ANALISIS FAKTOR YANG MEMENGARUHI MORTALITAS PASIEN RAWAT INAP DI RUMAH SAKIT AKADEMIK UGM
Abstract
Background: Hospital mortality indicators are important element of a hospital patient safety monitoring program. In 2022, the record of inpatient performance at RS Akademik UGM (RSA UGM) shows that the NDR value has not yet reached the ideal standard, namely 34.1‰.
Objective: Identifying factors that influence the mortality rate of adult patients ≥48 hours in inpatient care and developing a program plan to reduce hospital mortality at RSA UGM.
Methods: An explanatory sequential design of mixed methods research was used. The medical records of adult patients admitted to RSA UGM from October 2022 to December 2022. Quantitative data analysis used chi-square, Fisher’s exact tests and multivariate logistic regression. Qualitative data was obtained from focus group discussions with three separate groups, namely the managerial group, the doctor team and the nurse team., while qualitative data used thematic analysis.
Results: 388 subjects were obtained with 18 (4.64% or 46.4‰) patients died during treatment ≥48 hours. Independently, ward type (OR 10,799, CI 95 % 3,990 – 29,233), EWS score (OR 15,644, CI 95 % 5,511 – 44,412) and number of comorbidities (OR 8,603, CI 95 % 2,769 – 26,730) associated with with ≥48 hours in-hospital mortality (<0.001). Multivariate analysis showed that ward type (p=0.018, aOR 4,122, CI 95 % 1,279 – 13,284) and early warning system (EWS) score (p=0.016, aOR 4,531, CI 95 % 1,327 – 15,469) had a strong association with ≥48 hours in-hospital mortality. Qualitative results show that the problems faced daily related to the increasing death rate are the high complexity of patients, inadequate ICU facilities and inadequate human resource competency; the proposed program to reduce inpatient mortality by improving clinical management in intensive care, improving the competency and skills of doctors and nurses, and increasing the effectiveness of the early warning system.
Conclusion: The EWS score >5 and the intensive care are significantly related to in-hospital mortality ≥48 hours after hospitalization so it is important for management to improve the quality of services at the RSA UGM by carry out a strategy to reduce hospital mortality rates in order to decrease the net mortality rate in accordance with the Ministry of Health’s national standards.
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