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Abstract

Emergency Department (ED) overcrowding is a global challenge. In response, the government of Indonesia mandates an ED Length of Stay (LOS) of ≤4 hours. This study aims to evaluate the impact of implementing an Emergency Department Observation Unit (EDOU) combined with an Emergency Medicine (EM) specialist-led disposition process on ED LOS at a national referral hospital in Indonesia. This was a retrospective, pre-post analysis comparing all ED visits in 2023 (pre-intervention, n = 26,282) with all visits in 2024 (post-intervention, n = 31,483). The primary outcome was the proportion of patients with an ED LOS ≤4 hours. Secondary outcomes included median ED LOS and the odds ratios (OR) for yellow zone patients achieving the ≤4-hour target based on the intervention period and the deciding physician's specialty. Following the intervention, the median ED LOS decreased from 16.4 hours to 8.0 hours (p-value = <0.05). Yellow zone patients in the post-intervention period had 6.37 times the odds of achieving a ≤4-hour LOS compared to the pre-intervention period (95% CI [5.72–7.09]). When the decision to admit to the EDOU was made by an EM specialist, the odds of achieving the target were 1.86 times higher than for other specialists (95% CI [1.43–2.42]). The combined implementation of an EDOU and EM specialists-led disposition significantly reduced ED LOS and dramatically increased the odds of meeting national performance targets. The success was driven by both increased downstream bed capacity and streamlined, specialist-led disposition processes.

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Bahasa Abstract

Overcrowding di Instalasi Gawat Darurat (IGD) telah menjadi tantangan global. Sebagai solusi, pemerintah Indonesia menetapkan lama rawat (LOS) di IGD ≤4 jam sebagai salah satu standar nasional. Penelitian ini mengevaluasi dampak penerapan ruang rawat emergensi (RRE) yang dikombinasikan dengan proses admisi yang dikepalai oleh dokter spesialis emergensi (SpEm) terhadap pencapaian target tersebut. Metode penelitian ini mencakup analisis retrospektif sebelum dan sesudah intervensi di salah satu rumah sakit rujukan nasional Indonesia, yakni Rumah Sakit Dr. Cipto Mangunkusumo (RSCM), dan membandingkan seluruh kunjungan IGD pada tahun 2023 (sebelum intervensi, n = 26.282) dengan 2024 (sesudah intervensi, n = 31.483). Luaran primer studi adalah proporsi pasien yang memenuhi target ≤4 jam. Luaran sekunder mencakup median LOS IGD dan rasio odds (OR) untuk pencapaian target, spesifiknya pada populasi pasien zona kuning. Sesudah intervensi, median LOS IGD menurun dari 16,4 jam menjadi 8,0 jam (p-value = <0,05). Pada pasien zona kuning, rasio odds pencapaian target ≤4 jam 6,37 kali lebih tinggi pada periode sesudah intervensi (95% CI [5,72–7,09]). Disposisi ke RRE yang dipimpin oleh SpEM 1,86 kali lebih mungkin memenuhi target dibandingkan spesialis lain (95% CI [1,43–2,42]). Kombinasi RRE dan admisi yang dipimpin oleh SpEm secara signifikan memperbaiki alur pasien dan secara dramatis meningkatkan kemungkinan pencapaian target kinerja nasional. Keberhasilan ini didorong oleh peningkatan kapasitas tempat tidur dan proses disposisi yang lebih efisien oleh spesialis, serta berpotensi menjadi model yang dapat diterapkan oleh rumah sakit lain di Indonesia.

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