Perbandingan Luaran Pasien Level Of Care 3 yang Menggunakan Ventilator Sebelum dan Sesudah Operasional Ruang High Care Unit Di RSUP Dr. Sardjito Yogyakarta

Background: Mortality rate in emergency department (ED) of Dr. Sardjito General Hospital did not achieve national target. Result of evaluation and analysis of this condition was established of High Care Unit for critical care management of patient in ED with the goal to decrease morbidity and mortality rate.
Objective: To compare outcome such as mortality rate, MSOFA exit score, Length of Stay(LOS) in IMC, HCU, hospital and ventilator day at patients 3rd level of care (LOC) using ventilator before and after the implementation of HCU at the Dr. Sardjito General Hospital

Method: This research was an observational study using retrospective cohort analysis. Subjects had been collected from medical record included 198 meet the inclusion criteria; aged ≥18 years who were treated with critical illness with 3rd level of care (LOC) who used a ventilator in the HCU or IMC of RSUP dr.Sardjito. Exclusion criteria were patients with end-stage malignancies, patients with HIV / AIDS infections, patients with end-stage chronic disease and incomplete medical record.

Result: Mortality rate in HCU (40.4%) and IMC (73.3%) with p = 0.000. MSOFA exit score in HCU (5.5) and IMC (7.4) with p= 0.001. HCU and IMC length of stay (LOS) showed no statistically significant difference. Hospital LOS in HCU (314.7) hours and IMC (210.6) hours with p = 0.000. Ventilator day in HCU (5.1) days and IMC (4.8) days and showed no statistically significant difference.

Conclusion: Mortality rate and MSOFA exit score in HCU was lower than IMC. There was no significant difference between LOS in HCU and IMC. Hospital LOS in HCU group 314.7 hours and IMC group was 192.6 hours. Ventilator day in HCU group was 5.1 days and IMC group 4.8 days.

Latar Belakang: Angka kematian pasien di IGD RSUP Dr.Sardjito belum dapat mencapai target nasional yakni <0.2%. Hasil evaluasi dan analisis kondisi ini adalah dibentuknya ruang HCU untuk perawatan pasien kritis di IGD dengan tujuan akhir menurunkan morbiditas dan mortalitas.
Tujuan: Mengetahui perbandingan luaran berupa angka kematian, nilai MSOFA keluar, Length of Stay(LOS) Intermediate Care(IMC), High Care Unit(HCU) dan rumah sakit serta ventilator day pada pasien level of care (LOC) 3 yang menggunakan ventilator sebelum dan sesudah operasional HCU di RSUP Dr Sardjito. Metode: Penelitian ini merupakan penelitian observasional dengan desain kohort retrospektif.. Sampel diambil dari data rekam medis hingga jumlah sampel terpenuhi sebanyak 198 sampel dengan kriteria inklusi adalah pasien usia ≥18 tahun yang dirawat dengan penyakit kritis LOC 3 yang menggunakan ventilator di ruang HCU dan IMC RSUP Dr. Sardjito. Kriteria eksklusi penelitian ini yaitu pasien dengan keganasan stadium akhir, pasien dengan infeksi HIV/ AIDS, pasien dengan penyakit kronis stadium akhir, dan data rekam medis yang tidak lengkap.
Hasil: Angka kematian pasien di HCU (40,4%) dan di IMC (73,7%) dengan p = 0,000. Nilai MSOFA keluar di HCU 5,5 dan di IMC 7,4 dengan p=0,001. LOS HCU dan LOS IMC tidak menunjukkan perbedaan yang bermakna. LOS RS diperoleh di HCU sebesar (314,7) jam dan di IMC (192,6) jam dengan p = 0,000. Ventilator day di HCU (5,1) hari dan di IMC (4,8) hari dan tidak menunjukkan perbedaan yang bermakna. Kesimpulan: Angka kematian dan nilai MSOFA keluar di HCU lebih rendah dibandingkan di IMC. Tidak didapatkan perbedaan bermakna antara LOS di HCU dan IMC.LOS RS di HCU 314,7 jam dan di IMC 192,6 jam. Ventilator day di HCU selama 5,1 hari dan di IMC selama 4,8 hari.

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