Jurnal Keperawatan Volume 12 No 4, Hal 935 - 942, Desember 2020 p-ISSN 2085-1049

Sekolah Tinggi Ilmu Kesehatan Kendal e-ISSN 2549-8118

PATIENT SERVICE MANAGEMENT IN THE COMMUNITY HEALTH CENTERS

DURING THE COVID-19 PANDEMIC
Candra Dewi Rahayu*, Muhammad Sahli
Universitas Sains Al Qur’an Wonosobo, Jl. Kyai Hasyim Asya ri No.Km, RW.03, Kalibeber, Mojotengah,
Kabupaten Wonosobo, Jawa Tengah, Indonesia 56351
*candra.ners@gmail.com

ABSTRAK
The Community health centers are one of the health services that have a high risk of infection
transmission, safety and health of human resources in health care facilities, patients, patient
companions and visitors, especially during the COVID-19 pandemic. Community health centers are at
the forefront of efforts to contain and control pandemics. Good management and public health center
services will break the chain of transmission of COVID-19. The study aimed to review patient service
management in the public health center during the covid-19 pandemic. A literature review was done
by collecting the results of scientific publications within 2019-2020 from databases such as EBSCO,
AJN, Springer, Google scholar, and through a data base from credible sources. Data from the articles
were reviewed using CASP tools. Results of the review showed that that can be made to obtain a "zero
confirmation" COVID-19 result are by implementing the flow of patient admissions during the
pandemic in accordance with the technical guidelines for patient admission and discharge,
implementing infection prevention and control and conducting proper triage. Administrative control
that are carried out appropriately, such as the management pattern for admitting patients during the
COVID-19 pandemic, can ensure the safety of health services provided to the community without
transmission.

Keywords: community health centers; covid-19; pandemic

INTRODUCTION The impact of Covid-19 is felt in all

Coronavirus Disease 19 (COVID-19) is a
disease caused by the Novel Coronavirus
(2019-nCoV) which was later called
SARS-CoV-2, a new type of virus that has
never been identified in humans. The
addition and spread of COVID-19 cases
globally is quite fast (Kementrian
Kesehatan Republik Indonesia, 2020a).
Data until October 25, 2020, the number of
confirmed cases of COVID-19 globally
was reported as 45,512,186 cases from 216
infected countries and 180 countries with
local transmission. In Southeast Asia the
number of confirmed cases was 8,924,840,
and 1.6% were questioned as dead. With
the spread of COVID-19 cases in various
countries, WHO has designated COVID-
19 as a pandemic case. Indonesia is one of
the countries with local transmission with
a confirmed number of 400,483 thousand
cases, and 13,612 thousand cases of which
were reported dead. (Kementrian
Kesehatan Republik Indonesia, 2020b)
aspects, namely health, economy,
education, and others. Therefore, it is
necessary to take appropriate prevention
and control efforts to minimize the spread
of COVID-19. Various efforts made by the
government to reduce the spread of the
corona virus include large-scale social
restrictions, adherence to health protocols,
but every day there is still an increase in
the number of confirmed cases even the
death rate has also increased. Health
service facilities are workplaces that have
risks to the safety and health of human
resources of health care facilities, patients,
patient companions, visitors, and
communities around the facility, especially
during the COVID-19 pandemic. Services,
occupational safety and health in health
service facilities are contained in PMK No.
52 of 2018 and K3RS is contained in
Permenkes No. 66 of 2016.(Peraturan
Menteri Kesehatan Republik Indonesia,
2016, 2018)

935
Jurnal Keperawatan Volume 12 No 4, Hal 935 - 942, Desember 2020
Community health centers are at the
forefront of serving public health in their
areas, so that community health centers
never stop serving through preventive,
promotive, curative and rehabilitative
measures. Until 2019, there were 10,134
community health centers as the spearhead
of health services throughout Indonesia.
(Kementrian Kesehatan Republik
Indonesia, 2020b) Community health
centers are at the forefront of breaking the
chain of transmission of COVID-19
because they are located in every sub-
district and have a regional concept.
Research conducted by Kamerlin, Shina C.
L. and Kasson, Peter M. in 2020 shows
that Community health centers are able to
control communities to carry out
quarantine independently.(Shina C. L &
Peter M, 2020)
An appropriate quality of health
service at a health center is needed which
will reduce the level of the spread of
16.659 identified trough data
base searching
485 screening with full text
and PDF and English and
2019-2020
53 articles assessed for
eligibility
medeline and 2011-2026
8 articles included
Figure 1: Flow diagram of studies included in this literatre review
Sekolah Tinggi Ilmu Kesehatan Kendal
COVID-19 and increase the safety of
patients and health workers against
infection, so that proper health service
guidelines are needed during the COVID-
19 pandemic as an effort to improve the
quality of patient handling and improve
patient safety and health workers from
corona virus infection. The purpose of this
study was to determine the management of
patient services at health centers during the
COVID-19 pandemic
METHODS
The method used in this research is
literature review data obtained from health
articles, laws and regulations in Indonesia
that discuss COVID-19 through a data
base from credible sources. Literature
review is a data collection technique that is
not aimed directly at the research subject
in order to obtain information related to
the object discussed. The time span of the
information used is from 2019-2020.
432 records excluded
sources
45 articles excluded
- 9 duplicated
- 3 no result reported
- 33 not about
Community health
centers
936
Jurnal Keperawatan Volume 12 No 4, Hal 935 - 942, Desember 2020 Sekolah Tinggi Ilmu Kesehatan Kendal

This literature review was carried out by
collecting the results of scientific
publications from databases such as
EBSCO, American Journal of Nursing
(AJN), Springer, Google scholar, and
through a data base from credible sources.
Searching was done using the keywords of
community health centers; covid-19;
pandemic. Data from the articles were
reviewed using CASP tools and extracted,
and then classed as for triangulation to be
discussed and summarized inorder to know
the quality of the articles. Determining the
quality of the articles was done by
categorizing the percentage of extraction
results into good quality, fair quality and
poor quality.
RESULTS
The quality of health services at the health
center during a pandemic is very important
as an effort to control transmission of
COVID-19. The efforts of the Community
health centers in maintaining the quality of
care and safety for both patients and health
workers are by implementing triage/
screening for every visitor who comes,
changing the flow of services at the
Community health centers during the
pandemic, using appropriate Personal
Protective Equipment (PPE) for health
officers (Arditama, 2020; Kementrian
Kesehatan Republik Indonesia, 2020b;
Morfi, Junaidi, Elsesmita, & Pangestu,
2020; World Health Organization, 2020)
Triage during the Covid-19 pandemic
Triage is the selection and classification of
patients to determine priority needs with
Severe Acute Respiratory Infection (SARI)
and is carried out by taking into account
the principles of appropriate Infection
Prevention and Control (IPC) and
determining the appropriate place of care.
During the COVID-19 pandemic the
assessment and classification were
determined by the level of urgency based
on A-B-C-D and also determined by the
level of virulence of the patient with the
EWS Screening indicator for COVID-19.
(Arcellia Farosyah, 2020; World Health
Organization, 2020)

Table 1.
EWS Screening parameters for COVID-19
Parameters Assessment Score
Sign of pneumonia with pulmonary CT Yes 5
History of close contact with a confirmed patient with COVID-19 Yes 5
Fever Yes 3
Age ≥ 44 years 1
Gender male 1
Maximum temperature (measured from onset to health care ≥ 37.8oC 1
o
facilities) (100 F)
Symptoms of respiratory disorders (cough, sputum and tightness) ≥ 1 symptom 1
Neutrophil to lymphocyte ratio ≥ 5.8 1
The patient had a high suspicion of COVID-19 ≥10
Source:(Arcellia Farosyah, 2020 and CDC 2020).

Flow of services at health centers during
the Covid-19 pandemic
Sustainable health services will increase
the effectiveness of services. (Gabow,
Eisert, & Wright, 2003) The management
of health care providers during a pandemic
must also be effective so that it will reduce
the incidence and risk of incidence,
namely by providing continuous care from
the time the patient enters until the patient
is discharged.
a. Services at the Community health
centers
Flow of patient admission at
Community health centers according to
the Ministry of Health 2020

937
Jurnal Keperawatan Volume 12 No 4, Hal 935 - 942, Desember 2020
Source; (Kementrian Kesehatan Republik Indonesia, 2020b)
Figure2: Flow of patient admissions at health centers during the COVID-19 pandemic
Information:
Red: The red color is the flow of services
for confirmed COVID-19 patients without
an emergency or a COVID-19 case with an
emergency or non-COVID-19 cases.
Green: The green color is the service flow
for patients not related to the COVID-19
case, namely patients with complaints
other than Acute Respiratory Infektion
(ARI) in all age groups, pregnant women
who need pregnancy control, babies or
toddlers who need immunization, fertile
age couples who will carry out family
planning, dental services, nutrition
services, health checks, tests for TB, STIs,
HIV, special examinations, consultations,
and others.
b. Home care
One of the Scope of the Role of Health
Promotion at Community health centers in
the response to COVID-19 is organizing
and mobilizing community potential/
resources to optimize health promotion
activities and family empowerment in
preventing COVID-19 in the work area of
Community health centers (Kementrian
Sekolah Tinggi Ilmu Kesehatan Kendal
Kesehatan Republik Indonesia, 2020b)
The implementation that can be done by
Community health centers is the “jogo
tonggo” program. Jogo Tonggo is one of
the policies put forward by the Central
Java government with a local wisdom
approach(Arditama, 2020; Sulistiani &
Kaslam, 2020) The Jogo Tonggo policy is
a policy to accelerate the community-
based handling of Covid-19. Community
health centers efforts in implementing this
are by maintaining the quality and quantity
of visits and providing education related to
Covid-19 to the public. According to
(Arditama, 2020), the consciousness of
each individual is influenced by his
knowledge. As a result, the Jogo Tonggo
movement contributed to the pace of
information and education that was
previously inaccessible by some people.
Infection prevention and control during
a pandemic
IPC implementation during the COVID-19
pandemic (Morfi et al., 2020):
Triage: medical masks for suspected
infectious patients, isolation rooms, hand
hygiene practices.
938
Jurnal Keperawatan Volume 12 No 4, Hal 935 - 942, Desember 2020
a. Prevention of droplet transmission:
medical masks for health workers,
special rooms for patients with the same
possible etiology or clinical diagnosis,
eye protection, to limiting activities for
patients not to leave the room.
b. Prevention of contact: hand hygiene,
wearing complete PPE and removing
immediately after finishing outdoors,
using disposable tools whenever
possible, avoiding contact with areas
Source: (Indonesia, 2020)
Figure 3: An example of using PPE when treating a patient with suspected or confirmed
COVID-19
DISCUSSION
Covid-19 is a disease that was only
discovered in 2019, therefore knowledge
regarding its prevention, treatment and
handling is still limited. The key to
prevention includes breaking the chain of
transmission with isolation, early
detection, and basic protection. Improving
the quality of services in health services,
including health centers is very much
needed. In line with the increase in public
knowledge of their rights as service
recipients so that people can choose
various quality service alternatives that can
provide satisfaction for themselves and
their families. As an effort to meet the
minimum service standards for the
community that should not be left behind
during this pandemic period. Community
health centers make the necessary
adjustments in the management and
Sekolah Tinggi Ilmu Kesehatan Kendal
not directly related to the patient such
as door handles, adequate ventilation of
the room, and avoiding mobilization of
patients by staff .
c. Airborne prevention in airway
procedures (suction, intubation,
bronchoscopy, CPR): use a single room
with negative pressure, use of complete
PPE starting from N95 masks, gloves,
protective clothing, protective glasses
delivery of its services. These adjustments
need to be made to respond to the impact
that occurs due to COVID-19 as well as to
prevent the transmission of the severe
acute respiratory syndrome coronavirus 2
(SARS-C0V-2) during service
delivery.(Kementrian Kesehatan Republik
Indonesia, 2020b; Lubis. Agnes Jesika,
n.d.).
Health service facilities are at the forefront
of dealing with health problems in the
community due to COVID-19. Community
health centers, which have been the
spearhead of health services to reach
people in their working areas, have an
increasingly important role in overcoming
COVID-19. Puskesmas also have the duty
and function of organizing public health
efforts and individual health efforts.
Community health centers services in the
939
Jurnal Keperawatan Volume 12 No 4, Hal 935 - 942, Desember 2020
Covid-19 Pandemic Era include public
health management, public health efforts,
individual health efforts, and infection
prevention and control. (Hamzah, 2020).
Health services provided at the health
center are carried out in accordance with
the service flow that has been determined
by the government, namely Triage, which
begins with initial screening for incoming
patients using EWS screening parameters,
then nurses must also use standard PPE
according to the handler and the level of
triage. Services at the health center must
be comprehensive and sustainable so that
the service is not only done inside the
building but also outside the building. One
form of health care services outside the
building can be carried out by
implementing the jogo tonggo activity
where Community health centers officers
must intensively provide education to the
public regarding activities as directed by
the governor of Central Java. (Arcellia
Farosyah, 2020; Arditama, 2020;
Indonesia, 2020; Morfi et al., 2020;
Sulistiani & Kaslam, 2020) Intensive
education to the public will increase public
knowledge regarding COVID-19 so that
this program will run effectively. In
addition to the “jogo tonggo” program, the
community must also implement PPI,
namely by using masks, washing hands
and maintaining distance.
The implementation of PPI in health
service facilities cannot be carried out
effectively according to the data submitted
by (Dimas & Hira, 2020), that the IPC
used in providing services to COVID-19
patients is still lacking so that until April
2020 Indonesia is the largest contributor to
deaths due to Covid-19 in Southeast Asia .
In addition, the lack of PPE used by health
workers will also increase the workload for
nurses because an increase in COVID-19
cases, research shows that high workloads
will threaten patient safety and increase
work accidents (Aini & Purwaningsih,
2013; Dimkatni, 20220) This is in line
Sekolah Tinggi Ilmu Kesehatan Kendal
with Kusumaningsih's research.
(Kusumaningsih & Ricko Gunawan, M.
Arifki Zainaro, 2020), the results of the
study show a significant relationship
between the physical workload of nurses
and the application of patient safety during
the Covid 19 pandemic at the Community
health centers inpatient in Pesawaran.
Controlling the COVID-19 case apart from
standard IPC implementation also has to
be with patient care according to the
procedure. The implementation of triage
and patient care in accordance with
Standard Operating Procedures is an effort
to control the COVID-19 case. The
implementation of triage during the
COVID-19 period was different from the
daily triage. The implementation of triage
was started by using EWS screening after
screening the patients were separated and
then performed A-B-C-D triage. (Arcellia
Farosyah, 2020) If this triage is carried out
properly according to the flow, it will
suppress the transmission of Covid-19.
Triage using EWS screening is carried out
on every visitor to the Community health
centers who provides health services at the
health center, this is the first step in
finding cases of COVID-19 at the basic
service level as an effort to control
COVID-19 cases.
CONCLUSION
The management of health center services
during the pandemic period has been
regulated by the government in the form of
technical guidelines for health services at
the health center during the COVID-19
pandemic. Efforts are needed to improve
the quality of health services at the health
center to implement the regulations that
have been set by the government. Proper
service management, such as the pattern of
managing patient admissions during the
COVID-19 pandemic, can guarantee the
safety of health services provided to the
community without transmission
940
Jurnal Keperawatan Volume 12 No 4, Hal 935 - 942, Desember 2020
REFFERENCES
Aini, H. F., & Purwaningsih, P. (2013).
Hubungan Antara Beban Kerja
Dengan Stres Kerja Perawat Di
Instalasi Gawat Darurat Rsud
Kabupaten Semarang. Jurnal
Manajemen Keperawatan, 1(1).
Available at:
http://103.97.100.145/index.php/JM
K/article/view/949
Arcellia Farosyah, P. (2020). Triage dan
Penilaian Awal Pada Masa COVID-
19 di Instalasi Gawat Darurat. Tim
Gugus Tugas COVID-19. Jakarta.
http://www.hipgabi.org/p/pusat-
informasi.html
Arditama, E. (2020). Jogo Tonggo:
Membangkitkan Kesadaran Dan
Ketaatan Warga Berbasis Kearifan
Lokal Pada Masa Pandemi Covid-19
Di Jawa Tengah. Jurnal Pendidikan
Kewarganegaraan Undiksha, 8(2).
http://dx.doi.org/10.23887/jpku.v8i2.
25434
CDC. 2020. Standard Operating Procedure
(SOP) for Triage of Suspected
COVID-19 Patients. Tersedia pada
https://www.cdc.gov/coronavirus/20
19- ncov/hcp/non-us-settings/sop-
triage-prevent-transmission.html
Dimas, Z., & Hira, H. (2020). Pandemi
Covid-19: Flattening The Curve,
Kebijakan dan Peraturan. VOX
POPULI, 3(1).
https://doi.org/10.24252/vp.v3i1.140
77
Dimkatni, N. W. (20220). Apakah beban
kerja, stres kerja dan kualitas tidur
mempengaruhi kelelahan kerja pada
perawat di rumah sakit?. Sam
Ratulangi Journal Of Public Health,
1(1). Available at:
https://ejournal.unsrat.ac.id/index.ph
p/srjph/article/view/27273
Gabow, P., Eisert, S., & Wright, R. (2003).
Denver Health: A Model for the
Sekolah Tinggi Ilmu Kesehatan Kendal
Integration of a Public Hospital and
Community Health Centers. ACP
Journal.
https://doi.org/https://doi.org/10.732
6/0003-4819-138-2-200301210-
00016
Hamzah, B. (2020). Quality Improvement
of Community Health Center During
Covid-19 Pandemic. International
Journal of Multicultural and
Multireligious Understanding
(IJMMU)., 7(4).
http://dx.doi.org/10.18415/ijmmu.v7i
4.1614
Indonesia, K. K. R. (2020). Petunjuk
Teknis Alat Pelindung Diri (APD)
Dalam Menghadapi Wabah COVID-
19 versi April 2020. Jakarta.
https://covid19.go.id/p/protokol/petu
njuk-teknis-penggunaan-alat-
perlindungan-diri-apd-dalam-
menghadapi-wabah-covid-19
Kementrian Kesehatan Republik
Indonesia. (2020a). Pedoman
Kesiapsiagaan Menghadapi COVID-
19 versi 3 Maret 2020. Jakarta.
https://www.kemkes.go.id/article/vie
w/20031700001/Dokumen-Resmi-
dan-Protokol-Penanganan-COVID-
19.html
Kementrian Kesehatan Republik
Indonesia. (2020b). Petunjuk Teknis
Pelayanan Puskesmas Pada Masa
Pandemi COVID-19. Jakarta. ISBN
978-602-416-929-9 Available at:
http://repository.poltekkes-
denpasar.ac.id/3797/
Kusumaningsih, D., & Ricko Gunawan,
M. Arifki Zainaro, T. W. (2020).
Hubungan Beban Kerja Fisik Dan
Mental Perawat Dengan Penerapan
Pasien Safetypada Masa Pandemi
Covid 19 Di Upt Puskesmas Rawat
Inap Kabupaten Pesawaran.
Indonesian Nursing Journal, 2(2).
Available at:
941
Jurnal Keperawatan Volume 12 No 4, Hal 935 - 942, Desember 2020 Sekolah Tinggi Ilmu Kesehatan Kendal

https://ijhd.upnvj.ac.id/index.php/ijh em/WHO-2019-nCoV-IPC-2020.4
d/article/view/93
Lubis. Agnes Jesika. (n.d.). Terkait
Dengan Masa Masa Pandemi Covid-
19 Dilakukannya Kesimbangan
Dengan Pencegahan Dan
Meningkatkan Keselamatan Pasien
Rawat Inap.
https://doi.org/https://doi.org/10.312
19/osf.io/ygn6p
Morfi, C. W., Junaidi, A., Elsesmita, A., &
Pangestu, D. N. F. (2020).
KajianTerkini CoronaVirus Disease
2019 (COVID-19). JIKESI (Jurnal
Ilmu Kesehatan Indonesia), 1(1).
https://doi.org/10.25077/jikesi.v1i1.1
3
Peraturan Menteri Kesehatan Republik
Indonesia. 2018. Peraturan Menteri
Kesehatan Republik Indonesia
Nomor 52 Tahun 2018 Tentang
Keselamatan Dan Kesehatan Kerja
Di Fasilitas Pelayanan Kesehatan.
Indonesia.
http://www.kesjaor.kemkes.go.id/
Shina C. L, K., & Peter M, K. (2020).
Managing Coronavirus Disease
2019 Spread With Voluntary Public
Health Measures: Sweden as a Case
Study for Pandemic Control.
Clinical Infectious Diseases.
https://doi.org/https://doi.org/10.109
3/cid/ciaa864
Sulistiani, K., & Kaslam. (2020).
Kebijakan Jogo Tonggo Pemerintah
Provinsi Jawa Tengah dalam
Penanganan Pandemi Covid-19.
VOX POPULI, 3(2).
https://doi.org/10.24252/vp.v3i1.140
08
World Health Organization. (2020).
Clinical management of severe acute
respiratory infection when novel
coronavirus (2019-nCoV) infection
is suspected. Geneva. Available at:
https://www.who.int/publications/i/it

942