KEBIJAKAN AKSES KE RUMAH SAKIT DAN

KONTINUITAS PELAYANAN (ARK)

RS SUMBER HIDUP  –  GPM
 GPM

JLN. ANTHONY RHEEBOK NO.11

AMBON
2019
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KATA PENGANTAR

Segala puji dan syukur kepada Tuhan Yang Maha Esa karena atas Berkat dan
Karunianya sehingga pedoman akses ke rumah sakit dan kontinuitas pelayanan
(ARK) dapat diselesaikan, kami mengharapkan usul saran demi perbaikan Pedoman
ini.

Kami mengucapkan terima kasih

kasih kepada semua pihak yang telah membantu
hingga Pedoman akses ke rumah
rumah sakit
sakit dan kontinuitas pelayanan (ARK)dapat
(ARK)dapat
diselesaikan. Akhir semoga Pedoman ini dapat membantu meningkatkan mutu
layanan Rumah Sakit Sumber Hidup sehingga lebih bermutu.

Tim Akreditasi
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DAFTAR ISI

Halama Judul i
Kata Pengantar ii
Daftar Isi iii
Surat Keputusan iv
A. Kebijakan Umum 1
B. Kebijkan Khusus 2
1. Skrining Kontak Pertama 2
2. Skrining Di Unit Layanan
3. Skrining Di Luar Rumah Sakit
4. Triase
5. Pelayanan Menahan untuk Observasi
6. Penundaan Pelayanan/
7. Identifikn hambatan dalam pelayanan
8. Pemeriksaan Penunjang
9. Kriterian Pasien Rawat Inap
10. Kriteria Pasien Pulang
11. Kriteria Pasien Stabil
12. Kriteria Pasien Masuk Ruang Pengawasan (HCU)
13. Kriteria Pasien Keluar Ruang Pengawasan (HCU)
14. Pasien Cuti Rawat Inap
15. Kriteria Pasien di Rujuk Ke Rumah Sakit Lain
16. Kriteria Pendampingan Pasien Saat Tranfer
17. Transfer di dalam Rumah Sakit
18. Tranfer Keluar Rumah Sakit/Rujukan
19. Rujukan Tidak Mungkin Dilaksanakan
20. Resume Medis
21. DPJP
22. Tranportasi
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YAYASAN KESEHATAN GPM

RUMAH SAKIT SUMBER HIDUP
Jl. Anthoni Rheebok, No.11 Telp. (0911) 352373-351654
SURAT KEPUTUSAN
 Nomor :032/SKEP/RS.SH/E.2/02/2019
TENTANG
PEDOMAN AKSES KE RUMAH SAKIT DAN KONTINUITAS
PELAYANAN (ARK)
RUMAH SAKIT SUMBER HIDUP
DIREKTUR RUMAH SAKIT SUMBER HIDUP

MENIMBANG : a. bahwa dalam upaya meningkatkan mutu pelayanan di

Rumah Sakit Sumber Hidup, diperlukan Pedoman Akses Ke
Rumah Sakit dan Kontinuitas Pelayanan (ARK) Rumah
Sakit Sumber Hidup;
 b. Pedoman ARK sebagaimana tersebut di point a adalah
 pedomanan pelayanan yang wajib ditaati dimulai dari
Instalasi Gawat Darurat, Instalasi Rawat Inap dan Instalasi
Rawat Jalan;
c. bahwa untuk maksud point a dan b perlu ditetapkan dengan
keputusan Direktur
Direktur Rumah Sakit Sumber Hidup
MENGINGAT : 1. Peraturan Menteri Kesehatan repoblik Indonesi No 11 Tahun
2017 Tentang Keselamatan Pasien
2 Peraturan Menteri Kesehatan repoblik Indonesi No 7 Tahun
2019 Tentang Kesehatan Lingkungan
3 Peraturan Menteri Kesehatan repoblik Indonesi No 4 Tahun
Tentang standar Tekniks Pemenuhan Mutu Pelayanan Dasar
Pada Standae Pelayanan Minimal Bidang Kesehatan
4 Peraturan Menteri Kesehatan repoblik Indonesi No 7 Tahun
2019 Tentang Administrasi Rumah Sakit
5 Peraturan Menteri Kesehatan repoblik Indonesi No 2 Tahun
2019 Tentang Pelayanan operasional Pengguna Data Alokasi
Fisik Bidang Kesehatan
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Tahun 2018 Tentang Kewajiban Rumah Sakit dan

Kewajiban Pasien
8 Peraturan Menteri Kesehatan Republik Indonesia
Indonesia No 47
Tahun 2018 Tentang Pelayanan Kegawat Daruratan
9 Peraturan Menteri Kesehatan Republik Indonesia
Indonesia No 34
Tahun 2017 Tentang Akreditasi Rumah Sakit
10 Peraturan Menteri Kesehatan Republik Indonesia
Indonesia No 43
Tahun 2016 Tentang Standar Pelayanan Minimal Bidang
Kesehatan
11 Peraturan Menteri Kesehatan Republik Indonesia
Indonesia No 19
Tahun 2016 Tentang Sistem Penyelanggaran Gawat darurat
Terpadu
12 Peraturan Menteri Kesehatan Republik Indonesia
Indonesia No 24
Tahun 2016 Tentang Persyaratan Teknis Bangunan Dan
Prasarana Rumah Sakit
MEMPERHATIKAN : Usul dan saran
saran Kelompok
Kelompok Kerja (POKJA) ARK Standar I
Akreditasi Versi Snars Edisi I

MEMUTUSKAN
MENETAPKAN : Keputusan Direktur Rumah Sakit Sumber Hidup tentang
Pedoman Akses Ke Rumah Sakit dan Kontinuitas Pelayanan
(ARK) Rumah Sakit Sumber Hidup
PERTAMA : Menetapkan dan mengesahkan Pedoman Akses Ke Rumah
Sakit dan Kontinuitas Pelayanan (ARK) Rumah Sakit Sumber
Hidup sebagaimana terlampir;
KEDUA : Setiap unit layanan Rumah Sakit Sumber Hidup wajib menaati
dan melaksanakan Pedoman Akses Ke Rumah Sakit dan
Kontinuitas Pelayanan (ARK) Rumah Sakit Sumber Hidup
dengan penuh rasa tanggung jawab;
KETIGA : Pedoman Akses Ke Rumah Sakit dan Kontinuitas Pelayanan
(ARK) Rumah Sakit Sumber Hidup akann dari tinjua kembali
setelah 3 (tiga) tahun pelaksanaannya dan atau jika ada hal-hal
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di kemudian hari ternyata terdapat kekeliriun dalam penetapan

ini akan diadakan perbaikan sebagaimana mestinya

Ditetapkan di Ambon
Pada tanggal : 11 Juni 2019

Direktur RS Sumber Hidup GPM

Dr. Heni Tipka

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Lampiran SK Direktur RS Sumber Hidup Nomor : 032/SKEP/RS.SH/E.2/10/2018

Tentang : Pedoman Akses Ke Rumah Sakit dan Kontinuitas Pelayanan (ARK) Rumah
Sakit Sumber Hidup

A. KEBIJAKAN UMUM
1. Pelayanan Rumah Sakit Sumber Hidup GPM harus mematuhi undang-undang dan
 peraturan yang berlaku
berlaku dan memberikan
memberikan respon terhadap
terhadap setiap laporan
laporan dari lembaga
 pengawasan
 pengawasan dan regulator.
regulator.
2. Pelayanan rumah sakit di seluruh unit pelayanan harus selalu dilandasi dengan cinta
kasih,pelayanan yang seragam, tidak membedakan suku, ras, agama, golongan, dan
memperhatikan mereka yang lemah dan kurang mendapat perhatian (option for the
 poor).
3. Pelayanan rumah sakit di seluruh unit pelayanan harus selalu berorientasi pada mutu
layanan, keselamatan pasien, dan keselamatan dan kesehatan kerja (K3) bagi pasien,
keluarga dan masyarakat serta karyawan sesuai dengan Visi, Misi, Falsafah dan
Tujuan Rumah Sakit Sumber Hidup GPM
4. Pelayanan rumah sakit di seluruh unit pelayanan harus selalu berfokus pada pasien
(patient centeredness) dengan melaksanakan akses ke pelayanan dan kontinuitas
 pelayanan,
 pelayanan, memenuhi
memenuhi hak pasien dan keluarga, asesmenasesmen pasien, pemberian
pemberian
 pelayanan pasien, serta memberikan
memberikan edukasi kepada
kepada pasien,
pasien, keluarga
keluarga dan masyarakat
masyarakat
5. Pelayanan rumah sakit dilaksanakan selama 24 jam setiap hari, kecuali radiologi jam
12.00  –  17.00
  17.00 selanjutnya on call, kecuali cito. unit laboratorium jam 08.00  –  20.00
  20.00
selanjutnya on call. Kecuali cito. Dan pelayanan rawat jalan (poliklinik umum jam
08.00-12.00 WIT)
6. Setiap unit pelayanan harus menjalankan upaya peningkatan mutu.
7. Setiap unit pelayanan harus menjalankan kewaspadaan universal melalui kegiatan
 pencegahan
 pencegahan dan pengendalian
pengendalian infeksi yang menjangkau
menjangkau setiap pelayanan
pelayanan di rumah
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11. Peralatan di unit pelayanan harus selalu dilakukan pemeliharaan dan kalibrasi secara
teratur sesuai ketentuan yang berlaku dan selalu dalam kondisi siap pakai.
12. Penyediaan tenaga harus mengacu pada pola ketenagaan rumah sakit.
13. Semua petugas rumah sakit wajib memiliki ijin/ lisensi/ sertifikasi sesuai dengan
 profesi dan ketentuan
ketentuan yang berlaku
berlaku
14. Setiap petugas rumah sakit harus bekerja sesuai standar profesi, standar kompetensi,
standar prosedur operasional, etika profesi, kode etik rumah sakit dan semua
 peraturan rumah
rumah sakit
sakit yang berlaku.
berlaku.
15. Disemua fase pelayanan Rumah Sakit menempatkan staf yang berkompoten sebagai
orang yang bertanggung jawab terhadap koordinasi dan kesinambungan pelayanan
 pasien. (case manejer/ menejer pelayan pasien).
16. Setiap unit pelayanan harus mampu mengelola data yang dapat dijadikan sebagai
sumber informasi dan pengambilan keputusan bagi kepentingan manajemen dan
 pelayanan kepada masyarak
masyarakat.
at.
17. Setiap unit pelayanan harus berupaya memperoleh, mengolah dan menggunakan
informasi secara terintegrasi yang dikomunikasikan secara benar untuk meningkatkan
kesehatan pasien serta kinerja rumah sakit baik secara keseluruhan maupun individu.
18. Koordinasi dan evaluasi pelayanan disetiap unit pelayanan wajib dilaksanakan
melalui rapat.
19. Semua unit pelayanan wajib membuat laporan harian, bulanan, semester dan tahunan
kepadamanajemen rumah sakit
20. Rumah sakit menjalankan program keselamatan pasien melalui
melalui (enam) standar
keselamatan pasien, dan 6 (enam) langkah menuju keselamatan pasien rumah sakit
21. Rumah Sakit melaksanakan penanggulangan Tuberkulosa (TB) dan pelayanan HIV/
AIDS
22. RS melakukan proses pendaftaran pasien rawat jalan, pasien rawat inap, pasien gawat
darurat. Proses penerimaan pasien gawat darurat ke unit ranap dalam 24 jam sesuai
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ke RS/fasilitas kesehatan terdekat saat keadaan mendesak yang berkaitan dengan

kondisi pasien
28. Staf RS yang berkompoten dapat memberikan penjelasan tentang resiko jika pasien
rawat jalan/rawat inap menolak nasihat medis dan memilih pulang dan apabila ada
dokter keluarga kepadanya diberitahu
29. Rumah sakit mempertimbangkan rencana pemulangan pasien, pelayanan penunjang
dan kelanjutan pelayanan medis.
30. Rumah sakit mengidentifikasi organisasi dan penyedia pelayanan kesehatan di
lingkungan di mana pasien tersebut berasal yang berhubungan dengan pelayanan
yang ada di Rumah sakit serta populasi pasien.

B. KEBIJAKAN KHUSUS
1. SKRINING KONTAK PERTAMA.
1) Setiap petugas Rumah Sakit dapat melakukan skrining awal secara visual
dan verbal untuk membantu mengarahkan pasien sesuai dengan
kebutuhannya.
2) Skrining secara visual, dilakukan dengan cara mengamati keadaan secara
umum,ekspresi rasa kesakitan, pucat, ikterus, sianosis,sesak nafas. Dan
Kesadaran
3) Pasien yang telah dilakukan skrining bila sesuai dengan fasilitas rumah
sakit pasien tersebut akan diterima, jika tidak sesuai fasilitas atau pasien
kritis pasien akan dirujuk

2. SKRINING DI UNIT LAYANAN

Di IGD RS Sumber Hidup GPMpelayanan triase sehari-hari menggunakan
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c. Tidak gawat tidak Darurat -HIJAU. Pasien mendapat cedera minimal,

dapat berjalan dan menolong diri sendiri atau mencari
 pertolongan.Pelayanan 15-30 menit
d. Expextant (0)-HITAM. Pasien mati atau cedera fatal yang jelas dan
tidak mungkin diresusitasi.

Tes diagnosa sebelum ditentukan pasien masuk rawat inap, rawat jalan atau
dirujuk, antara lain:
1) Pasien dewasa
a) Darah lengkap (sesuai indikasi)
 b) Gula darah sewaktu. (sesuai indikasi)
2) Pasien dengan usia lebih dari 40 tahun
a) Darah lengkap (sesuai indikasi)
 b) Gula darah sewaktu (sesuai indikasi)
c) ECG
3) Pasien Febris
Febris 2 hari. :
• Darah rutin / DDR
Febris lebih dari 5 hari
✓ Darah rutin.
✓ Widal

4) Pasien GE
✓ Darah rutin (sesuai indikasi).
5) Pasien operasi.
Paket operasi anak.
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g) Konsul dokter Penyaki Dalam

6) Pasien nyeri dada.
❖ ECG.
❖ Thorak foto AP (sesuai indikasi).

7) Pasien cedera kepala.

❖ Darah rutin (sesuai indikasi)
❖ Foto kepala AP/lateral
8) Pasien anak:
a) Darah rutin.

3. SKRINING DILUAR RUMAH SAKIT

Skrining bisa dilakukan saat pasien berada di unit kesehatan lain dan akan
dirujuk kerumah sakit Sumber Hidup GPM, petugas IGD yang menerima
telepon, melakukan skrining dengan petugas yang akan merujuk. Sehingga
 petugas IGD bisa mempersiapkan sarana dan prasarana yang diperlukan.

4. SKRINING PENERIMAAN PASIEN UNTUK KEBUTUHAN

PELAYANAN PREVENTIF, PALIATIF, KURATIF DAN
REHABILITATIF
a) Pelayanan Preventif
Adalah sebuah usaha yang dilakukan individu dalam mencegah
terjadinya sesuatu yang tidak diinginkan. Prevensi secara etimologi
 berasal dari bahasa latin,  pravenire yang artinya datang sebelum atau
antisipasi atau mencegah untuk tidak terjadi sesuatu. Dalam pengertian
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 b. Pemeriksaan dan pemeliharaan kehamilan, nifas dan menyusui

c. Deteksi dini kasus dan faktor resiko (maternal, balita, penyakit).

d. Imunisasi terhadap bayi dan anak balita

b) Pelayanan Paliatif
Pelayanan paliatif adalah pelayanan interdisipliner yang
 berfokus pada pasien penyakit serius atau mengancam jiwa. Tujuan
 pelayanan paliatif adalah mengurangi beban penyakit, meringankan
 penderitaan, dan mempertahankan kualitas hidup dari saat setelah
diagnosis. Tujuan ini dicapai melalui intervensi yang mempertahankan
kesejahteraan fisik, psikologis, sosial dan spiritual, meningkatkan
komunikasi dan koordinasi pelayanan, memastikan pelayanan yang
layak secara budaya dan konsisten dengan nilai-nilai dan preferensi
 pasien, memberi bantuan konkrit jika diperlukan dan meningkatkan
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d) Pelayanan Rehabilitatif
Merupakan upaya pemulihan kesehatan bagi penderita-penderita
yang dirawat dirumah, maupun terhadap kelompok-kelompok tertentu
yang menderita penyakit yang sama. Usaha yang dilakukan, yaitu:
a. Latihan fisik tertentu bagi penderita penyakit tertentu misalnya, TBC
(latihan nafas dan batuk), Stroke (fisioterapi).
Dalam pelaksanaannya skrining didalam rumah sakit dilaksanakan
melalui tahapan berikut :
1. Pemeriksaan saat pasien datang
Semua pasien yang datang ke IGD harus diprioritaskan pada saat
kedatangan, oleh tenaga terlatih dan perawat berpengalaman. Penilaian
awal umumnya harus tidak mengambil lebih dari 2 - 5 menit. Penilaian
awal tersebut dilaksanakan melalui kriteria triase yang menggunakan
skala triase Australia, selanjutnya petugas melaksankan penilaian
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c. Pemeriksaan fisik
d. Pemeriksaan penunjang
e. Diagnosis pasien
4. Dokumentasi dilakukan melalui status Rekam Medis elektronik di
admisi yang mencakup:
a. Identitas pasien
 b. Anamnesis pasien
c. Pemeriksaan penunjang
5. TRIASE
Pasien Datang ke RS Sumber Hidup GPM di seleksi/TRIASE
 berdasarkan kegawatannya menurut START (Simple Tryase and Rapid
Treadmant ).
).

6. PELAYANAN MENAHAN PASIEN UNTUK OBSERVASI

1) Bila kamar penuh ruangan observasi IGD dapat digunakan untuk pasien
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7. PENUNDAAN PELAYANAN
1) Memperhatikan kebutuhan klinis pasien pada waktu menunggu
ataupenundaan untuk pelayanan diagnostik dan pengobatan
2) Memberikan informasi apabila akan terjadi penundaan pelayanan atau
 pengobatan
3) Informasikan ke pasien tentang tertundanya jadwal keberadaan
dokter,kerusakan alat,keadaan pasien yang tidak memungkinkan,
4) Sampaikan permintaan maaf tentang pelayanan atau pengobatan yang
 batal di dapatkan
5) Memberi informasi alasan penundaan atau menunggu dan memberikan
informasi tentang alternatif yang tersedia sesuai dengan keperluan klinik
mereka ( SPO Pemberian Informasi Penundaan Pelayanan )
6) Penundaan yang lebih dari 2 jam dijelaskan dan diminta mengisi form
 penundaan, dan yang menjelaskan
me njelaskan Penanggung jawab ruangan (PJ), bila
b ila di
IGD atau poliklinik adalah dokter.
7) Penundaan pelayanan yang harus memakai formulir Yng dicatat dalam
rekam medis, misalnya kerusakan alat, dokter berhalangan hadir, keadaan
 pasien yang tidak memungkinkan (penurunan kesadaran, sesak nafas,
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 pasien penyandang cacat akan diberi jalan terlebih dahulu dengan

menggunakan kursi roda dibantu oleh satpam/keluarga yang
mengantar.
• Hambatan tidak sadar
 bekerjasama dengan pengantar keluarga/ pengantar pasien untuk
melakukan anamnesa pasien.
pasien.
• Hambatan budaya
Pasien dan keluarga di edukasi bahwa tidak ada hubungannya antara
 pulang hari sabtu dengan penyakit pasien.
Daftar penterjemah bahasa,antara lain:
✓ Bahasa inggris: Yenita Satumalay 081240985450
Gloria Halawet 085215606071

9. KRITERIA PASIEN RAWAT INAP

• Gangguan pernafasan ( adanya Bunyi nafas ngorok atau gargling)
• Trauma atau luka bakarlebih 10 % ( atau yang mengenai daerah wajah
sampai leher, dan mengenai saluran pernafasan.)
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10. KRITERIA PASIEN PULANG DARI RANAP.

a. Sembuh/Membaik
1) Hemodinamik stabil antara lain:
a)  Nadi : 60-100x/mnt
 b) TD stabil antara systole antara 100-140 mmHg, diastole; 60-90
mmHg.
2) Pernapasan
a) Dewasa : Frekuensi 12 -20x/mnt
 b) Anak frekuensi:
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6. 0 –  5
Skala Nyeri : 0 – 
 5
7. Bila telah memenuhi 4 kriteria dari 6 kriteria tersebut sudah
dinyatakan stabil
8. Setelah dinyatakan stabil observasi maksimal 2 jam baru pasien
 boleh dipindahkan ke hcu atau dirujuk.
9. Kejang sudah teratasi, tidak berulang dalam 30 menit
10. Masalah metabolik sudah teratasi.
11. Kadar gula darah sewaktu > 80 mmHg dan < 300 mmHg
12. Gambaran EKG : Sinus rythm
rythm
13. Masalah spesifik pasien sudah dilakukan manajemen medis
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a. Edema paru
 b. Status konvulsi
c. Savety shock

2. Prioritas Kedua
Pasien golongan ini pada saat masuk tidak dalam keadaan kritis terapi
kondisi klinisnya membutuhkan pemantauan intensive baik secara invansive
maupun non invansive atau keadaan  –   keadaan yang dapat menimbulkan
ancaman gangguan pada sistem organ vital. Pada pasien seperti ini terapi
 juga tidak dibatasi, misalnya:
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KRITERIA / INDIKASI PASIEN YANG TIDAK BISA DIRAWAT DI HCU

a. Pasien dengan diagnosa TB
 b. Pasien dengan HbsAg positif
c. Pasien dengan diagnosa HIV

14. PASIEN CUTI RAWAT INAP

a. Krteria Pasien Cuti Rawat Inap :
1) Untuk melakukan second opinion.
2) Untuk keperluan pribadi atau keluarga yang tidak bisa ditinggalkan
(Mengikuti ujian, menikah atau menikahkan, ada keluarga yang
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15. KRITERIA PASIEN DI RUJUK KE RUMAH SAKIT LAIN.

Rujukan Sementara:
1) Tujuan diagnostik (USG second opinion,Head CT SCAN)
2) Dimana Rumah SakitSumber Hidup GPM tidak mempunyai fasilitas.
Rujukan Pasien ke Rumah Sakit Lain:
a) Pasien dirujuk ke Rumah Sakit lain untuk mendapatkan layanan
sesuai dengan kebutuhan pasien yang tidak dimiliki oleh RS.
Sumber Hidup GPM.
 b) Semua Pasien yang dirujuk perlu mendapatkan surat rujukan dan
hasil pemeriksaan medis milik Pasien disertakan.
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 pendampingan oleh petugas yang berkompeten serta dilengkapi dengan

fasilitas emergency kit.
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8) Observasi selama proses transfer di dokumentasikan pada form observasi

saat rujukan, serta dicatat segala perubahan dari kondisi pasien selama
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• Ms CT- 3 Dimensi
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13. Hemodialisa
14. Rehabilitasi Medik
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- Nama, dan lokasi untuk pelayanan lanjutan ( dapat diberikan yang

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