Addressing Legal Uncertainty in Delayed Informed Consent: Protecting Health Workers in Indonesian Hospitals

Introduction and purpose Patient risk in non-ST-segment elevation myocardial infarction (NSTEMI) depends on clinical setting, individual patient variables and procedural characteristics. Standardized risk-adjusted periprocedural management for catheterization procedures using a Standard Operating Procedure (SOP) was investigated to evaluate associations with in-hospital clinical outcomes. Methods In 01/2018, our heart center established an SOP for coronary catheterization procedures in NSTEMI, targeting 1) standardized pre-procedural risk assessment using National Cardiovascular Data Registry (NCDR) risk models, and 2) standardized post-procedural risk-adjusted safety measures, including advanced patient monitoring (intermediate/intensive care) and use of vascular closure devices. All patients presenting with invasively-managed NSTEMI in 2018 were retrospectively evaluated for SOP-based pre-procedural risk scoring, SOP-based post-procedural management and in-hospital clinical outcomes of mortality, major bleeding (MB, according to BARC ≥3) and acute kidney injury (AKI, according to KDIGO). Results A total of 430 patients (age 72±12 years, 71% male, BMI 27±5) presenting with NSTEMI from 01 to 12/2018 were included, 9.8% presented in cardiogenic shock and 4.7% had suffered a preclinical cardiac arrest. Overall in-hospital mortality was 3.7%, MB occurred in 6.5%. 207 patients (48.1%, SOP+ group) had received both 1) pre-procedural risk assessment and 2) post-procedural risk-adjusted safety measures; the other 223 patients (51.9%, SOP- group) had not received either 1) or 2). There were no significant differences in baseline characteristics and prior-existing medical conditions between groups, however, significantly more patients in SOP- group were treated in emergency settings (39.9% vs. 21.7%, p=0.004). However, significantly more patients in SOP- were treated in emergency settings at higher risk (39.9% (SOP-) vs. 21.7% (SOP+); p<0.001). In univariate analysis, all in-hospital clinical outcomes of mortality (1.4% (SOP+) vs. 5.8% (SOP-); p=0.016), MB (2.9% (SOP+) vs. 9.9% (SOP-); p=0.003) and AKI were significantly lower in the SOP+ group (15.9% (SOP+) vs. 24.2% (SOP-); p=0.033). After correction for the difference in risk between groups due to emergency settings by multivariate logistic regression analysis, MB remained significantly lower in SOP+ (p=0.02), while mortality (p=0.14) and AKI (p=0.19) were not significantly associated with SOP-status anymore. Conclusion Standardized risk management in invasively managed NSTEMI was associated with significantly lower rates of in-hospital major bleedings. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Junior Clinician Scientist Track, Medical faculty, Heinrich-Heine-University Düsseldorf, Germany

Malpractice cases are a crime that is very common in Indonesia. Malpractice is basically an act of a professional that is contrary to standard operating procedures (SOP), code of ethics, and applicable laws, whether intentional or as a result of negligence that results in loss or death to others. Aspects of legal protection for patients who are victims of malpractice by doctors based on Indonesian law, namely : preventively with the existence of regulations governing malpractice, namely in the Civil Code (KUH Perdata), the Health Law, the Consumer Protection Law, the Medical Practice Law, and the Legal Code, Penal (Penal Code) and repressively the lack of action resulted in a loss, the person who performed the action imposed sanctions in the form of civil sanctions, namely to compensate both the administrator sanctions and criminal sanctions.

The delayed retrieval (return) of medical records at Muna Anggita Hospital Bojonegoro in January-May 2022 hindered the data process, reporting, and BPJS claim submissions. It also impeded services when patients underwent health check-ups and affected the quality of hospitals and patient satisfaction. This study aims to analyze the factors causing the tardy return of inpatient medical records based on Lawrence Green's behavior theory, which includes predisposing, enabling, and reinforcing factors. This qualitative study collected data through interviews, observations, documentation, USG (Urgency Seriousness and Growth), and brainstorming. The research subjects include one medical record head, two assembling officers, and four inpatient ward heads. The results indicated that predisposing factors included the lack of knowledge of ward heads and their attitude (behavior) towards extending the return time of medical records. These predisposing factors can occur due to the lack of supporting facilities. Also, motivating external factors such as rewards or reprimands from ward heads and minimal socialization of standard operating procedures (SOPs) regarding borrowing and return of medical records also contribute to the delay. Behavioral factors refer to the ward heads' lack of compliance and discipline in returning medical records. Muna Anggita Hospital should conduct SOP socialization every three months and regularly provide supporting facilities. The ward heads should also set an example regarding medical record return punctuality. The subsequent researchers are encouraged to formulate a strategic plan to reduce the delays in returning inpatient medical records at Muna Anggita Hospital in Bojonegoro.

Background: Activity of care documentation is a main element of responsibility for care profession performance. Therefore, treatment supervision is needed in order that effectiveness and efficiency of work are optimum. In approximately recent 4 months, the implementation of treatment supervision in the PKU Muhammadiyah Hospital of Bantul was vacuum, results of interview with the ward heads indicated that there was indication of dissatisfaction of ward head which was also appointed as supervisor in terms of incentive acceptance. Method: This study is quantitative research with quasi experiment pre and post-test design without control group. Respondents of this study were all inpatient ward heads using total sampling. Results and discussion: Results of this study indicated that average percentage of care documentation (standard operational procedure) implementation before treatment supervision training in the inpatient wards of PKU Muhammadiyah Hospital of Bantul was 42.6%, and after training, the percentage was 51.4%. Based on results of statistical test with paired t-test, it was found that p-value of effectiveness of ward head supervision application on implementation of care documentation in the inpatient ward s of PKU Muhammadiyah Hospital of Bantul was 0.002 (p<0.05). There was 8.8% increase in average percentage of care documentation implementation before and after ward head supervision training. Conclusion: The ward head supervision training was found effective on implementation of care documentation in the inpatient wards of PKU Muhammadiyah Hospital of Bantul.

This study examines the forms and mechanisms of legal protection for patients using stem cell therapy based on the Indonesian health legal framework, which is regulated by the Health Law, the Medical Practice Law, the Health Workers Law, the Hospital Law, and specifically by Minister of Health Regulation Number 32 of 2018 concerning the Implementation of Stem Cell Therapy. Stem cell therapy, as a form of advanced medical therapy, carries high risks and therefore requires preventive and repressive legal protection. Preventive protection is provided through the right to information, informed consent mechanisms, healthcare professional competency standards, healthcare facility certification, and strict technical procedures for stem cell processing and use. Repressive legal protection is provided through administrative, civil, and criminal mechanisms in the event of violations, malpractice, or misuse of stem cell therapy. Patients can seek compensation through civil lawsuits under Articles 1365 and 1367 of the Civil Code, while criminal sanctions can be imposed for illegal stem cell use under the Health Law and the Medical Practice Law.

The construction of the legal relationship between participants BPJS with BPJS Health is a social insurance; Health BPJS with Hospital Prof. Dr. Margono Soekarjo is an agreement to perform certain services pursuant to Article 1601 of the Civil Code; where responsibility for reimbursement by INA CBGs by BPJS to RSMS. The method used is the juridical approach to normative or legal research only examined the references so that it referred to legal research library. As for another approach used is the Analytical approach (Analytical Approach). Â Legal protection of participants BPJS in Hospital Prof. Dr. Margono Soekarjo, namely protection is based on two legal protection of participants BPJS by Social Security Law, the Law on Health Insurance BPJS and regulation as well as the Medical Practice Law, Health Law, and the Law Hospital. The pattern of legal protection by Social Security Law, the Law on Health Insurance BPJS and regulation is carried out through participant BPJS rights protection and the right to file a complaint related to health care in the National Health Insurance (JKN). While based on the Medical Practice Law, Health Law, and the Law Hospital, legal protection BPJS participants in Hospital Prof. Dr. Margono Soekarjo in the receiving health care in Hospital Prof. Dr. Margono Soekarjo. Keywords: BPJS, Legal Protection, Legal Relationship. Â

Infection in pregnant women can be caused by several viruses, one of which is Human Immunodeficiency Virus (HIV). Mother-to-child transmission of HIV reaches 2.6% of all cases of HIV-AIDs, and more than 90% of the incidence of HIV in children is transmitted by mothers. The increase in HIV cases in infants occurred in line with the increase in HIV cases in women, namely 20% in 2007, 25% in 2008, and 27% in 2011. Objectives, Programs are developed to reduce the risk of mother-to-child and mother-to-child transmission of HIV. health workers to achieve improvement in maternal health, reduce infant mortality and protect health workers in RSUD city C. Preparation stage, identification of problems in the midwifery unit, shared perceptions of PMTCT. Implementation, seminars on PMTCT, formation of an education team in early screening (early screening) of pregnant women about PMTCT, making standard operating procedures (SOPs) in prenatal HIV screening, SOPs for delivery in HIV positive patients, SOPs in breastfeeding, and techniques breastfeeding for infants with HIV-positive mothers. Finally, evaluating the results of work related to making SOPs and implementing HIV screening for every prenatal patient. In conclusion, the screening format that has been prepared can capture pregnant women who are at high risk of HIV. Suggestion, HIV screening format needs to be integrated with antenatal care form.

Purpose: Legal problems that may arise as a result of using hospital services when a general practitioner is on call to carry out medical procedures that are the rights of the treating doctor. This article aims to determine the practice of implementing health law in relation to the protection of doctors who carry out daily practice in Indonesia. This article also reviews deviations in health law in relation to medical practice in Indonesia. In the end, the author intends to offer and provide solutions to problems and irregularities in the implementation of health law in medical practice so it is hoped that this article can become a reference in increasing compliance with health law, especially regarding the protection of doctors when carrying out medical practice. Theoretical Framework: Legal protection is something an effort to protect individual interests by allocating a human right of power to the individual to be able to act in the context of those interests. Legal protection is basically protection given to legal subjects in the form of legal instruments. Doctors who carry out their profession have the right to receive legal protection as regulated in Article 50 of Law Number 29 of 2004 concerning Medical Practice. Hospitals are obliged to provide legal protection to doctors who work in their hospitals in accordance with the hospital's obligations as regulated in Article 29 paragraph (1) letter (s) of Law Number 44 of 2009 concerning Hospitals. In Indonesia, laws and regulations do not yet clearly regulate legal protection for doctors. Method: This study uses normative legal methods supported by literature reviews from national and scientific journals international. The main focus of the subject is law, which is understood as social standards or regulations that guide everyone's behavior. Results: The research results show that as long as doctors follow standard operating procedures in their practice, they are allowed to carry out medical procedures to save lives in emergencies. Professional standards refer to a set of minimum competencies (knowledge, abilities, and attitudes) that a doctor must possess. Conclusions: Legal protection for medical professionals practicing in hospitals is necessary to ensure that the health services offered comply with medical standards and medical ethics. At the same time, improving health service standards needs to be supported by providing a supportive work environment for doctors.

Study Objective: The aims of this study were to analysis the relationship between the various severity triage levels and time expenditure in an emergency department (ED). This involved the analysis of time expended on the different triage level patients during rush or non-rush periods. Materials and Methods: The medical records of 400 patients were collected from the ED at the Mackay Memorial Hospital and retrospectively reviewed. The subjects were divided into different stages based on their progress through the ED. Recorded data included triage assessment, the different times expended at the different stages of treatment in the ED including triage assessment, registration, doctor's attendance and laboratory data examination and the arrival/departure times ofr the patients. Results: When the study groups were compared, there were significant differences between triage levels 1 patients compared to triage level 2 and 3 patients (p＜0.05) for all treatment stage times other than triage/ registration and the wait for initial physician attendance. In addition, overall, triage/registration and waiting for attendance times did not differ between the rush and non-rush periods. However, Level 1 triage patients took longer for all other timings during rush periods compared to non-rush periods (p＜0.05). Furthermore, level 2 and 3 triage patients took longer for triage and registration during rush periods compared to non-rush periods (p＜0.05). Conclusion: Typically, triage level 1 patients are more complex and require a longer diagnostic times than either level 2 or level 3 patients. Although disease/injury severity determines treatment priority, no such discrimination is used in less severe cases. This study indicates that level 1 cases use up much more time than level 2 and 3 for both doctor and laboratory examinations, but there is no increase in the waiting time for doctors during rush periods. Triage level 2 or 3 patients seem to have similar times for most activities except registration whether the ED is busy or not. It can therefore be concluded that improving procedures or setting up a team specifically for patients who are severely injured and who arrive during a busy periods may be helpful and reduce the risk of any delay in treatment of these patients, which is very important to every ED physician.

IntroductionThe purpose of this investigation was to perform an audit of the standards of consent forms in which patients sign prior to operative intervention for orthopaedic trauma in an emergency setting in our institution, with comparison to the ‘Orthopaedic Surgical Consent’ standards, as set by the American Association of Orthopaedic Surgeons (AAOS). If required, the investigator aimed to close the loop in this audit by educating orthopaedic surgeons on the necessary standards of obtaining written consent for orthopaedic trauma.MethodsFollowing being granted approval by our institutional audit committee, a pre-intervention cycle was performed to assess the quality of consent obtained in written format using electronic patient records in consecutive patients over a four-week period. Following the analysis of this data, an education session was provided for all orthopaedic doctors responsible for obtaining informed written consent from patients who are planned to undergo operative management of a soft tissue or bony injury by the trauma and orthopaedic service in the emergency setting. Thereafter, a post-intervention cycle was performed with subsequent descriptive analysis using the GraphPad software.ResultsIn the pre-intervention audit cycle, all included (n = 107) consent forms (100%) correctly included the patient’s name, date of birth (DOB) and institutional board number (BN). However, only 79 consent forms (74.5%) were completed without using abbreviations or acronyms of any kind, whilst 81 consent forms (76.4%) were completed without correctly stating the side or site of the planned intervention. In the post-intervention cycle, all included (n = 40) consent forms (100%) correctly included the patient’s name, DOB and institutional BN. Additionally, a total of 37 consent forms (92.5%) were correctly completed without using abbreviations or acronyms of any kind (74.5% versus 92.5%, p = 0.02). Furthermore, a total of 39 consent forms (97.5%) were completed correctly stating the side or site of the planned intervention (76.4% versus 97.5%, p = 0.0015).ConclusionThis closed-loop audit found that the quality of informed consent obtained by orthopaedic surgeons in the emergency setting might potentially be significantly improved with at least one virtual education session. Such simple education sessions may potentially improve the documentation of the planned potential operative intervention by orthopaedic surgeons for cases of orthopaedic trauma to ensure patient safety is optimised. As the turnover of non-consultant hospital doctors is high in university teaching hospitals, regular education sessions on such topics may introduce a cultural shift in maintaining high standards when marking and consenting patients in the emergency setting.

Doctors cannot avoid the possibility of disabled patients even dying, even though in practice they are in accordance with professional standards and standard operational procedures based on patient health needs. This situation should be referred to as a medical risk, but it is often interpreted by parties outside the medical profession as malpractice, so an understanding of legal protection for doctors suspected of malpractice is needed in terms of applicable laws and regulations. By looking at the decision of the Supreme Court Number 233 K / PID. SUS/2021, even though found guilty, the Defendant cannot be charged under the Criminal Code because it has been regulated in Law Number 17 of 2023 concerning Health (Health Law) and Law Number 29 of 2004 concerning Medical Practice (Law on Medical Practice), thus affirming the existence of legal protection from laws that specifically regulate the practice of medicine. This study aims to analyze legal liability for doctors who commit malpractice, and analyze legal protection for doctors suspected of malpractice in terms of applicable laws and regulations. The research method is carried out in a normative juridical manner with statutory approach methods, conceptual approaches, and case approaches. As a result of the research, the principle of justice is not accommodated in the claim for accountability under Article 79 letter c of the Medical Practice Law. The Health Act has preventive and repressive means of protection. The defendant did not carry out his practice in accordance with the standards of the medical profession, and the standard of operational procedures and health needs of patients, so automatically medical ethics were violated, causing the defendant to be held accountable for his actions in disciplinary law, civil law, and criminal law. In order to be protected from legal liability, doctors must always carry out their practices in accordance with professional standards, and standard operational procedures based on patient health needs.

Quality laboratory services are a requisite to guide rational case management of malaria. Using a pre-tested, standardized assessment tool, we assessed laboratory diagnostic capacity in 69 primary, secondary and tertiary health facilities as well as specialized laboratories in five administrative zones in Oromia Regional State, Ethiopia, during February and March 2009. There was marked variability in laboratory diagnostic capacity among the facilities assessed. Of 69 facilities surveyed, 53 provided both comprehensive malaria laboratory diagnosis and outpatient treatment services, five provided malaria microscopy services (referring elsewhere for treatment), and 11 primary care health posts provided rapid diagnostic testing and outpatient malaria treatment. The facilities' median catchment population was 39, 562 and 3581 people for secondary/tertiary and primary health facilities, respectively. Depending on facility type, facilities provided services 24 hrs a day, had inpatient capacity, and access to water and electricity. Facilities were staffed by general practitioners, health officers, nurses or health extension workers. Of the 58 facilities providing laboratory services, 24% of the 159 laboratory staff had received malaria microscopy training in the year prior to this survey, and 72% of the facilities had at least one functional electric binocular microscope. Facilities had variable levels of equipment, materials and biosafety procedures necessary for laboratory diagnosis of malaria. The mean monthly number of malaria blood films processed at secondary/tertiary facilities was 225, with a mean monthly 56 confirmed parasitologically. In primary facilities, the mean monthly number of clinical malaria cases seen was 75, of which 57 were tested by rapid diagnostic test (RDTs). None of the surveyed laboratory facilities had formal quality assurance/quality control protocols for either microscopy or RDTs. This is the first published report on malaria diagnostic capacity in Ethiopia. While our assessment indicated that malaria laboratory diagnosis was available in most facilities surveyed, we observed significant gaps in laboratory services which could significantly impact quality and accessibility of malaria diagnosis, including laboratory infrastructure, equipment, laboratory supplies and human resources.

Southeast Asian countries to allow free flow of doctors

In this study, we developed a document for managing Information Technology suppliers in hospitals. This document is used to ensure the proper management of IT suppliers in the hospital. Products and services in Information Technology have characteristics and specifications that are always up to date, making it difficult for non-IT people to understand. Hospitals whose main business in the health sector is often lack of human resources who understand IT. Observations and interviews were conducted in Indonesian hospital, to identify the characteristics and problems in supplier management. Control Objectives for Information and Related Technologies (COBIT), Information Technology Infrastructure Library (ITIL) and government regulations on supplier management were reviewed and combined as a benchmark and guidance on how supplier management activities are carried out. The result of the process is a Standard Operating Procedure (SOP) document. The parties involved in the supplier management process have evaluated the SOP document. From the results of the study, it is known that currently, the hospital is still focused on procedures procurement of goods and services that are government regulated. This study proposes some new activities that are not currently done by the hospital.

An effective strategy for combatting AMR in Indonesia is to make the use of antibiotics in hospitals more rational with the help of an Antimicrobial Resistance Control Program (AMR-CP). This study aims to analyze the implementation of the AMR-CP in hospitals by conducting in-depth interviews with health professionals from ten hospitals and health officers of ten provincial health offices in ten different provinces and observation towards its documents. The sample location was selected by purposive sampling. Informants at the hospitals were hospital directors, chairmen of the AMR-CP team, chairmen of the medical committee, persons in charge of the microbiology laboratory, clinicians, nurses, clinical pharmacists, and those program managers at the provincial health offices who are responsible for administering antibiotics. Information is first collected and then a thematic analysis is applied along with triangulation to confirm the validity of information from multiple sources, including document observation results. The analysis is adapted to the framework of the system (i.e., input, process, and output). Results show that hospitals in Indonesia already have the resources to implement AMR-CP, including AMR-CP team and microbiology laboratories. Six hospitals examined also have clinicians trained in microbiology. Though hospital leadership and its commitment to implementing AMR-CP are favorable, there is room for improvement. AMR-CP teams organize routine activities for socialization and training, develop standard operating procedures (SOPs) for antibiotic use, antibiotic patterns surveillance, and bacterial mapping. Some obstacles to implementing AMR-CP policies are posed by the human resources, facilities, budget, antibiotics and reagent shortages, and clinician compliance with SOPs. The study concludes that there was an improvement in antibiotic sensitivity patterns, rational use of antibiotics, use of microbiological laboratories, and cost-efficiency. It recommends the government and healthcare providers continue to improve AMR-CP in hospitals and promote AMR-CP policy by making the regional health office of the hospital a representative of the regional government.