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Abstract

The Emergency Department (ED) is crucial for ensuring patient care and safety in hospitals. A key performance indicator is Length of Stay (LOS), where prolonged LOS can lead to overcrowding, increase the risk of adverse events, and lower patient satisfaction. This study examines the service flow, barriers, and root causes of LOS in Hospital X's ED and provides improvement recommendations. Data were gathered through observation of 30 patients, interviews, and document reviews. Lean Thinking principles and the BAS method from BASICS (Baseline, Assess, Suggest Solution, Implement, Check Result, Sustain) were used in the analysis, employing flowcharts to map the process, Value Stream Mapping to identify waste, and The Five Whys to analyze root causes. Results show that 65.5% of time was spent on non-value-added activities, 23.4% on necessary but non-value-added, and 11.1% on value-added activities, with a total Lead Time of 7 hours, 55 minutes, and 29 seconds. Patient-side waste includes waiting (94.9%) and transportation (5.1%). Bottlenecks were found in waiting for inpatient registration (25.2%), waiting for the primary physician's advice (22.9%), waiting for diagnostic results (22.3%), and waiting for inpatient readiness (18.2%), totaling 88.6%. LOS improvement can be achieved through lean tools such as standardized work, visual management, heijunka, kaizen, and just-in-time.

References

Abdul Wahab, E., Jak, Y. and Germas Kodyat, A. (2021) ‘Analisis Faktor- Faktor Yang Berhubungan Dengan Length Of Stay (LOS) Pasien Rawat Inap Di Instalasi Gawat Darurat RSUD Cibinong’, Jurnal Manajemen dan Administrasi Rumah Sakit Indonesia (MARSI), 5(2). doi:10.52643/marsi.v5i2.1746.

Aisyah, P. S., 2023. Analisis Faktor Yang mempengaruhi length of stay Pasien di Instalasi Gawat Darurat RSUP dr. M. Djamil Padang. [Skripsi] Universitas Andalas. Available at: http://scholar.unand.ac.id/206904/ [Accessed 2 March 2024].

Alemu, G.H. et al. (2019) ‘Factors associated with the length of stay in emergency departments in Southern-Ethiopia’, BMC Research Notes, 12(1). doi:10.1186/s13104-019-4271-7.

Bastakoti, M. et al. (2022) ‘Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality’, 9(1), pp. 107–114. doi:10.1515/dx-2021-0001.

Bhasin, S. (2008) ‘Lean and performance measurement’, Journal of Manufacturing Technology Management, 19(5), pp. 670–684. doi:10.1108/17410380810877311.

Charron, R. et al. (2014) The lean management systems handbook, The Lean Management Systems Handbook. doi:10.1201/b17201.

De Kok, B.M. et al. (2021) ‘Lean-driven interventions, including a dedicated radiologist, improve diagnostic imaging turnaround time and radiology report time at the emergency department’, Emergency Radiology, 28(1). doi:10.1007/s10140-020-01803-3.

Deli, H., Hasanah, O., Novayelinda, R. & Purwanti, E. (2020) 'Analisis faktor-faktor yang mempengaruhi length of stay (LOS) pasien anak di instalasi gawat darurat (IGD)', Journal Title, 16(1), pp. 59–65. doi: 10.31983/link.v16i1.5719.

Departemen Kesehatan Republik Indonesia, 2008. Keputusan Menteri Kesehatan Republik Indonesia No. 129/Menkes/SK/II/2008 Tentang Standar Pelayanan Minimal Rumah Sakit. Jakarta: Depkes RI.

Graban, M. (2018) Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Third Edition. doi:10.4324/9781315380827.

Habib, H. and Sudaryo, M.K. (2023) ‘Association Between the Emergency Department Length of Stay and in-Hospital Mortality: A Retrospective Cohort Study’, Open Access Emergency Medicine, 15. doi:10.2147/OAEM.S415971.

Ledbetter, P. (2018) The Toyota template: The plan for just-in-time and culture change beyond lean tools, The Toyota Template: The Plan for Just-In-Time and Culture Change beyond Lean Tools. doi:10.4324/9781351263726.

Lee, K.S. et al. (2022) ‘Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea’, BMC Emergency Medicine, 22(1). doi:10.1186/s12873-022-00745-y.

Moffatt, S. et al. (2022) ‘The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery’, International Journal of Environmental Research and Public Health, 19(3). doi:10.3390/ijerph19031588.

Morgan, J. and Brenig-Jones, M. (2013) Lean Six Sigma for dummies, John Wiley & Sons.

Nhdi, N. Al, Asmari, H. Al and Thobaity, A. Al (2021) ‘Investigating indicators of waiting time and length of stay in emergency departments’, Open Access Emergency Medicine, 13. doi:10.2147/OAEM.S316366.

Novita, Ika, I.M. and VIA, S.H. (2023) ‘Analisis Faktor-Faktor yang Mempengaruhi Waktu Tunggu Pasien di Instalasi Gawat Darurat (IGD) Rumah Sakit Umum dr. Zainoel Abidin Banda Aceh’, Journal of Medical Science, 4(2 SE-Articles), pp. 71–81. doi:10.55572/jms.v4i2.100.

Nurhidayat, N., Firman, F. and Utarini, A. (2020) ‘Pemborosan (Waste) di Instalasi Gawat Darurat RSI PKU Muhammadiyah Tegal’, The Journal of Hospital Accreditation, 2(02). doi:10.35727/jha.v2i02.73.

Pines, J.M. et al. (2009) ‘The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain’, Academic Emergency Medicine, 16(7). doi:10.1111/j.1553-2712.2009.00456.x.

Pitts, S.R. et al. (2014) ‘A cross-sectional study of emergency department boarding practices in the united states’, Academic Emergency Medicine, 21(5). doi:10.1111/acem.12375.

Purawijaya, H., et al. (2023) 'Analisis faktor-faktor yang mempengaruhi length of stay (LOS) di instalasi gawat darurat Rumah Sakit Hermina Ciputat', Jurnal Manajemen dan Administrasi Rumah Sakit Indonesia (MARSI), 7(4), pp. 356–368. doi: 10.52643/marsi.v7i4.3565.

Pyzdek, T. (2021) ‘Pareto Analysis’, in Management for Professionals. doi:10.1007/978-3-030-69901-7_14.

Republik Indonesia, 2009. Undang-Undang Nomor 44 Tahun 2009 tentang Rumah Sakit.

Ristyowati, T., Muhsin, A. and Nurani, P.P. (2017) ‘'Minimasi Waste pada Aktivitas Proses Produksi dengan Konsep Lean Manufacturing (Studi Kasus di PT. Sport Glove Indonesia)’, OPSI, 10(1). doi:10.31315/opsi.v10i1.2191.

Rochana, N. and Djogotuga, N. N. (2020) 'Kepuasan pasien stagnan di instalasi gawat darurat (IGD) di Kupang', Holistic Nursing and Health Science, 3(2), pp. 12–20. doi: 10.14710/hnhs.3.2.2020.12-20.

Saputera, C., 2023. Reduksi Service Time Instalasi Gawat Darurat RS St.Carolus Summarecon Serpong dengan Pendekatan Lean Six Sigma Tahun 2023 [Tesis]. Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia.

Singer, A.J. et al. (2011) ‘The association between length of emergency department boarding and mortality’, Academic Emergency Medicine, 18(12). doi:10.1111/j.1553-2712.2011.01236.x.

Sitanggang, P.T.H., 2024. Analisis Length Of Stay Pasien IGD Ke Rawat Inap Dengan Metode Lean Six Sigma Di Rumah Sakit Umum Daerah Kembangan Tahun 2023 [Tesis]. Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia.

Tezel, A., Koskela, L. and Tzortzopoulos, P. (2016) ‘Visual management in production management: a literature synthesis’, Journal of Manufacturing Technology Management, 27(6), pp. 766–799. doi:10.1108/JMTM-08-2015-0071.

Usman, I. and Ardiyana, M. (2017) ‘Lean Hospital Management, Studi Empirik pada Layanan Gawat Darurat’, Jurnal Manajemen Teori dan Terapan | Journal of Theory and Applied Management, 10(3). doi:10.20473/jmtt.v10i3.7089.

Vajna, I. and Tangl, A. (2017) ‘The lean effect of the 5S and standard work development in different automated machine process standardization’, in Management and Organization: Concepts, Tools and Applications. doi:10.18515/dbem.m2017.n02.ch06.

Wati, A.L., Muhardi, M. and Nu’man, H. (2022) ‘Penerapan Lean Hospital pada Pelayanan Unit Gawat Darurat di RSUD Bayu Asih Kabupaten Purwakarta’, Jurnal Sosial Teknologi, 2(4). doi:10.59188/jurnalsostech.v2i4.326.

Wibowo, A., 2014. Metodologi Penelitian Praktis. Jakarta: PT Raja Grafindo Persada.

Womack, J.P. and Jones, D.T. (1997) ‘Lean Thinking—Banish Waste and Create Wealth in your Corporation’, Journal of the Operational Research Society, 48(11), p. 1148. doi:10.1057/palgrave.jors.2600967.

World Health Organization (WHO), 2018. Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured. Available at: https://www.who.int/publications/i/item/emergency-care-systems-for-universal-health-coverage-ensuring-timely-care-for-the-acutely-ill-and-injured

Yulianingsih, H., Firman and Meliala, A. (2022) ‘Implementasi Manajemen LEAN di Instalasi Gawat Darurat Rumah Sakit Akademik Universitas Gadjah Mada’, The Journal of Hospital Accreditation, 04.

Bahasa Abstract

Pelayanan Instalasi Gawat Darurat (IGD) berperan penting dalam menentukan kualitas dan keselamatan pasien di rumah sakit. Salah satu indikator kinerja IGD adalah Length of Stay (LOS), yang jika terlalu panjang dapat menyebabkan penumpukan pasien, meningkatkan risiko kejadian tidak diharapkan, dan menurunkan kepuasan pasien. Penelitian ini bertujuan mengidentifikasi alur pelayanan, hambatan, dan akar masalah terkait LOS di IGD Rumah Sakit X serta memberikan saran perbaikan. Data dikumpulkan melalui observasi pada 30 pasien, wawancara, dan telaah dokumen dengan analisis menggunakan penggabungan prinsip Lean Thinking dan pendekatan implementasi lean, yaitu metode BAS dari BASICS (Baseline, Assess, Suggest Solution, Implement, Check Result, Sustain). Flowchart digunakan untuk memetakan alur pelayanan, Value Stream Mapping untuk mengidentifikasi kegiatan bernilai dan waste, serta The Five Whys untuk menganalisis akar penyebab hambatan. Hasil menunjukkan bahwa alur pelayanan IGD melibatkan lima tahapan; 65,5% waktu adalah kegiatan non-value added, 23,4% adalah necessary but non-value added, dan 11,1% value added, dengan total Lead Time 7 jam 55 menit 29 detik. Waste dari sisi pasien meliputi waiting (94,9%) dan transportation (5,1%). Bottlenecks teridentifikasi dalam menunggu pendaftaran rawat inap (25,2%), advis DPJP (22,9%), menunggu hasil pemeriksaan (22,3%), dan menunggu kesiapan rawat inap (18,2%). Perbaikan LOS dapat dicapai dengan menggunakan lean tools seperti standardized work, visual management, heijunka, kaizen, dan just-in-time.

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