Tesis

Efektivitas Rujukan Obstetri Ke Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo di Era Pandemi COVID-19 = Effectiveness of Obstetric Referral to dr. Cipto Mangunkusumo General Hospital during the COVID-19 Pandemic.

Latar belakang: Salah satu aspek penting dalam upaya menurunkan angka kematian dan morbiditas Ibu adalah sistem rujukan yang efektif. Pandemi COVID-19 memberikan tantangan tersendiri dalam pelaksanaan sistem rujukan. Belum pernah dilakukan penilaian terhadap penerapan sistem rujukan obstetri di era pandemi COVID-19. Metode: Penelitian deskriptif-analitik berdesain potong lintang yang membandingkan efektivitas rujukan sebelum (Juli-Desember 2019) dan saat di era pandemi COVID-19 (Maret-Agustus 2020) di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo. Efektivitas rujukan dinilai berdasarkan dua kriteria, yakni kesesuaian diagnosis rujukan dan ketepatan prosedur yang meliputi komunikasi melalui sistem penanggulangan gawat darurat terpadu (SPGDT), pengantaran dengan ambulans, dan pelampiran surat rujukan. Hasil: Penelitian menemukan 198 kasus rujukan dari 464 kasus obstetri (42,67%) sebelum pandemi dan 231 kasus rujukan dari 486 kasus obstetri (47,53%) di era pandemi. Kesesuaian diagnosis dan ketepatan prosedur rujukan di era pandemi COVID-19 secara signifikan lebih tinggi. Kesesuaian diagnosis meningkat dari 57,58% sebelum pandemi menjadi 71,00% di era pandemi (p = 0,004). Ketepatan prosedur rujukan meningkat dari 28,28% sebelum pandemi menjadi 45,45% di era pandemi (p < 0,001). Berdasarkan kriteria tersebut, efektivitas rujukan di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo pada era pandemi COVID19 ditemukan lebih tinggi secara signifikan, yakni sebelum masa pandemi sebesar 21,72% dan di era pandemi sebesar 40,26% (p < 0,001). Kesimpulan: Terdapat peningkatan efektivitas rujukan ke Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo berdasarkan kesesuaian diagnosis dan ketepatan prosedur di era pandemi COVID-19 hingga 2x dibanding sebelum masa pandemi COVID-19.
Kata kunci: COVID-19, pandemi, sistem rujukan obstetri


Introduction: One important aspect in reducing maternal mortality and morbidity is an effective referral system. The COVID-19 pandemic presents its own challenges in implementing the referral system. There has never been an assessment of the application of an obstetric referral system during the COVID-19 pandemic. Methods: A cross-sectional descriptive-analytic study comparing the effectiveness of referrals before (July-December 2019) and during the pandemic (March-August 2020) at the Cipto Mangunkusumo Central General Hospital. The effectiveness of referrals is assessed based on two criteria; procedural compliance which includes communication through the integrated emergency response system (SPGDT), delivery by ambulance, and referral letters, as well as the accuracy of referral diagnoses compared with the diagnosis at admission. Results: The study found 198 referral cases out of 464 obstetric cases (42.67%) before the pandemic and 231 referral cases out of 486 obstetric cases (47.53%) during the pandemic. The accuracy of diagnosis increased from 57.58% before the pandemic to 71.00% during the pandemic (p = 0.004). Procedural adherence increased from 28.28% before the pandemic to 45.45% during the pandemic (p < 0.001). Based on these criteria, the effectiveness of referrals at the Cipto Mangunkusumo Central General Hospital during the pandemic was found to be significantly higher, namely 21.72% before the pandemic and 40.26% during the pandemic (p < 0.001). Conclusion: The effectiveness of referrals at the Cipto Mangunkusumo Central General Hospital, both based on procedural compliance and the accuracy of the diagnosis, was found to be better during the COVID-19 pandemic.
Keywords: COVID-19, pandemic, obstetric referral system