Author : Gabby Doaly*, Grace D. Kando, Tubagus D. E. Abeng
The referral system is a set of health services that delegation of tasks and responsibilities of health services on a reciprocal basis both vertically and horizontally. In the era of National Health Insurance (JKN), based of the Presidential Regulation No. 12 Year 2013 on Health Insurance, health services implemented by the Social Security Agency (BPJS) Health adheres to the referral system. Health care facilities that work with BPJS Health required to implement a referral system. The Dr. Sam Ratulangi hospital is advanced referral health facilities that have established close cooperation with the BPJS Health beginning in 2013. Through an initial interview with the hospital doctor and the first-level health facilities (FKTP) doctor found problems such as: follow up letter from Dr. Sam Ratulangi Hospital was not filled by doctors, not returned to the FKTP doctors, the writing in the follow up letter unreadable by the FKTP doctor, and there was no communication between healthcare facilities in the process of referring and receiving patients. The purpose of this study was to analyze the implementation of the referral system of patient seen from administrative and operational procedures in the Dr. Sam Ratulangi Tondano hospital. This qualitative descriptive research was carried out at the Dr. Sam Ratulangi Tondano hospital for 3 months (October – December 2016). Primary data concerning the implementation of the referral system of patient seen from administrative and operational procedures in Dr. Sam Ratulangi hospital obtained through in-depth interviews to 8 informants i.e., Director, Head of Section, FKTP doctor, emergency room nurse, inpatient nurse, outpatient nurse, Chief Medical Record Unit and Admission Officer -and supported by direct observation and research documents. The results showed that that the administrative procedure for the receipt and delivery of patient referrals in the Dr. Sam Ratulangi Tondano hospital has been implemented according to the standard. Operational procedures refer patients in Dr. Sam Ratulangi Tondano hospital, has not performed according to the standard namely the Dr. Sam Ratulangi hospital did not contact the intended health facilities. The operational procedure of referring back to the faskes 1 has been implemented according to the standard operating procedures while the follow-up over the reference from faskes level 3 has not been carried out according to the standard where there is no communication between faskes level 3 with the Dr. Sam Ratulangi hospital. From the result it can be concluded that theimplementation of the system of referral patients in Dr. Sam Ratulangi Tondano Hospitalas seen from administrative procedures, has implemented appropriate standard, contrarily from operational procedures, theimplementation of the system of referral patients in Dr. Sam Ratulangi Tondano Hospital hasnot yet implemented appropriate standard. RSUD Dr. Sam Ratulangi Tondano require a qualified human resources in medical record sectionand whole employees need to be socialized about the operational procedure of the reference system. Key words: Presepsin, C-Reactive Protein, Procalcitonin, Late-Onset Neonatal Sepsis (LONS).
Dr. Arend L Mapanawang, Sp.PD, FINASIM, PhD