Hospital Surge Capacity T R E V I N O A R I S TA R K U S PA K A S I

G R A C E C I E L I A

I I S Z AT N I K A

Curriculum Vitae-1

Dokter : FKUI 1997

Flight Surgeon : TNI AU 1999

Magister sains dalam Kedokteran Kerja : Pascasarjana UI 2000

Doctor of Phylosophy : UMCN, the Nethelands, 2009

SpDLP : UNPAD, 2017

FISPH : Fellow Indonesian Society of Public Health

FISCM : Fellow Indonesian Society of Community Medicine

Curriculum Vitae-2

Staf pengajar FKUI di Departemen Ilmu Kedokteran Komunitas : 1997-sekarang

Kepala klinik dokter keluarga FKUI Kiara : 1999-2002

Wakil Kaprodi FK UNIPA, Sorong, Papua Barat : 2014-2015

Kaprodi Spesialis Kedokteran Penerbangan FKUI: 2017-2018

Koordinator P3 Klinik Satelit UI Makara : 2018- sekarang

Co-founder Travel and Adventure Medicine in Asia

Founder Klinik Pencegahan: Klinik Cimanggis Jaya

Objective

To explore and capture the best practice the hospital’s capacity in facing the

pandemic during the first months of the outbreak, in terms of:

1. Human resources

2. Management of the services

3. Disaster management and mitigation plan

Method

Desain qualitative study

Conceptual framework based on a system-based analysis

Masukan Proses Luaran Dampak

Umpan

Balik

Lingkungan

Tujuan umum

Method

Key persons: director, financial manager, human resources manager, OSH officer, patient–safety

officer, Satgas Covid 19 or the Hospital Disaster Incidence Command system

Data collection: group interview via online system, form to be filled in

8 hospitals: Panti Wilasa, Panti Wilasa Citarum, Emanuel, Bethesda, Panti Rahayu, Ngesti Waluyo,

Mardi Waluyo

The selected hospitals were selected due to the performance they did during the pandemic

Result and Discussion

YAKKUM set up the overall goal of the Total COVID 19 response management

To ensure patient’s management is

effective, educate community,

synergy with occupational safety and

health, and drafting the business

continuity plan.

Strategy -1

TUJUAN

1. Rumah sakit Yakkum mampu melakukan

penapisan pasien yang datang ke

rumah sakit sesuai kategorinya,

termasuk pengiriman material sample

darah atau swab ke fasilitas yang

kompeten menegakkan diagnosis

pasti, serta melakukan “surge capacity”

untuk menambah ruang perawatan

isolasi dan ICU bagi pasien Covid-19.

2. Unit Ekstra mural bersama unit Intra

Mural serta Unit Akademik mampu

melakukan edukasi “social distancing”,

karantina diri, menjadi influencer serta

edukator pencegahan penularan Covid-

19 di wilayah dan kelompok

dampingannya.

STRATEGY:

1. Set the goals for patient’s services from

screening to diagnose and referral diagnostic,

continued with isolation room, ward and ICU.

2. Set the goals for extramural unit , which are the

communities being served, and doing the

education to the community

Strategy - 1

Strategy - 2

3. EMU memastikan kelompok rentan

dampingannya didukung dalam fase

tanggap darurat dan pemulihan awal

4. Memberi perlindungan , pencegahan

penularan bagi staf Yakkum dan

relawan yang terlibat langsung dan

tidak langsung dalam penanganan

pasien Covid-19 selama masa tanggap

bencana (29 Mei 2020)

5. Yakkum memiliki rencana lanjutan

untuk menanggulangi dampak social

dan klinis akibat bencana ini (Juni –

Desember 2020)

STRATEGY:

3. Work closely with the community

4. Make it work the occupational health and

safety and the patient safety.

5. Set the business continuity plan as part of

the objective (recovery plan)

STRATEGY:

Set measurables indicators, in term of

6. Mapping the resources

7. Working with communities, churches,

and other organization as partners and

donors

8. New standard operating procedure for

occupational safety and health and

patient safety

9. Set the team for recovery plan

(business continuity plan)

Indikator target

Kebutuhan 12 RS YAKKUM untuk

penanganan darurat menyediakan cohort

isolation dipetakan dan sumber daya

tersedia (lewat penggalangan dana,

advokasi dan pengadaan yang

terkoordinir) : jumlah cohort isolation room

Strategy - 3

Semua karyawan YAKKUM khususnya di

RS yang menjadi garda depan pelayanan

kesehatan pasien mendapat informasi

tentang strategi YAKKUM untuk

perlindungan dan keamanan karyawan

baik medis dan non medis dan

dilaksanakan dengan semangat kerja

sama bahu membahu : jumlah karyawan

Yakkum yang bekerja utk Yakkum

response

Indikator targetMembentuk tim kecil yang

mengasilkan draft panduan

/framework bcpTersedia draft bcp atau paling

tidak framework untuk bcp

sehingga dampak covid 19

jangka menengah dan panjang

dapat diaddress dgn memadai :

panduan bcp dan unit yang

membuat bcp

Findings and Gap

Process

✓ Planning: Goals and socialization of the

goals

✓ Organizing: incidence command system

in the Yakkum level and hospital level

(Satgas COVID-19)

✓ Implementation

✓ Monitoring and supervision

✓ Evaluation and feedback mechanism

Findings and Gap

✓Method:

✓SOP – trained and monitored

✓Online service: registration, medical service,

pharmacy

✓Working system

➢For the Hospitals staffs

➢For screening patients

➢For diagnostic and referral

➢For services

Input

✓Man: hospital staffs are available

✓Money: fund raising

✓Facility:

✓PPE

✓ICU, emergency, isolation room,

✓Environment / engineering control

Finding and Gap

Output

1. Fulfillment of the personal protective

equipment

2. Improving facilities:

◦ ICU,

◦ Isolation,

◦ Emergency

◦ Policlinic

◦ Environment control

3. Methods → SOP → socialization →

implementation → monitoring and

supervision → feedback mechanism

4. Finance

5. Digitalization of the services (next slide)

Finding and Gap

5. Digitalization of the service – workshop on

18th September 2020

➢Some hospitals done

➢Some do not due to unfit situation with the

community

➢Business Continuation Plan for digitalization

➢workshop has been done

➢aspects of service, legal, finance, patient safety,

satisfaction

Impact

1. Number of Covid 19 patients

2. Number of Covid 19 among hospital

staffs – % low – no fatality, case finding

still in August

Covid 19 among hospital staffsHospitals #Case #Sex Age #staffs

RS Panti Wilasa

Citarum

23 6M 17F 21-56 636

RS Panti Wilasa Dr.

Cipto

11 1M 10F 28-49 568

RS Panti Rahayu 9 4M 5F

RS Mardi Waluyo 2 1M 1 F 488

RS Emanuel 1 1F 459

RS Bethesda 10 3M 7F 23-57 1089

RS Ngesti Waluyo 0

RS Panti Waluyo 15 6M 9F 24-47 662

Covid 19 Survey among hospital staffs

❑ Good knowledge

❑Practices towards prevention

Need more exploration vs Overall goals

Overall goals

•Number of patients (decreased)

•Patient to patient /visitor transmission (?)

•Staffs to patient transmission (?)

•Patient satisfaction (?)

•Impact to the community (not observed in this study)

Environment factor

0

1000

2000

3000

4000

5000

6000

Kab

Banjarnegara

Kota Semarang Kota Surakarta Kota

Yogyakarta

Kab Grobogan  Kabupaten

Temanggung

Kota Metro

Situation of COVID-19 as external factor to the hospital

PDP Dirawat PDP Sembuh PDP Meninggal Suspek Positif Covid Dirawat Covid Sembuh Covid Meninggal OTG ODP

ExposureVariabel PW-1 PW-2 PW E B PR NW MW

Jumlah pasien

(2019 / 2020)

Jan 16306 21408 6938 12115 10,588

Feb 16097 20990 6752 11498 10,538

Mar 15805 20165 6593 11567 10,344 13093

Apr 9544 11715 3680 7617 7,226 8480

Mei 8079 9234 3463 7350 6,331 7265

Jun 10997 6994 3638 9676 7,626 10661

Jul 11685 10998 3971 9882 11434

Rata-rata per bulan 12645 14501 5005 9958 11,951 8,7755 6935 10187

Jumlah pasien COVID-19

ODP/PDP/

Suspek

392 257 54 190 667 73 58

Terkonfirmasi 223 229 1 5 56 7 2

Probable 3 8 6

Infection control

Elimination ➔ impossible

Substitution ➔ online

Engineering control ➔ ?

Administrative control ➔ working hours,

staffing, WFH : WFO

PPE ➔ no gap, supplementation to increase

immunity

Conclusion

1. Yakkum hospitals has shown increasing capacity to face the COVID 19 pandemic in terms of :

services, fund raising, reduce impact to the hospitals’ staffs as well as patient

2. Attachment with specific communities increased resilience → fund raising and donation

3. Strong organization commitment – BCP and the use of online service

4. Engineering control needs to be improved

5. No evidence of transmission between patients/ visitors and hospital’s staffs, but need to be

clarified

6. No evidence of client / patient satisfaction and providers’ satisfaction regarding the use of

online service

Lesson learnt

❑Good management

❑Working as a group of hospitals

❑Working with community

Need to be improved

❑ Environmental control was not well observed

❑Indoor air quality

❑Working with community might be implemented as:

❑Primary care and family physician

❑Screening patients and maintaining patients in their domicile

❑Working supported by the BPJS in the primary care level

❑Improve scientific service and also continuity of care

Discussion ?

Contact:

Dr. Trevino A. Pakasi

Dept of Community Medicine

Faculty of Medicine Universitas Indonesia

E-mail: tpakasi@yahoo.com