TEMPO.CO , Yogyakarta:Penderita kelainan saraf otak, seperti tumor otak dan stroke di Indonesia bisa bernafas lega. Lantaran proses operasi tak lagi harus dengan cara membedah tempurung kepala. Melainkan cukup membuat sayatan pada alis mata sebesar lubang kunci atau yang dikenal dengan teknik operasi lubang kunci (keyhole surgery).

“Kenapa di alis mata? Karena bekas sayatan bisa disembunyikan di alis mata, sehingga tidak terlihat,” kata dokter spesialias bedah saraf Rumah Sakit Mitra Keluarga Surabaya Asra Al Fauzi saat dihubungi Tempo di sela acara Symposium on Cerebrovascular Disease; Enhancing Neuroendovascular Management in Indonesia di Sahid Rich Hotel di Jalan Magelang kabupaten Sleman, Ahad 5 Mei 2013.

Keuntungan lain dari teknik tersebut, sayatan akibat proses pembedahan minimalis, proses operasi berlangsung singkat, dan pasien tak membutuhkan waktu lama berada di rumah sakit. Jika pada operasi kepala secara konvensional membutuhkan waktu 4-5 jam, maka teknik bedah lubang jarum hanya berlangsung dua jam.

“Risiko perdarahannya sedikit. Sehingga banyak pasien yang memilih teknik ini. Pasien saya banyak yang usia tua, di atas 50 tahun,” kata Asra yang tergabung dalam Tim Brain and Spine Center (BSC) RS Mitra Keluarga Surabaya.

Pemahaman publik selama ini, penyakit akibat kelainan syaraf seperti tumor otak dan stroke dimaknai sebagai jenis penyakit yang sangat menakutkan dan fatal. Selain penanganannya sangat serius, tindakan operasi yang biasa dilakukan terhadap pasien berupa operasi besar dan menyeramkan. Inovasi pembedahan dengan resiko terkecil dan tingkat keberhasilan yang lebih baikmenjadi amat penting. Bedah lubang kunci, menurut Asra, merupakan salah satu inovasi dalam penanganan kasus minimally invasive neurosurgery.

“Prosedur tindakan dengan bedah lubang kunci ini lebih ringan dan lebih acceptable bagi pasien. Kami sarankan pasien untuk menggunakan metode ini,” kata Asra.

Teknik bedah lubang jarum adalah membuat satu lubang sebesar lubang kunci pada alis mata, tepatnya di antara bagian atas mata dan di bawah otak. Dari lubang tersebut kemudian dimasukkan alat mikro dan endoskopi untuk melihat sejumlah saraf yang mengalami kelainan. Proses operasi dilakukan dengan alat tersebut. Pasien harus menjalani bius total agar proses operasi berjalan tenang.

Hanya saja, teknik operasi tersebut tidak dapat diterapkan pada semua kelainan saraf. Hanya kelainan saraf pada stadium dini atau yang cepat terdeteksi yang bisa diterapkan metode tersebut.”Kalau tumornya sudah membesar atau stadium lanjut, jangan menggunakan cara ini,” kata Asra.

Kendala lainnya, metode bedah lubang kunci belum diterapkan di semua rumah sakit di Indonesia. Hingga saat ini, baru Rumah Sakit Mitra Keluarga Surabaya yang menerapkannya. Bahkan metode tersebut baru dikenal di Indonesia sejak tiga tahun lalu. Asra adalah dokter yang mempelopori penggunaan metode tersebut di Indonesia.

“Saya mempelajari teknik tersebut di Jepang. Semoga segera menyusul rumah sakit lain di Indonesia yang menggunakan teknik ini,” kata Asra.

Dia menjelaskan, teknik tersebut pertama kali diterapkan di Jerman sejak 10 tahun lalu. Beberapa negara di Asia yang sudah turut menerapkan adalah Cina, Korea Selatan, India, dan Jepang. Beberapa dokter di Filipina juga dikabarkan telah mempraktikkannya. Asra mempelajari teknik tersebut pada 2008 di rumah sakit Aizawa di Matsumoto, Jepang.

“Pertama kali saya kabarkan pada pasien saya soal metode ini, mereka terkejut. Tapi antusias dan ingin mencoba,” kata Asra.

Sumber: tempo.co

Citizen6, Klaten: Stroke yang tidak segera ditangani dengan tepat bisa menyebabkan kematian. Jika penderita segera dibawa ke rumah sakit dan terselamatkan, kadang-kadang penderita mengalami kelumpuhan pada anggota badannya atau hilangnya sebagian ingatan atau kemampuan bicaranya.

Untuk mencegah hal fatal tersebut, Rumah Sakit Islam Klaten membuat unit khusus stroke dan meresmikannya pada Selasa (30/04/2013). Peresmian dilakukan di Gedung Al Mabrur Kompleks Rumah Sakit.

“Penderita stroke makin tahun makin meningkat. Pada 2010 terdapat 424 penderita yang dirawat di rumah sakit ini. Sementara pada 2011 berjumlah 426 orang. Tahun 2012 meningkat menjadi 566 orang,” terang Agus Susanto, Sekretaris Humas & Pemasaran RS. Islam Klaten.

Dengan adanya unit khusus stroke tersebut bertujuan untuk memulihkan pemulihan fungsional penderita stroke sehingga akan menurunkan derajat kecacatan akibat stroke, membantu adaptasi keluarga penderita stroke, menurunkan mortalitas stroke.

Tim yang menangani unit Stroke terdiri dari tim inti dan tim konsultasi. Tim inti terdiri dari dokter spesialis saraf, perawat stroke, fisioterapist, ahli gizi dan psikolog. Sementara tim konsultasi terdiri dari penyakit dalam, kardiolog, pulmunolog, ahli Bedah Syaraf, dokter anestesi, rehabilitasi Medik, psikiater dll

Peresmian dilakukan oleh Ketua Yayasan Jamaah Haji Klaten, Drs. H. Soebiyanto didampingi oleh Jajaran Pengurus Yayasan serta Direksi dan Manajer RS. Islam Klaten di Unit Stroke RS. Islam Klaten yang lokasinya bersebelahan dengan ICU RS. Islam Klaten.

Sumber: news.liputan6.com

In a letter to affiliated physicians and staff, Hoag Hospital in Newport Beach has announced that elective abortions will no longer be performed at the hospital.

The letter said the decision is based of the low number of procedures done annually at the hospital and was made following a review of clinical services performed at the facility.

Hoag Chief Executive and President Robert Braithwaite said there is a direct correlation between quality of care and the number of procedures performed. Elective abortions, he said, are seldom performed in hospitals, partly because of the expense and the less private or intimate setting.

Hoag provided about 100 abortions a year, compared with 6,000 births and 10,000 mammograms, Braithwaite said.

“The bottom line is to provide high-quality healthcare to this community,” he said.

The decision does not affect the dispensing of emergency contraception following rape or sexual assault, emergency services for women who experience complications from pregnancy termination at other facilities, or management of ectopic or other pregnancy complications, according to the letter sent out to physicians dated May 1.

The review of services was prompted by the hospital’s partnership with St. Joseph Health, a Roman Catholic-affiliated institution, although Braithwaite said at no point did St. Joseph pressure the board to change its policy on elective abortions.

Braithwaite cited other procedures still performed at Hoag, including tubal ligation, which are typically not provided by Catholic healthcare providers.

Hospital officials emphasized that patient-physician relationships wouldn’t change and that Hoag-affiliated doctors could still perform abortions, just not at Hoag.

Physicians had mixed reactions to the announcement, according to Dr. Allyson Brooks, the executive medical director for Hoag’s Women’s Health Institute.

“We consider ourselves a center of excellence … and have provided great care, so it’s not unusual for our OB/GYN staff to feel like something went away,” Brooks said.

She said that on an individual basis, many physicians understood the change because so few elective abortions were performed at Hoag. Some doctors were worried that other factors played a part in the decision, Brooks said, but she denied this.

Brooks said there would not be a lack of access to the service since there are many other nearby academic and outpatient centers where elective abortions are performed, including UC Irvine, Planned Parenthood and Family Planning Associates Medical Group.

The elimination of elective abortions isn’t the first time the hospital has gotten rid of a program, Braithwaite said. About five years ago, the hospital decided to eliminate in-patient pediatric care because it felt those patients were best served by the Children’s Hospital of Orange County.

Source: latimes.com

As provincial government revenues stagnate with the sluggish economy, provinces are turning their eye to hospitals as a very obvious target for reductions in spending growth. Provinces spend more than $60 billion a year on hospitals — about $2.5 billion in Manitoba — which is more than they spend on many of their entire ministries.

Right now, most of this money flows to hospitals with few strings attached. Changes are underway to hospital funding pathways, however, to try and ensure that we get good value for that money.

The most recent data from the Canadian Institute for Health Information points to marked variation between hospitals in what this money buys. For example, a hospitalization for a hip replacement in one hospital can cost in excess of 50 per cent more than other hospitals in the same province.

The public should care about this, since large differences in spending between hospitals for the same type of care imply that there is potential for governments to cut spending. If hospital A can do hip replacements for $5,000 per patient why are we paying hospital B $8,000 per patient? If governments can find ways to bring hospital B’s costs closer to $5,000 the hospital has become more efficient and government spends less.

Every year provinces give hospitals a fixed percentage increase to their budget from the previous year. This across-the-board increase, similar to a cost-of-living increase, is intended to reflect increasing input costs, such as wage increases and new technologies and drugs. Over the past half-decade, these annual increases have been in the neighborhood of five per cent.

This type of budgeting and incentive structure rewards all hospitals with new funding equally. Perpetuating across-the-board increases provides little motivation for inefficient hospitals to change the way they operate.

Ontario and British Columbia are starting to change the way they fund hospitals. For the past few years, both provinces have directed hundreds of millions of dollars to hospitals as an incentive to perform more surgeries by tying funding to a fixed price per surgery. Hospitals that can perform surgeries at or below that price will generate free cash flow. Hospitals whose costs per surgery are higher quickly realize that they are receiving smaller increases than their more cost-efficient peers.

Some hospitals can’t compete on cost-efficiency alone. Hospital spending data shows that it costs more to operate hospitals in small and isolated communities than in urban centres.

Ontario and British Columbia are hoping their new hospital funding initiatives won’t close hospitals or undermine quality, but will instead put financial pressure on inefficient hospitals to change their management practices.

It’s not all about saving money.

Every opportunity to improve the safety and quality of hospital care should be seized. Government regulations can be vigilantly monitored to ensure hospitals are meeting acceptable standards of safety. Meeting such standards could also be tied to new hospital funding.

Another idea is to measure quality from the perspective of the patient. The experiences of patients at the hospital and changes in their quality-of-life after surgery should be tracked. Too often, provinces are choosing hip and knee replacements without considering other surgeries and procedures.

The value we get for the money we spend on hospital care can be improved by changing the way we spend that money. Perpetually distributing lump sums to hospitals with few strings attached can no longer be excused in the current economic climate. While change won’t be easy, it’s good that Ontario and British Columbia are leading the way. Other provinces will follow.

Jason M. Sutherland is an expert adviser with EvidenceNetwork.ca and assistant professor at the centre for health services and policy research, University of British Columbia. Nadya Repin is a research coordinator with the centre for health services and policy research, UBC. Their C.D. Howe Institute publication, Paying for Hospital Services: A Hard Look at the Options can be found at www.cdhowe.org

Source: winnipegfreepress.com

Sister Hospital dan Performance Management & Leadership di NTT

Kupang-PMPK. Kegiatan Sister Hospital sudah berlangsung selama lebih dari dua tahun dan PML lebih dari setahun. Selama proses tersebut banyak dinamika yang telah terjadi terkait dengan upaya penurunan angka kematian ibu dan bayi yang menjadi  tujuan utama kegiatan ini. Pertemuan yang dilaksanakan di Kupang pada 29 April 2013 lalu membuka pelaksanaan Monev Program SH-PML di 11 RSUD di NTT.

Berbeda dengan monev-monev sebelumnya, monev kali ini selain untuk mengevaluasi progress yang dicapai oleh RS Mitra A (Sembilan RS besar di Jawa-Bali-Sulawesi) dan RS Mitra B (11 RSUD di NTT), juga untuk mentransfer tanggung jawab dari PMPK FK UGM kepada mitra local di NTT yang telah ditunjuk, yaitu Undana, POGI dan IDAI Kupang serta Dinas Kesehatan Provinsi NTT. Monev dibuka dengan memberikan pelatihan pada para evaluator yang berasal dari keempat institusi tersebut. Hari berikutnyatim dibadi menjadi tiga kelompok, yaitu:

1. Kelompok A (melakukan Monev di RSUD Soe Kab. Timor Tengah Selatan, RSUD Kefamenanu Kab. Timor Tengah Utara dan RSUD Atambua Kab. Belu),
2. Kelompok B (melakukan monev di RSUD Larantuka Kab. Flores Timur, RSUD Lewoleba Kab. Lembata, RSUD Waikabubak Kab. Sumba Barat, dan RSUD Umbu Rara Meha Kab. Sumba Timur)
3. Kelompok C (melakukan monev di RSUD Ruteng Kab. Manggarai, RSUD Ende Kab. Ende, RSUD Bajawa Kab. Ngada dan RSUD TC Hillers Kab. Maumere)

Masing-masing kelompok terdiri dari: evaluator pelayanan maternal, evaluator pelayanan perinatal, evaluator SH, evaluator PML, serta peneliti kualitatif yang menggali pendapat stakeholder internal dan eksternal RSUD terhadap program SH dan PML ini. Tim dari UGM juga dibagi menjadi tiga kelompok dan bertugas mendampingi para evaluator tersebut.

Sampai saat tulisan ini diturunkan proses monev masih berlangsung. Hasil sementara yang didapat menunjukkan adanya variasi progress kegiatan dan pencapaian tujuannya. Sebagai contoh, beberapa RS menggunakan kontainer air kecil yang dilengkapi dengan keran sebagai pengganti wastafel untuk cuci tangan. Hal ini dilakukan untuk mengatasi kesulitan instalasi wastafel dan juga kekurangan air yang menjadi masalah umum di Provinsi NTT. Dengan inovasi ini, tidak ada alas an bagi petugas kesehatan di RS untuk tidak menjalankan prosedur hand hygiene untuk keselamatan pasien. Namun sayangnya fasiiltas pengering tangan masih menggunakan handung yang dipakai bersama dan berkali-kali, bukan handuk yang sekali pakai.

Pengelolaan sampah mulai dilakukan dengan baik. Tempat sampah untuk sampah medis dan non medis dipisahkan dan untuk memudahkan pengguna, kedua tempat sampah ini menggunakan kantong plastic dengan warna yang berbeda. Kantong plastik merah untuk sampah medis dan kantong plastik hitam untuk sampah non medis. Namun di beberapa lokasi masih ditemui kotak sampah yang tidak membedakan warna kantong plastik untuk sampah medis dan non medis.

Obat-obatan yang disediakan di ruang pelayanan sudah ditata menggunakan kontainer kecil dengan banyak laci dan setiap laci ditulisi nama obatnya. Namun masih ditemukan beberapa laci berisi obat yang tidak sesuai dengan label yang tertera di laci. Hal ini terkait dengan kedisiplinan petugas dalam mengembalikan sisa obat ke laci yang sesuai.

Beberapa RSUD mengalami pergantian direktur sehingga hal ini mempengaruhi tingkat kecepatan pelaksanaan program PML yang direncanakan di tahun 2013 ini. Proses hand over dari direktur lama ke direktur yang baru tampaknya kurnag berjalan dengan baik sehingga direktur baru tidak mengetahui detil kegiatan yang sudah terlaksana, hasil yang telah dicapai dan rencana yang akan dilaksanakan di tahun 2013. Pada akhirnya ini mempengaruhi pencapaian program PML secara keseluruhan. Sebagai contoh, beberapa RSUD merencanakan untuk mulai proses persiapan penerapan PPK BLUD dan mentargetkan untuk mencapai status ini pada pertengahan tahun 2013. Namun pada kenyataannya banyak yang belum memiliki rencana konkrit bagaimana untuk mencapai status tersebut.

Hasil dari monev ini akan disampaikan pada sebuah pertemuan yang rencananya akan diselenggarakan pada akhir Mei 2013 mendatang di Surabaya.

The Bermuda Hospitals Board today announced that it will be ceasing to provide a day care service for seniors from its Continuing Care Unit from 28 June 2013.

Clients and their families have been informed and directed to other organizations that provide a similar day time service in the community. The service is separate to the CCU residential service in CCU Lower, CCU Upper and the Alzheimer’s Related Disorder Unit [ARDU], which has over 100 beds and will continue operating as usual.

The day care service was for seniors who lived outside of CCU and provided supervision, recreation/socialization, meals and medication delivery on week days.

BHB had provided this service from the Continuing Care Unit for over twenty years, but the number of visits had decreased in recent times. The average monthly number of visits per client had dropped 50% from 15 to 8 from fiscal year 2008/9 to 2012/13. This resulted in about 6 to 8 clients using the service each day last year. The service costs $270,000 per year to run, BHB said.

Granville Russell, Director of the Continuing Care Unit comments: “We are sorry to say goodbye to our day care clients, but with reduced client visits, the retirement of two key members of staff and increasing space pressures within the CCU facility, it was time to review the viability of this service.

“We felt this was not a core BHB service and similar services are already provided by others in the community at a fair price. For the numbers concerned, BHB could not maintain this service at a viable price in order to cover its costs. I would like to thank our retiring staff and the drivers who provided a wonderful day time service and recognize their hard work in catering for this group.”

The service employed one registered nurse, an activity aide and two part-time drivers. The staff members in the nurse and activity aide positions are retiring. The drivers already had other duties within CCU and will remain with BHB.

Venetta Symonds, CEO & President adds: “BHB is about to go through an intensive process of service review and reshaping that will take about 4 to 6 months. The retirement of key staff in this service meant a decision on this service had to made ahead of the full review, but a full business case with multiple options was considered by the Senior Management Team.

“We will be asking the same questions about all our services – should BHB be providing it, or is it better provided by others, whether Government or the private sector. The pressure is there for BHB to focus on its core services and ensure they are provided at the highest quality and at best value.

“The strategic planning process will require collaboration and cooperation across the healthcare continuum, which is a positive development for Bermuda. While I anticipate some reshaping of BHB services after this process, it will be coordinated sensitively to ensure minimal disruptions for our clients, patients and staff.”

Source: bernews.com

At the special meeting of the Mineral County Commissioners on April 23, Denyse Traeder of the Mineral Community Hospital made a presentation on the hospital’s Frontier Medicine Better Health Partnership. According to Traeder, the partnership was formed by MCH as a response to the changing nature of health care in the country.

“The Innovations Program (another name for the Frontier Medicine Better Health Partnership) was formed by the legislature to look at new and innovative ways to look at health care,” Traeder said.

According to Traeder, employees at the hospital wrote in “many cool things” in the grant and the hospital won the nationwide grant out of over 9,000 hospitals that applied.

“Health care as we know it isn’t sustainable,” Traeder said. “If health care had risen by the same percentage as food we would be paying $108 for a pound of oranges. So we know that it’s outrageous and if this was happening with food there would be a huge outcry. But because we all need healthcare we aren’t really seeing as much of a pushback so we are here trying to tackle some of these issues.”

The Frontier Medicine Better Health Partnership was created for Critical Access Hospitals, hospitals with less than 25 beds, as a response to the changing nature of health care in the nation.

“It’s a grass root effort created by critical access hospitals for critical access hospitals,” Traeder said.

Traeder added that the partnership was created to “give small, critical access hospitals a voice” by teaming them all together and creating a nationwide partnership.

“We have been funded for three years and we have the possibility of continuing for seven years if we show the cost-cutting we think we can show,” Traeder said.

Twenty-five hospitals in the state have already teamed up with MCH in the partnership and according to Traeder the number will only increase with time.

“We believe that we will have closer to all 48 (critical access hospitals in Montana) join,” Traeder said. “They are very excited about this because it gives them quite a bit to work with within their communities.”

Traeder, who has been “running and writing grants in the county for a long time,” said that there are several primary areas of focus of focus in the partnership including developing a larger workforce and improving the efficiency of systems in critical access hospitals.

“It’s all about the patients,” Traeder said. “That is what we really want to focus on.”

One aspect of the partnership is training military veterans to be able to transition from service directly into fields in health care. According to Traeder that transition has been hard in the past due to military training not carrying over and counting in the private sector.

“When they get stateside they can actually get a job immediately,” Traeder said. “We have a 20 percent unemployment rate among our veterans right now and one of the major problems is once they get home the nation doesn’t accept their training.”

Another aspect of the partnership is developing better communication and transportation protocols in critical access hospitals.

“One of the things we have identified is that we are using rotor transportation at a very high rate when ground transportation would be appropriate,” Traeder said. “Each time a rotary comes out to pick up a patient it is about $15,000 and sometimes as much as $30,000.”

In order to combat those costs the partnership is looking at improving ground transportation in critical access hospitals in order to have staff available to ride in an ambulance with a patient to give support to the patient that would otherwise require a helicopter for transportation.

Source: vp-mi.com

Manajemen Rumah Sakit ------------------------------------------------- Laporan----Liputan 

–Editor: Ni Luh Putu Eka Putri Andayani, SKM,. M.Kes ([email protected])

1. Liputan Seminar Tahunan VI Pateint Safety Kongres XII PERSI –
2. Liputan Seminar Harapan Direktur terhadap Perilaku Dokter Spesialis dan Dokter di RS Puri Indah —dalam Konteks Sistem Kontrak Kerja –
3. Liputan Khusus 20 Tahun MMR UGM dan Forum MUTU IHQN VIII –
4. Liputan Khusus dari BANGKOK –
5. Capacity Building untuk tim dari P2K3 Undana dan RSUD Prof. Yohannes Kupang

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SLEMAN, suaramerdeka.com – Rumah Sakit Umum Daerah (RSUD) Sleman menargetkan realisasi kerjasama dengan Badan Penyelenggara Jaminan Sosial (BPJS) mulai tahun depan. Saat ini, pihak pengelola masih merintis sejumlah upaya untuk mencapai sasaran tersebut.

“Sesuai undang-undang, per 1 Januari 2014 seluruh penduduk harus tercover jaminan sosial. Kami kejar target itu karena 60 persen pasien merupakan peserta Askes dan jaminan kesehatan,” kata Direktur RSUD Sleman, Joko Hastaryo kepada wartawan, Rabu (1/5).

Mengacu UU no 42/2012, setidaknya ada tiga persyaratan yang harus dipenuhi rumah sakit sebelum menjalin kerjasama dengan BPJS. Salah satunya mengenai pemenuhan syarat kelas. Sampai awal tahun ini, RSUD Sleman baru memiliki 168 tempat tidur. Padahal, rumah sakit kelas B disyaratkan memiliki 200 unit tempat tidur.

“Tapi sekarang syarat itu sudah kami penuhi. Sejak awal Februari, fasilitas tempat tidur sudah ditambah jadi 214 unit,” ujarnya.

Namun demikian, masih ada kendala lain yakni menyangkut ketersediaan layanan spesialis penyakit jantung, dan ortopedi (bedah tulang). RSUD Sleman belum memiliki dua unit layanan tersebut. Selama ini, pasien ditangani dokter bagian lain atau dirujuk ke rumah sakit yang memiliki spesialisasi tersebut.

Mengatasi kendala ini, RSUD Sleman telah mengirimkan salah satu dokter umum untuk mengikuti pendidikan ortopedi. Namun penanganan khusus penyakit jantung masih dilakukan sebatas bekerjasama dengan RS Sarjito. Paling tidak satu minggu sekali, dokter spesialis jantung RS Sarjito berpraktik di RSUD Sleman.

Upaya lain terkait rencana kerjasama dengan BPJS adalah perbaruan akreditasi. Saat ini, baru 16 dari 23 layanan kesehatan di RSUD Sleman memiliki akreditasi. Beberapa unit layanan yang belum terakreditasi antara lain bedah tulang, jantung, patologi anatomi, dan sterilisasi sentral.

Tahun depan ditargetkan semua pelayanan mencapai angka kredit sesuai yang ditentukan. “Hal ini jadi salah satu fokus kami. Apalagi sistem penilaian akan berbeda, nantinya diawali implementasi standar dulu baru kemudian evaluasi dokumen,” terang Joko.

RSUD Sleman juga sedang menggenjot peningkatan layanan bagi masyarakat miskin. Pasalnya, syarat kerjasama dengan BPJS adalah rumah sakit harus menyediakan fasilitas layak untuk pasien tidak mampu. Salah satu upayanya adalah menambah fasilitas tempat tidur di ruang kelas III yang saat ini jumlahnya baru 55 persen.

Sumber: suaramerdeka.com