Patients newly colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at higher risk of clinical MRSA infection. At present, there are limited data on the duration or magnitude of this risk in a hospital population with a known time of MRSA acquisition.

Balm, et al. (2013) reported on a retrospective cohort study of 909 adult patients known to have newly identified MRSA colonization during admission to National University Hospital, Singapore that was undertaken between July 1, 2007 and June 30, 2011. Patients were excluded if they had history of previous MRSA colonization or infection, or if they had been a hospital inpatient in the preceding 12 months. Data were collected on the development of MRSA infection requiring hospitalization up to June 30, 2012.

Of 840 patients newly colonized with MRSA as identified on active surveillance and not clinical specimens, 546 were men (65.0 percent) and the median age was 65 years (range 18-103 years). Median follow up was 24 months (range 0-64 months, 85.1 percent followed >6 months). Clinical infection occurred in 121 patients (14.4 percent) with median time to infection of 22 days (95 percent CI 14-31). Overall 71.9 percent (87/121) of infected patients developed infection within 60 days of the date MRSA colonization was detected. However, 17/121 patients (14.0 percent) developed clinical infection more than six months after documented MRSA acquisition. The most common sites of clinical infection were skin and soft tissue (49/121, 40.5 percent, 95 percent CI 31.7-49.8), respiratory tract (37/121, 30.6 percent, 95 percent CI 22.5-39.6) and bone and joint infections (14/121, 11.6 percent, 95 percent CI 6.5-18.7). Thirteen patients (13/121, 10.7 percent, 95 percent CI 5.8-17.7) had bacteremias, of which six (5.0 percent 95 percent CI 1.8-10.5) were primary and seven (5.7 percent, 95 percent CI 2.3-11.6) were secondary to infection at other sites. Crude mortality at 30 days and six months was higher in patients with MRSA infection than colonization alone (aOR 5.49, 95 percent CI 2.75-10.95, p<0.001 and aOR 2.94, 95 percent CI 1.78-4.85, p<0.001 respectively).

The researchers concluded that risk of clinical infection is highest soon after MRSA acquisition and say that prevention of MRSA acquisition in the hospital will have significant impact on morbidity and mortality for patients. Their research was published in BMC Infectious Diseases.

Reference: Balm MND, Lover AA, Salmon S, Tambyah PA and Fisher DA. Progression from new methicillin-resistant Staphylococcus aureus colonization to infection: an observational study in a hospital cohort. BMC Infectious Diseases 2013, 13:491 doi:10.1186/1471-2334-13-491

Source: infectioncontroltoday.com

Meski pelayanan di Rumah Sakit Umum Daerah (RSUD) Tarakan, Jakarta Pusat, telah mengalami peningkatan. Namun, ada saja masyarakat yang kurang puas dengan pelayanan yang diberikan. Termasuk adanya keluhan terkait pembatasan obat yang disampaikan langsung masyarakat kepada Gubernur DKI Jakarta, Joko Widodo, saat ia berkunjung ke rumah sakit tersebut.

Kepada pasien, Jokowi mengatakan, sebenarnya tidak ada pembatasan-pembatasan seperti itu. Meski begitu, pasien memang tidak bisa memilih obat untuk pengobatannya.

“Tidak ada seperti itu (pembatasan), tapi memang tidak boleh memilih obatnya, harus sesuai dengan formularium (daftar obat). Karena sudah ada standarnya, kita punya aturannya,” kata Jokowi kepada seorang ibu, di RSUD Tarakan, Rabu (23/10).

Dikatakan Jokowi, untuk pemberian obat kepada pasien adalah kewenangan dokter yang menanganinya. Namun, tetap sesuai dengan penyakit yang diderita oleh pasien. “Tergantung dokter kasih apa, kalau butuhnya berapa tapi dikasihnya berapa nanti tidak sembuh-sembuh dong,” tegasnya.

Kendati mendapat keluhan dari pasien, Jokowi tetap menilai pelayanan kesehatan di RSUD Tarakan sudah meningkat dibandingkan dengan sebelumnya. Terlebih jumlah pasein sudah menurun dibandingkan dengan awal penerapan program Kartu Jakarta Sehat (KJS). “Tadi itu kita cuma cek saja pelayanannya seperti apa, ternyata sekarang sudah mulai menurun (antrean pasien),” kata Jokowi.

Diakui Jokowi program KJS menimbulkan euforia pada bulan pertama hingga bulan keenam pada awal peluncurannya, sehingga pasien membludak di setiap RSUD. Tapi saat ini kondisinya sudah mulai normal. “Kalau pertama-pertama itu kan karena bertahun-tahun bertumpuk-tumpuk semua ke rumah sakit. Kita mau menunjukkan bahwa yang penting adalah sistem dan kebijakan itu bisa diakses dengan mudah di masyarakat,” tandasnya.

Sumber: beritajakarta.com

Jakarta, InfoPublik – Ketetapan berlakunya jaminan kesehatan oleh Badan Pengelola Jaminan Sosial (BPJS) Kesehatan mulai 2014 terhadap seluruh rakyat Indonesia, hendaknya diikuti kesiapan puskesmas dan rumah sakit.

“Kalau tidak disertai dukungan sarana, prasarana maupun tenaga medisnya tentu akan menimbulkan masalah baru, karena puskesmas dan rumah sakit belum siap, sehingga memungkinkan adanya penumpukan warga yang berobat lantaran tenaga medis masih terbatas,” kata anggota Komisi IX DPR Zuber Safawi di Jakarta, Selasa (22/10).

Zuber menilai, dukungan anggaran perlu ditingkatkan agar sarana dan prasarana puskesmas dan rumah sakit dapat meningkat. Saat ini baru sekitar 1,9 hingga 2 persen dari APBN. “Semestinya anggaran yang ideal untuk kesehatan adalah 5 persen dari APBN.”

Keberadaan BPJS kesehatan menurutnya sangat dibutuhkan oleh masyarakat, sehingga kalau sakit mereka tidak bingung lagi mau berobat kemana.

Program BPJS Kesehatan harus lebih menjangkau seluruh masyarakat Indonesia, sehingga kerjasamanya pun perlu lebih luas, yakni rumah sakit daerah milik pemerintah maupun swasta.

Kepesertaan BPJS Kesehatan harus lebih dipahami oleh masyarakat. Kalau seseorang sudah menjadi peserta Askes berarti cukup mendatangi kantor Askes dengan mendaftar kembali menjagi anggota BPJS Kesehatan. Sementara bagi swasta didaftarkan oleh kantornya dan iuran dibayar oleh perusahan.

Adapun masyarakat yang tidak bekerja dan keluarga miskin dapat mendaftar langsung dan iuranya dibayarkan oleh negara, tapi bagi yang mampu iuran dibayar sendiri setiap bulannya.

Sumber: kominfo.go.id

YOGYAKARTA – Hasil audit investigasi Badan Pengawas Keuangan dan Pembangunan (BPKP) Perwakilan DIY dalam kasus dugaan korupsi pengadaan alat kesehatan (alkes) Rumah Sakit Jogja belum juga keluar.

Padahal, hasil audit itu sangat dibutuhkan Kejaksaan Tinggi (Kejati) DIY untuk menyelesaikan proses penyidikan. Penyidik Kejati meminta bantuan BPKP untuk mengaudit proyek pengadaan alkes RS Jogja pada 2012 lalu. Proyek yang memakai dana APBN Rp4,5 miliar ini, Kejati DIY menduga ada penyimpangan hingga keuangan negara merugi.

“Hasil audit belum keluar, kami masih menunggu hasil audit dan bisa diketahui berapa jumlah pasti kerugian negaranya,” ucap Asisten Bidang Tindak Pidana Khusus Kejati DIY Pindo Kartikani kepada wartawan, kemarin. Pengajuan bantuan audit sudah diajukan Kejati ke BPKP sejak beberapa bulan lalu. Tim penyidik berharap hasil audit segera rampung. “Semoga cepat rampung.”

Dalam kasus ini, Kejati DIY menetapkan dua orang yang diduga kuat bertanggung jawab dalam dugaan penyimpangan pengadaan alkes. Yakni, Pejabat Pembuat Komitmen (PPK) Bambang Suparyono dan pihak rekanan CV Jogja Mitra Solusindo Johan Hendarman. Sejauh ini, tim penyidik telah memeriksa puluhan saksi baik itu dari rumah sakit yang dulu bernama RSUD Wirosaban, pihak rekanan, Pemkot Yogyakarta, dan beberapa saksi ahli.

Bahkan, dua tersangka juga telah dimintai keterangannya. Terpisah, Jogja Corruption Watch (JCW) mendesak BPKP segera menuntaskan audit agar penanganan kasus bisa tuntas. “Jangan berlama-lama lagi, memang audit harus dilakukan secara teliti dan cermat. Tetapi jangan berlama-lama, agar kasus ini segera rampung,” kata Divisi Pengaduan Masyarakat JCW Baharudin Kamba.

Selain itu, JCW juga mendesak Kejati DIY segera menahan kedua tersangka. Karena hasil penyidikan selama ini telah menemukan bukti-bukti adanya dugaan penyimpangan dalam proses pengadaan alkes Rumah Sakit Jogja. ● ristu hanafi

Sumber: koran-sindo.com

The use of telemonitoring to remotely support patients with managing COPD did not reduce their risk of being admitted to hospital with an acute exacerbation, according to the authors of a one-year randomised study.

Patients receiving the telemonitoring intervention were just as likely to end up in hospital as a result of an exacerbation as those who were not remotely monitored, despite having many more telephone consultations and home visits and the approach is unlikely to be cost-effective, the researchers found.

The findings come as GPs face concerns over the cost of setting up the government’s new DES for remote telemonitoring and add further doubts over the benefits of the approach for people with long-term conditions such as COPD, after the government-backed Whole Systems Demonstrator (WSD) trial found telemonitoring was not cost-effective.

Moreover, the authors said their findings suggest the benefits of telemonitoring seen in WSD – in which the remote monitoring did cut admissions and mortality in people with long-term conditions – are likely down to ‘enhancement of the underpinning clinical service’ rather than telemonitoring itself.

They concluded telemonitoring ‘is unlikely to reduce admissions unless it is a means of enhancing clinical services’.

The study, published in the BMJ, included 256 patients registered with practices in Lothian, all of whom had a recent history of being admitted to hospital for an acute exacerbation of COPD.

All participants received the usual clinical care provided in their region, including self-management advice, but the half assigned to telemonitoring also submitted daily recordings of their symptoms, treatment and oxygen saturation levels for remote monitoring by the supporting clinical team.

The median time from the beginning of the study until the first hospital admission with an exacerbation did differ between patient groups, at 362 days in those using the telemonitoring and 361 days in the control group.

The mean number of admissions was also similar, with 1.2 admissions per person in the telemonitoring arm and 1.1 in the control arm, as was the mean length of stay in hospital.

Telemonitoring failed to improve patients’ health-related quality of life, with similar changes recorded on the St George’s respiratory questionnaire in each group, and was associated with a slight, albeit non-significant, increase in self-reported exacerbations, in which patients needed to take antibiotics or steroids.

The telemonitoring group also needed significantly more home visits, including 113 as a result of telemonitoring alerts – working out at around 25 contacts per patient over the year, or one contact every two weeks – as well as another five telephone and eight home contacts per patient, compared with four telephone and seven home contacts over the year in the control group.

The authors concluded: ‘Integration of telemonitoring into existing clinical services – such that both intervention and control groups had access to the same clinical care – had no effect on delaying time to a hospital admission, and had a substantial impact on workload.

‘The positive effect of telemonitoring seen in previous trials could thus be due to enhancement of the underpinning clinical service rather than the telemonitoring communication. Specific developments that could improve the performace of telemonitoring in COPD in the future include the validation of measures and algorithms that can predict potentially serious exacerbations more reliably, and an understanding of clinical contexts in which telemonitoring is most effective.

‘In the meantime, long-term telemonitoring of people with COPD is unlikely to reduce admissions unless it is a means of enhancing clinical services.’

Source: pulsetoday.co.uk

The mortality figures as they are currently calculated for Dutch hospitals are not a good measure for the quality of the health care they provide.

The picture of hospitals with the lowest intramural mortality figures can look less favourable when the number of patients who die shortly after having been discharged from the hospital is taken into consideration as well. This was shown in a study conducted by University Medical Center Utrecht and Erasmus Medical Center in the Netherlands, which was published today in the leading medical publication the British Medical Journal. The researchers recommended that post-discharge mortality figures should be incorporated into official mortality figures.

The study showed that hospitals with low intramural mortality have relatively high mortality levels after discharge and vice versa. This is why, based on the 30-day mortality (deaths that occur within the first 30 days after hospital admission, irrespective of the place of death), many hospitals have a different so-called ‘Hospital Standardized Mortality Ratio’ (HSMR) than that based on hospital mortality (deaths that occur during the hospital stay). The absolute differences in the HSMR between hospitals are also smaller when the new calculation method is used.

“A lower HSMR, which is currently being interpreted as a rough indication for a good quality of care, may partially be the result of a shorter hospital stay and a relatively higher mortality rate after discharge. A hospital’s responsibility doesn’t stop after the patient has been discharged. This is why it is important that mortality shortly after the discharge is incorporated when calculating the HSMR”, says Prof. Cor Kalkman, Professor of Anaesthesiology at UMC Utrecht and co-author of the BMJ publication.

A measure of the quality of care

The HSMR is a standard used to express mortality in hospitals. The HSMR is published annually and is presented as an important measure for the quality of care. Currently, only patients that die while in hospital are included in the calculation of the HSMR. For example: a patient undergoing a hip operation is discharged from hospital A after three days. That same patient might be discharged from hospital B after five days. If this patient would die on day four, the death would not be counted in hospital A but it would be included in hospital B. This difference between the method of recording data results is an unfair comparison between the quality of care in the hospitals in question.

Deaths within 30 days after discharge should be included

The study used the Municipal Personal Records Database to be able to continue monitoring patients even after their discharge from the hospital. This has made it possible to include all deaths within 30 days after admission in the calculation of the HSMR, irrespective of the place of death.

According to the researchers, the HSMR has other limitations as a measure for the quality of care as well. For example, the adjustment made for the patient’s health status at the time of their hospital admission is limited. Furthermore, a single number as a measure of quality for an entire hospital is difficult to interpret: patients don’t know how the hospital performs with respect to their specific condition.

The study was subsidised by a grant from the Ministry of Health, Welfare and Sport. The study data was collected by the Dutch Hospital Data Foundation (on behalf of the Dutch Association of Hospitals and the Dutch Federation of University Medical Centres) and Statistics Netherlands.

Source: european-hospital.com

Reportase

Pelatihan Unit Cost dengan Metode ABC dan Strategi Penetapan Tarif

Jember 10-12 Oktober 2013

Penulis: Barkah Wahyu P. SE., Ak.

Editor: Widarti, S. I. P

Foto peserta bersama pembicara

PKMK-Jember. Fakultas Kesehatan Masyarakat Bagian Administrasi dan Kebijakan Kesehatan (AKK) Universitas Jember baru saja mengadakan workshop untuk menambah skill mahasiswanya pada 10-12 Oktober 2013. Acara ini diselenggarakan untuk memenuhi kebutuhan dunia kesehatan di Indonesia yang mulai memperhatikan pentingnya akuntansi, pengelolaan keuangan dan strategi yang terkait dengan keuangan. Workshop yang dilaksanakan bertajuk “Pelatihan Unit Cost dengan Metode ABC dan Strategi Penetapan Tarif”. Pelatihan ini mengundang pembicara dari Yogyakarta yang merupakan kontributor website manajemenrumahsakit.net yakni Dr Anastasia Susty A. MSi., Akt., CA. dan Barkah Wahyu P. SE., Ak.

Suasana Pelatihan

Unit cost merupakan salah satu faktor penting dalam merumuskan suatu tarif, baik itu rumah sakit maupun pelayanan kesehatan lainnya. Selain itu, unit cost dapat dijadikan alat ukur dalam menilai efisiensi serta dalam menetapkan besaran margin atau subsidi yang diinginkan dari suatu pelayanan. Unit cost dirasa sangat penting ketika saat ini banyak rumah sakit pemerintah yang berbondong-bondong menjadi Badan Layanan Umum/Daerah (BLU/BLUD). Salah satu pasal dalam peraturan  baik Permendagri maupun Permenkes terkait BLU/BLUD menyatakan bahwa tarif rumah sakit harus berdasarkan pada satuan biaya/unit cost pelayanan. Oleh karena itu, pembekalan pengetahuan tentang unit cost sangat diperlukan bagi mahasiswa ketika mereka terjun ke dunia kerja.

Activity based costing (ABC) merupakan ilmu costing termutakhir yang berkembang saat ini. ABC dinilai lebih mampu untuk mengukur biaya secara lebih tepat. Penerapan Activity Based Costing dalam penghitungan unit cost di rumah sakit merupakan penerapan yang sesuai dengan teori dalam ABC, bahwasanya ABC tepat digunakan pada entitas yang memiliki diversitas produk tinggi.

Antusiasme peserta dalam mengikuti pelatihan ini sangat tinggi dimana banyak peserta mengikuti pelatihan ini sampai selesai walaupun waktu pelatihan sempat mundur dari yang dijadwalkan. Hal tersebut diperkuat pernyataan dari Ketua Panitia, Nuryadi S.KM, K.Kes. bahwasanya pelatihan selalu dipenuhi peminat selama 2 tahun terakhir dan pada tahun ini peserta undangan dari beberapa rumah sakit di wilayah Jember-pun ada yang meminta tambahan stafnya untuk mengikuti pelatihan ini.

Suasana Pelatihan

Suasana Pelatihan

HEALTH chiefs have unveiled plans to improve access to health and social care services closer to home as part of efforts to reduce demand on hospitals.

Officials from the GP-led NHS Scarborough and Ryedale Clinical Commissioning Group (CCG), working with North Yorkshire County Council and other NHS organisations, say the programme involves a series of projects to improve access to care in the community.

Its focus will be on elderly patients and those with long-term conditions including respiratory disease, diabetes and heart problems.

Patients with a high risk of being admitted to hospital will be given packages of care to prevent their condition deteriorating, allowing them to stay at home.

Teams of health and social care staff will work together to devise the plans, while evening services until 10pm for people with urgent care needs will be stepped up to also prevent hospital admissions.

Individual support will be offered to people leaving hospital to help them settle back to life at home.

Patients with the respiratory condition chronic obstructive pulmonary disease, asthma and heart failure will be helped to better use their medicines and health trainers will give people with long-term conditions one-to-one support.

Better links with care homes will also be created through the appointment of dedicated nurses to support patients.

GP Phil Garnett, chairman of the CCG, said: “This programme of work is a really positive step forward for patient care in the area.

“It’s important, now more than ever, that we look at how we can better support patients in the community and avoid the risk of them needing hospital treatment – particularly as the number of elderly people living in the area is on the rise and in light of the pressures on our A&E departments.

“Our ageing population, which will see the number of over 65s increase by 30 per cent by 2021, will bring real challenges for NHS and social care organisations as demand for services increases.”

Coun Clare Wood, executive member for health and adult services at North Yorkshire County Council, said: “It is the goal of both organisations to improve how care is delivered to people through better integration of health and social care services.

“These programmes aim to reduce duplication and provide more streamlined and co-ordinated health and social care which
is designed around people’s needs.”

Source: yorkshirepost.co.uk

Chase Farm Hospital has opened an urgent care centre to treat people with non life threatening injuries.

Urgent care centres now open at the Enfield hospital and at Barnet Hospital will help to take pressure off accident and emergency units.

Staffed by doctors, they will treat broken bones, minor head injuries, bad sprains or strains and eye injuries.

The Enfield centre will run alongside the existing A&E at Chase Farm in The Ridgeway, which is due to close next month following a decision by the Clinical Commissioning Group.

Cathy Geddes, director of clinical strategy at Barnet and Chase Farm Hospitals NHS Trust, said: “The opening of these centres shows there is a determination to provide the very best services possible for everyone living in the area. There is no need to book an appointment, people can simply turn up and will be seen by either a doctor or nurse.

“However, they are for patients with urgent care needs. Those who attend A&E or the new urgent care centres with minor illnesses or injuries will be sent back to their GPs or an appointment made for them. The centres are part of a raft of changes aimed at ensuring people in the area receive the right treatment at the right place and the right time.”

It was revealed that more than 40 per cent of patients who go to either hospital’s A&E departments do not need emergency care, but can be treated in an urgent care centre.

An assessment will be carried out and patients can be transferred to a local A&E department if necessary.

There will be a GP out-of-hours service available when the urgent care centres are closed, which can be contacted by calling 111.

Enfield Borough Council has since opted to take legal action against the proposed closure of Chase Farm A&E.

Source: enfieldindependent.co.uk

Upaya itu dilakukan untuk mendukung target RSUD dr Murjani Sampit mengejar akreditasi versi 2012 pada 2014 nanti

SAMPIT, Jaringnews.com – Rumah Sakit dr Murjani Sampit, Kabupaten Kotawaringin Timur (Kotim) Kalimantan Tengah mengancam akan memotong insentif pegawai rumah sakit setempat jika tidak menjalankan prosedur pelayanan, salah satunya adalah mencuci tangan. Juga termasuk untuk insentif para dokter yang bertugas di rumah sakit itu.

“Tim TKPRS (tim keselamatan pasien rumah sakit) akan melakukan pembinaan. Kami juga sedang membuat sistem renumenerasi, apabila tidak dilakukan maka akan dipotong jasa pelayanan sebagai penilaiannya,” kata Direktur RSUD dr Murjani Sampit, dr Yuendri Irawanto di Sampit, Senin (21/10).

Kewajiban cuci tangan sebelum dan sesudah memberikan pelayanan kepada pasien, hanyalah sebagian kecil prosedur tetap yang kini harus benar-benar dijalankan oleh seluruh pegawai di rumah sakit itu. Langkah itu merupakan bagian upaya untuk meningkatkan pelayanan dan menjamin keselamatan pasien.

Dituturkan Yuendri, semua upaya itu dilakukan untuk mendukung target rumah sakit ini mengejar akreditasi versi 2012 pada 2014 nanti. Pihak rumah sakit menargetkan bisa meraih akreditasi Utama, atau paling tidak bisa mendapatkan akreditasi Madya.

Ada 15 buku terkait prosedur tetap yang dibuat pihak rumah sakit dan harus dijalankan dengan disiplin oleh seluruh pegawai. Mengingat, penilaian akreditasi dilakukan secara menyeluruh dan tim penilai akan langsung mengevaluasi di lapangan, termasuk mengonfirmasi kepada pasien apakah benar mendapatkan pelayanan maksimal yang dijanjikan.

“Ini upaya untuk meningkatkan pelayanan kepada pasien. Dengan pasien selamat, kualitas pelayanan kita jadi tinggi. Selain itu rumah sakit bisa menciptakan hal ini agar tidak ada “bonus” penyakit dari rumah sakit. Ini sederhana tapi penting sekali, termasuk dalam hal cuci tangan, jangan sampai terjadi penularan dari tangan petugas kita,” terangnya.

Sumber: jaringnews.com