Implementationof ClinicalPathways

Dr. Dody Firmanda, Sp.A, MA

Head of Medical Committee
Fatmawati Hospital, Jakarta

Presented in 1st Indonesian-Malaysian Casemix Conference, Batam 19-21 Oktober 2006

CLINICAL GOVERNANCE, MEDICAL STAFF BYLAWS,
CLINICAL PATHWAYS AND CASEMIX SYSTEM
http://www.yanmedik-depkes.net/dokumen_casemix.htm

Roles of Medical
Committee:
from enforcing
medical ethics and
quality to
implementation of
casemix System
 Paper:
Preparation of
Fatmawati Hospital in
the implementation of
Casemix System
 ClinicalPathways
Clinical Risks Management and Patient Safety
High Impact Interventions
Medical Audits
 First Edition of
Fatmawati Hospital’s Clinical Pathways
Contents of Fatmawati Hospital’s
Clinical Pathways
General Format and explanation of
Clinical Pathways
 ROLE OF
MEDICAL AUDIT
AND
PSBH
IN
PATIENT SAFETY

MEDICAL AUDIT & PSBH

TIME TABLE:
 ImplementationDesign:
• Introductions and Aims:
• Methods:
– Retrospective : January – September 2006
– Prospective (Cross Sectional) : October 2006
• Results:
– Forms and Tables
• Analysis:
– Descriptive
– Statistical Analytic (if applicable)
• Discussions:
• Conclusions:
MONITORING FORM :
 ClinicalPathways: Orthopaedics
1. Closed-type Fractureof Tibia
2. Closed-type Fractureof Tibia with
Impending CompartmentSyndrome
3. Thoracal Spondylitis TBC
4. Thoraco-vertebralFracture with
neurologicaldeficits less than 8 hours
5. Thoraco-vertebralFracture with
neurologicaldeficits more than 8 hours
Clinical Pathways:
Closed-type
Fracture of
Tibia
Closed-type Fracture of Tibia
with Impending Compartment
Syndrome
Thoracal Spondylitis TBC
 Thoraco-vertebralFracture
withn eurological deficits less
than8 hours
 Thoraco-vertebral Fracture
with neurological deficits more than 8 hours
IMPLEMENTATION OF ORTHOPAEDICS
CLINICAL PATHWAYS

1. Closed-type Fracture of Tibia

2. Thoracal Spondylitis TBC
3. Closed –type Fracture of Tibia with
Impending Compartment Syndome
1 2

Audit Medis

MILIK KOMITE MEDIK

RSUP FATMAWATI
df-2006
1
2

MILIK KOMITE MEDIK

RSUP FATMAWATI
df-2006
1 2

MILIK KOMITE MEDIK

RSUP FATMAWATI
df-2006
3 4

Audit Medis

MILIK KOMITE MEDIK

RSUP FATMAWATI
df-2006
Audit Medis

MILIK KOMITE MEDIK

RSUP FATMAWATI
df-2006
Laporan tentang Kodefikasi
dalam Clinical Pathways

Solusi:
Pelatihan petugas
input koding di ruangan

In-house Training of ICD 10

and ICD 9 CM
ClinicalPathways: Paediatrics
ClinicalPathways: Paediatrics
Paediatrics Clinical Pathways:
Pneumonia
 n=16

n=18

n=28

n=35

Hasil sementara CP Kes Anak: Pneumonia (N=97)

 Analyses:
1. LOS:
a. Planned : 5 days
b. Reality: 4 days
c. Finance : 3 days

Notes:
Recommendation :
Formula
(Date of Discharge –
Date of hospitalised)
+1

2. Antibiotics:
a. Standard: Gram (+) and
Gram (-)
b. Reality: Gram (+)

Notes:
• Surveilance and HII
(for Patient Safety)
• Revision of Practice
Guidelines
Clinical Pathways & Patient Safety
 IMPLEMENTATION OF
PAEDIATRICS CLINICAL PATHWAYS
ACUTE DIARHEA

ROLES OF:
PSBH,
PATIENT SAFETY
AND
HIGH IMPACT INTERVENTIONS (HII)
PSBH
Clinical Pathways: Pulmonology
ClinicalPathways: Pulmonology
1. Pulmonary TBC
2. TBC Pleural Effusion
3. Avian Pneumonia
4. COPD-Acute Exacerbation
5. Acute Bronchitis
6. Pneumothorax
7. Bronchial Asthma
8. Pulmonary malignancy
9. Bronchiecstasis
10. Pneumonia
Clinical Pathways
Of
Pulmonary TBC
 Clinical Pathways
of
TBC Pleural Efusion
Clinical Pathways of
Avian Pneumonia
 COPD
Acute Exacerbation
Acute Bronchitis
Pneumothorax
Clinical Pathways: Dermatology
Clinical Pathways: Dermatology
Eritroderma Psoariatika
 Clinical Pathways: Dermatology
Herpes Zoster with Nervous System Involvement
Clinical Pathways: Dermatology
Opthalmics Herpes Zoster
Clinical Pathways: Dermatology
Leprosy with reaction
Clinical Pathways: Dermatology
Pemphigoid Bulosae
TERIMAKASIH