Purpose: A national referral hospital in Indonesia developed a three-category triage acuity method called the Cipto Triage Method (CTM) for emergency departments (ED) in developing countries. This was a validation study to assess the performance of the triage method. Methods: This cohort, retrospective, single-centre study was conducted in the ED of Cipto Mangunkusumo Hospital that receives approximately 30,000 patient visits per year. The ED medical records throughout the year 2017 were randomly selected as the study sample. Completely written forms of triage and ED initial assessment were included in this study. Validation of the CTM decision was done by using expert panel opinion as reference standard, and also using surrogate conditions such as patient outcome for hospital admission and in-hospital mortality. Results: There were 1348 samples assigned to the following three categories: resuscitation (14.9%), urgent (63.8%) and non-urgent (21.3%). Overall accuracy was more than 80%, positive predictive value and negative predictive value for resuscitation category were 99% (95% confidence interval [CI], 96.5-99.9) and 96.9% (95% CI, 95.7−97.8), respectively. Resuscitation category had a relative risk (RR) for admission of 1.341 (95% CI, 1.259-1.429) and a RR for mortality of 4.294 (95% CI, 3.180-5.799). Undertriage increases the risk of mortality compared to correct triage (RR, 3.1; 95% CI, 2.11-4.54). Conclusion: CTM has a good criterion and construct validity; it is also easy to understand and can accommodate a simple ED design in the majority of hospitals in Indonesia.

Objective: 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. Methods: 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. Results: 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%). Conclusion: 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.

Introduction Interprofessional collaboration between units in a hospital is essential in order to reach desired time for primary percutaneous intervention (PCI) in acute ST-Segment Elevation Myocardial Infarction (STEMI) cases. We developed a simulation to engage various medical and nonmedical staff in interprofessional and interunit team collaboration. Method We used a scenario in this simulation. Beginning in the emergency department, it detailed a 50-year-old male presenting with progressive chest pain since 7 hours before admission. The emergency team directly examined the patient, and STEMI diagnosis was made, followed by sending the patient to the cardiac catheterization laboratory to undergo primary PCI. A resuscitation kit was required for the simulation. An evaluation sheet was prepared to evaluate every step of patient management. Three judges observed the simulation. At the end of the simulation, debriefing was done, and recommendation for the simulation was discussed. Besides medical activities during patient management, interprofessional communication, administration activities, consultations, and handover process were also evaluated. Results The team achieved the appropriate door-to-electrocardiogram (ECG) time in 8 minutes, but overall target was delayed since door-to-skin puncture time was reached in 110 minutes. Some factors that contributed to these conditions were long waiting time during patient admission, several attempts for telephone consultation to the cardiologist, and prolonged admission process in the cardiac catheterization laboratory. Conclusions The simulation was well received by both participant and our institution, stating that it is a valuable resource for developing interdisciplinary learning program. This simulation also contributed to the development of the clinical pathway, STEMI protocol, in our institution.

Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute respiratory distress syndrome (ARDS) is a feature of SARS-CoV-2, and transferring patients with severe ARDS is challenging owing to their condition and risk of infection during the transfer process. The hemodynamic instability of critically ill patients adds to the challenge of safe transfer, which requires thorough preparation of personnel, medication, equipment, and communication and transport methods, all of which must be organised within the infection control framework. In this case report we discuss a woman, 37 years of age, with suggested COVID-19, intubated due to severe ARDS. Owing to the hospital referral policy in Indonesia, the patient was transferred to a specialist infectious disease hospital by land ambulance, with a special transfer team formed to adhere to infection control protocols and critical patient transfer procedures.

Background A national referral hospital in Indonesia developed a three-category triage acuity method called the Cipto Triage Method (CTM) for emergency departments (ED) in developing countries. This was a validation study to assess the performance of the triage method.Methods This cohort, retrospective, single-centre study was conducted in the ED of Cipto Mangunkusumo Hospital that receives approximately 30,000 patient visits per year. The ED medical records throughout the year 2017 were randomly selected as the study sample. Completely written forms of triage and ED initial assessment were included in this study. Validation of the CTM decision was done by using expert panel opinion as reference standard, and also using surrogate conditions such as patient outcome for hospital admission and in-hospital mortality.Results There were 1,348 samples assigned to the following three categories: resuscitation (14.9%), urgent (63.8%) and non- urgent (21.3%). Overall accuracy was more than 80%, positive predictive value (PPV) and negative predictive value (NPV) for resuscitation category were 99% (95% confident interval [CI], 96.5-99.9) and 96.9% (95% CI, 95.7 -97.8), respectively. Resuscitation category had a relative risk (RR) for admission of 1.341 (95% CI, 1.259-1.429) and a RR for mortality of 4.294 (95%CI, 3.180-5.799). Undertriage increases the risk of mortality compared to correct triage (RR, 3.1; 95% CI, 2.11-4.54)Conclusion CTM has a good criterion and construct validity; it is also easy to understand and can accommodate a simple ED design in the majority of hospitals in Indonesia.