Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Indonesia Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Emerg Med Australas. 2020 Oct;32(5):830-839. doi: 10.1111/1742-6723.13570. Epub 2020 Jul 31.
EDs in Indonesia face an unprecedented increase in patient influx after the expansion of national health insurance system coverage. The present study aims to describe EDs' characteristics and capabilities utilisation in Jakarta.
An ED inventory was created from the Jakarta Provincial Health Office and the Indonesian Hospital Association registries. The EDs that were accessible to the general public 24/7 were surveyed about their characteristics during the calendar year 2017. For further ED analysis, we stratified the hospitals into four types (A, B, C and D) based on their size and capabilities, with type A being the largest.
From the 118 (81%) out of 146 EDs that responded, there were 2 million ED visits or 202 per 1000 people. The median annual visit volume was 11 200 (interquartile range 4233-18 000). Further stratification highlights the annual visit difference among hospital types where type A hospitals reported the most with 32 000 (interquartile range 13 459-38 873). Almost half of the EDs (47%) answered that ≥60% of the inpatient census came from the ED. Less than half of the EDs (44%) can manage psychiatry, oral-maxillofacial and plastic surgery cases. Consultant coverage varied across hospitals and by hospital type (P < 0.05), except for general surgery and obstetrics and gynaecology consultants who were available in most hospitals (74%).
Physicians with limited experience and EDs with heterogeneous emergency care capabilities likely threatened the consistency of quality emergency care, particularly for time-sensitive conditions. Our study provides a benchmark for future improvements in emergency care.
在印度尼西亚国家医疗保险系统覆盖范围扩大后，急诊部门面临着前所未有的患者涌入。本研究旨在描述雅加达急诊部门的特点和能力利用情况。
从雅加达省卫生办公室和印度尼西亚医院协会的登记处创建了一份急诊清单。对在 2017 年全年可向公众 24/7 开放的急诊进行了调查，了解其特点。为了进一步分析急诊，我们根据医院的规模和能力将其分为四类（A、B、C 和 D），其中 A 类最大。
在 118 家（81%）回应的急诊中，有 200 万人次的急诊就诊量，即每 1000 人中有 202 人次。年就诊量中位数为 11200 人次（四分位距为 4233-18000 人次）。进一步分层突出了不同医院类型之间的年度就诊差异，其中 A 类医院报告的就诊量最多，为 32000 人次（四分位距为 13459-38873 人次）。近一半的急诊（47%）表示，≥60%的住院病人来自急诊。不到一半的急诊（44%）能够处理精神病学、口腔颌面和整形手术病例。顾问的覆盖率在医院之间和按医院类型有所不同（P<0.05），但大多数医院都有普通外科和妇产科顾问（74%）。
经验有限的医生和急诊部门具有异质的紧急护理能力，可能会威胁到紧急护理质量的一致性，特别是对时间敏感的情况。我们的研究为未来的急诊护理改进提供了基准。
