurses with job dissatisfaction. There was a relationship between workloads to nursing job satisfaction (p-value 0.001). This research recommend the hospitals to re-evaluate nurses job satisfaction, give reward and set excellent and evident career path in nursing.

scholarly journals HUBUNGAN PENANGANAN AWAL GASTRITIS DENGAN SKALA NYERI PASIEN UGD RUMAH SAKIT GMIM BETHESDA TOMOHON

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Irfan Irianto Rizky ◽  
Billy J. Kepel ◽  
Maykel Killing
Keyword(s):  
Gastric Mucosa ◽  
Emergency Room ◽  
Pain Intensity ◽  
Research Design ◽  
Pain Scale ◽  
P Value ◽  
Cross Sectional ◽  
Initial Management ◽  
Significance Level ◽  
The Relationship

Abstract : Gastritis is inflammation of the gastric mucosa and sub gastric mucosa. the management of gastritis which needs to be considered as the main problem or the patient's main consideration of this disease is pain. The initial management of gastritis can affect the patient's pain intensity. The purpose of the study was to identify the relationship between the initial management of gastritis and the patient's pain scale at UGD RSU GMIM Bethesda tomohon. Method uses a correlation analytic research design with a cross sectional approach The sample in this study patients who entered the Emergency Room of the GMIM Hospital in Bethesda Tomohon and had been gastritis diagnosed with a population is 60 patients. Results of the study used the spearmen’s test at a significance level is 95%, significant for initial management of gastritis with the patient's pain scale ( p value 0,066 ; α 0,05). Conclusion, initial management of gastritis related with the patient's pain scale at UGD RSU GMIM Bethesda Tomohon. Keywords : Gastritis, initial Management of Gastritis, Pain Scale. Abstrak : Gastritis adalah proses inflamasi pada mukosa lambung dan sub mukosa lambung. Dalam penatalaksanaan penyakit gastritis hal yang perlu diperhatikan yang menjadi masalah atau keluhan utama pasien dari penyakit ini adalah nyeri. Penatalaksanaan awal gastritis dapat mempengaruhi insensitas nyeri pasien. Tujuan penelitian untuk mengindentifikasi hubungan antara penatalaksanaan awal gastritis dengan skala nyeri pasien UGD RSU GMIM Bethesda Tomohon. Metode penelitian ini menggunakan desain penelitian analitik korelasi dengan pendekatan cross sectional. Sampel penelitian ini adalah pasien yang masuk di UGD RSU GMIM Bethesda Tomohon dan telah didiagnosis gastritis dengan jumlah populasi sebanyak 60 pasien. Hasil penelitian dengan menggunakan uji spearman pada tingkat kemaknaan 95%, signifikan untuk penatalaksanaan awal gastritis dengan skala nyeri pada pasien (nilai p 0,066 ; α 0,05). Kesimpulan, Penatalaksanaan awal gastritis berhubungan secara bermakna dengan skala nyeri pasien gastritis di UGD RSU GMIM Bethesda Tomohon.Kata Kunci : Gastritis, Penatalaksanaan awal Gastritis, Skala Nyeri

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