FAKTOR YANG MEMENGARUHI MORTALITAS PASIEN RAWAT INAP DI RUMAH SAKIT AKADEMIK UGM

Abstract

Background: Hospital mortality indicators are an important element of a hospital patient safety monitoring program. In 2022, the record of inpatient performance at Academic Hospital UGM (RSA UGM) shows that the Net Death Rate (NDR) value has not yet reached the ideal standard, namely 34.1‰. Objective: Identifying factors that influence the mortality rate of adult patients ≥48 hours in inpatient care and developing a program plan to reduce hospital mortality at RSA UGM. Methods: An explanatory sequential design of mixed methods research was used. The medical records of adult patients admitted to RSA UGM from October 2022 to December 2022. Quantitative data analysis used chi-square, Fisher’s exact tests, and multivariate logistic regression. Qualitative data was obtained from focus group discussions with three separate groups, namely the managerial group, the doctor team, and the nurse team., while qualitative data used thematic analysis. Results: 388 subjects were obtained with 18 (4.64% or 46.4‰) patients who died during treatment ≥48 hours. Independently, ward type (OR 10,799, CI 95 % 3,990 – 29,233), EWS score (OR 15,644, CI 95 % 5,511 – 44,412), and some comorbidities (OR 8,603, CI 95 % 2,769 – 26,730) associated with ≥48 hours in-hospital mortality (<0.001). Multivariate analysis showed that ward type (p=0.018, aOR 4,122, CI 95 % 1,279 – 13,284) and Early Warning System (EWS) score (p=0.016, aOR 4,531, CI 95 % 1,327 – 15,469) had a strong association with ≥48 hours in-hospital mortality. The proposed program to reduce hospital mortality rates by increasing ICU capacity, improving the competency and skills of ICU nurses, adding intensivists, controlling nosocomial infections in ICU, increasing understanding regarding EWS for ward nurses, improving the EWS monitoring, and improving the competency of ward nurses in emergencies condition. Conclusion: The EWS score >5 and intensive care are significantly related to in-hospital mortality ≥48 hours after hospitalization so management needs to improve the quality of services at the RSA UGM by carrying out a strategy to reduce hospital mortality rates to decrease the net mortality rate in accordance with the Ministry of Health’s national standards.