Identifikasi Bottleneck pada Alur Pelayanan Intervensi Koroner Perkutan Primer Menggunakan Theory of Constraints di Rumah Sakit Umum Daerah Jayapura

Joel Herbet Marudut Hasiholan Manurung, Dumilah Ayuningtyas

Abstract


Pendahuluan: Keterlambatan pelayanan Intervensi Koroner Perkutan Primer (IKPP) pada pasien Infark Miokard Akut dengan Elevasi Segmen ST (IMA-EST) berdampak signifikan terhadap luaran klinis. Penelitian ini mengidentifikasi titik hambatan (bottleneck) operasional pada alur pelayanan IKPP di RSUD Jayapura menggunakan Theory of Constraints (TOC). Metode: Studi kasus kualitatif dengan observasi partisipatif dan Focus Group Discussion (FGD) terhadap tiga kasus pasien IMA-EST. Alur pelayanan dibagi menjadi delapan tahapan, dan durasi waktu pada setiap tahapan dicatat. Analisis menggunakan kerangka TOC dan analisis Pareto untuk mengidentifikasi jenis kendala dan prioritas perbaikan. Hasil: Total door-to-balloon time pada ketiga kasus adalah 694 menit, 2207 menit, dan 1937 menit, jauh melampaui target ≤90 menit. Analisis Pareto dan TOC mengidentifikasi bottleneck dominan pada transisi tahap 4-5 (dari informed consent hingga persiapan di cathlab), menyumbang 37,3% hingga 94,5% dari total keterlambatan. Hambatan ini merupakan capacity constraint akibat keterbatasan sumber daya manusia dan ketiadaan sistem siaga 24 jam. Kesimpulan: Upaya perbaikan kinerja pelayanan IKPP harus difokuskan pada peningkatan kapasitas operasional cathlab dan optimalisasi sistem penjadwalan emergensi untuk mencapai target door-to-balloon time yang optimal.
Kata Kunci: Intervensi Koroner Perkutan Primer, Door-to-Balloon Time, Theory of Constraints, Bottleneck, Manajemen Rumah Sakit

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DOI: https://doi.org/10.52643/marsi.v10i4.9042

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