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

PAMEKASAN, KOMPAS.com – Kecewa terhadap pelayanan Rumah Sakit dr.Slamet Martodirdjo, Pamekasan, Jawa Timur, puluhan warga yang mengatasnamakan Aliansi Masyarakat Peduli Pamekasan Sehat (Ampas), mendatangi Kantor DPRD Pamekasan, Senin (21/10/2013).

Mereka ingin mengadukan kekecewaannya kepada anggota dewan menyusul tak membaiknya pelayanan di rumah sakit milik Pemkab Pamekasan itu. Bahkan, tidak sesuai dengan undang-undang dan norma di suku Madura.

Wahyu Garuda, koordinator aksi dalam orasinya menyampaikan, pelayanan rumah sakit plat merah itu tidak memperhatikan nilai-nilai kemanusiaan dan norma orang Madura. Itu terbukti ketika ada pasien yang sakit tidak boleh ditunggui oleh anggota keluarganya.

Bahkan pasien yang sudah kritis menjelang kematiannya, juga tidak diperbolehkan untuk ditunggui. “Pelayanan macam apa yang diinginkan rumah sakit Pamekasan ini? Kalau pasien miskin rumitnya minta ampun untuk dijenguk anggota keluarganya,” ungkap Wahyu.

Lebih lanjut Wahyu megatakan, penerapan aturan baru di rumah sakit itu bertentangan dengan Undang-undang Nomor 44 Tahun 2009 tentang Rumah Sakit. Dalam undang-undang itu dijelaskan dalam Pasal 32 poin C dijelaskan, setiap pasien memperoleh layanan yang manusiawi, adil, jujur dan tanpa diskriminasi.

Di dalam poin L dijelaskan pula, setiap pasien didampingi keluarganya dalam keadaan kritis. “Di Rumah Sakit Pamekasan, pasien yang sudah kritis justru ditinggalkan sendirian dan tidak boleh didampingi keluarganya. Ini sudah tindakan melawan hukum,” imbuh Wahyu.

Menanggapi hal itu, Wakil Ketua DPRD Pamekasan Khairul Kalam mengaku, demi peningkatan pelayanan rumah sakit, pihak dewan mengaku rajin melakukan inspeksi mendadak.

Diakuinya, selama ini memang rumah sakit belum memberikan pelayanan sesuai dengan harapan masyarakat. Namun, dia berharap perlahan pelayanan di rumah sakit segera membaik.

Sementara itu, Pelaksana Tugas Direktur Rumah Sakit Saleh Lalhadi mengaku pelayanan di rumah sakit sudah sesuai prosedur. Sedangkan, pengunjung yang datang ke rumah sakit, memang diberi waktu dan diatur untuk kebutuhan pasien sendiri. Sebab, jika tidak diatur maka pasien akan terganggu.

“Tidak ada upaya mempersulit pelayanan di rumah sakit. Yang kami lakukan semata-mata untuk kebaikan pasien,” ungkap Saleh.

Penjelasan dewan dan pihak rumah sakit itu dinilai tidak memuaskan massa. Massa menuntut agar DPRD Pamekasan mebentuk tim khusus penanganan pelayanan rumah sakit. Sebab selama ini, pelayanan rumah sakit dan PDAM Pamekasan disebut paling banyak dikeluhkan warga.

Sumber: kompas.com

(dailyRx News) It’s not uncommon for hospitalized patients to have weakened immune systems that aren’t able to fight off infections. And that can make a hospital stay a risk to sick people.

Helping to stop the spread of infectious illness in healthcare facilities is the reason behind International Infection Prevention Week — which runs October 20 through 26.

“Cleanliness protects against hospital infections.”

Laura Buford, RN, BSN, CIC, told dailyRX News that just about everyone who comes in contact with a hospitalized patient can play a role in protecting that ailing person from avoidable diseases spread by human contact.

“Healthcare personnel, patients and even families,” said Buford, listing those key players in infection prevention.

“Each year, nearly 100,000 lives are lost due to preventable healthcare-associated infections. This is a tragedy. [We] want to raise awareness of the issue and empower everyone on how they can help to reduce this number.”

Reducing the tally of infectious illnesses isn’t that hard, added Buford, who works in infection prevention at St. David’s South Austin Medical Center in Austin, Texas.

“So often, people forget about the basics. They forget about washing their hands. They forget about covering their cough,” said Buford, also a member of the Association of Professionals in Infection Control and Epidemiology (APIC). “They forget about simple cleaning. Infection prevention doesn’t have to be complicated. It truly is about doing easy things, and the results of those save lives.”

Beyond this specially designated awareness week, there are ongoing efforts to curb hospital-borne infections. APIC’s “Infection Prevention and You” campaign, in part, encourages patients themselves to champion their own safety against hospital infections. They include:

Asking whether to bathe with germ-killing soap prior to surgery

Taking all medications as directed

Ensuring that needled syringes are sterile, only used once and then properly disposed of

Requesting that an untidy room be cleaned

Asking daily whether it’s time for removal of a catheter, which can result in urinary tract infections

Also, according to APIC, patients and others should sneeze into their elbows instead of their hands, which touch other people and objects.

Those at highest risk for becoming infected or having the hardest time bouncing back from infectious disease include the very young, very old, and individuals whose immune systems are consistently weak, Buford said.

With flu season looming — and avoidance of the flu on many people’s minds — those groups that are especially at risk deserve added attention and protection, Buford said. Those three at-risk groups should have limited contact with carriers of the flu or, for that matter, all other infections.

Special care should be given to the cleanliness and safety of their food. Everyone who comes into contact with those vulnerable populations should wash their hands. And, Buford added, “Don’t visit if you are sick.”

People who have been sick should also be mindful that they can be “…re-infected,” Buford said, “or, at least prolong your illness, if you don’t wash your hands [regularly].”

Source: dailyrx.com

(Fremont County, Wyo.) – For the second consecutive year, Lander Regional and Riverton Memorial Hospitals were presented with a hospital quality award from Mountain-Pacific Quality Health during the Wyoming Hospital Association convention in Sheridan in September.

Both hospitals were awarded the Commitment to Quality Award for their outstanding performance in giving excellent care in the nationally measured areas of heart failure, pneumonia, acute myocardial infarction, infections prevention and surgical complications. The award also recognizes the hospitals’ strong leadership support for quality and patient safety.

“I’m extremely proud of the quality of care we provide in both Fremont County hospitals,” Steve Erixon, CEO for Lander Regional Hospital and Riverton Memorial Hospital, said. “Quality and patient safety are at the forefront of our operations each day, and it’s nice to be recognized for our efforts.”

This is the 11th year Mountain-Pacific has presented Wyoming medical facilities with Hospital Quality Awards.

Source: county10.com

Dianggarkan di APBD 2014 dalam Bentuk Multiyears

SELAIN penganggaran lanjutan proyek Jembatan 1 Dompak di Anggaran Pendapatan Belanja daerah (APBD) 2014 mendatang. Pemerintah Provinsi (Pemprov) Kepri dan Dewan Perwakilan Rakyat Daerah (DPRD) juga akan menganggarkan sekitar Rp80 miliar untuk melanjutkan penyelesaian Rumah Sakit Umum Provinsi (RSUP) Batu 8 Tanjungpinang.

“Direncanakan sistem proyeknya juga dalam bentuk multiyears atau tahun jamak,” ungkap Wakil Ketua DPRD Kepri Ing Iskandarsyah kepada Tanjungpinang Pos, Minggu (13/10) kemarin.

Iskandar mengatakan, salah satu alasan kenapa dibuat multiyears meskipun anggarannya tidak sebesar penyelesaian Jemabtan 1, sebab dikhawatirkan kondisi waktu penyelesaian dan kemampuan anggaran menjadi kendala ketika nanti dibuat proyek tahun berjalan. Untuk itu, salah satu komitmen bersama pemerintah dan dewan adalah menyelesaikan empat lantai (lantai 5,6,7 dan 8) RSUP itu secepat mungkin.

“Kalau tahun berjalan lelangnya pasti dua kali, dan ini prosesnya menyita waktu yang tidak sedikit. Untuk itu lebih bagus dalam bentuk tahun jamak, supaya dalam dua tahun kedepan bisa selesai,” ujarnya.

Iskandar mengungkapkan, sebenarnya awal tahun 2012 lalu pihaknya sempat melobi pemerintah pusat supaya ada APBN yang dikucurkan untuk penyelesaian RSUP tersebut. Berhubung ini kategori proyek lanjutan, maka sumber pendanaannya tetap APBD dan tidak bisa dari APBN pusat.

“Target kami pertengahan tahun 2015 RSUP ini sudah selesai keseluruhan dan bisa dipergunakan untuk seluruh masyarakat Kepri, khususnya yang ada di Pulau Bintan,” imbuhnya.

Menurut Iskandar, secara prinsip para anggota DPRD Kepri juga tidak ada yang keberatan dengan penyelesaian RSUP tersebut. Apalagi Pemda juga berpendapat, bahwa sudah saatnya ada rumah sakit milik pemerintah yang bertipe B dengan fasilitas ruangan yang sangat baik. (fik)

Sumber: tanjungpinangpos.co.id