Factors Influenced the Endoscopic Services Volume during the COVID-19 Pandemic at National Tertiary Referral Hospital in Indonesia: Dr. Cipto Mangunkusumo Hospital.

The impact of the COVID-19 pandemic caused a decrease in healthcare services, the intervention of non-surgical procedures, and endoscopy. This study examined the volume of endoscopy at Dr. Cipto Mangukusumo Hospital, the highest referral hospital in Indonesia. A cross-sectional mixed method was used to assess the relationship between endoscopy volume, age, gender, number of COVID-19 cases, type of patient's case, the origin of treatment, and the kind of endoscopic procedure before and during the pandemic. The secondary data were collected through the hospital's Electronic Health Record (EHR) System and "Kawal COVID-19" Websites, while the primary data were collected through observation, document reviews, and in-depth online interviews with doctors at endoscopic units. This study period was divided into six intervals of three months, respectively, from January 2020 to September 2021, and 5030 endoscopic procedures were collected. The data were analyzed both quantitatively through the SPSS statistics and qualitatively. The quantitative data presented as descriptive and bivariate results in an Independent T-Test and a Chi-Square test. The results showed there was a significant difference (p = 0.004) in the volume of endoscopes before (the highest volume) and during the pandemic (the lowest volume during April-June 2020 period). The mean age of the patients was higher before the pandemic. There was a significant difference between patient admissions from outpatient and emergency procedures before and during the pandemic. There are changes in the flow of outpatient to do endoscopies which were different from the flow of emergency patients during the pandemic, which focused on the long waiting list for inward entry queues, the mandatory COVID-19 PCR swab, and the criteria of emergency cases for fast-track procedures, the reduced bed capacity, and the expired date of laboratory examinations. The decreased volume was also caused by the limitation of patient intervention by the doctors. However, the duration of the action procedure was accelerated without reducing its quality. Furthermore, there was a high wave of Delta Variant cases from May to July 2021. In addition, the factors of age, type of patient's case, origin, and treatment showed significant differences before and during the COVID-19 pandemic. Finally, changes in the flow of services also influenced various impacts on endoscopy and service costs. Therefore, further study is required to calculate the unit costs.

Usefulness of the CODE ST-Segment Elevation Myocardial Infarction Program to Improve Quality Assurance in Patients With ST-Segment Elevation Myocardial Infarction.

The highest mortality rate associated with acute coronary syndrome is observed in patients with ST-segment elevation myocardial infarction (STEMI). Quality care in STEMI management depends on timely reperfusion of the ischemic coronary artery. The CODE STEMI program has been developed to reduce delays and serves as a method to improve quality care in patients with STEMI. Our study aimed to investigate the effects of implementing the CODE STEMI program on quality care and hospital marketing strategy. Our research was a descriptive study with mixed evaluation methods. We enrolled 207 patients with STEMI who underwent primary percutaneous coronary intervention from 2015 to 2018. We used quantitative methods by tracking medical records and administrative documents, as well as qualitative methods by observation and in-depth interviews. Statistical analysis was done using Mann-Whitney and chi-square tests. Our study demonstrated reduced door-to-balloon time, total cost, and length of stay of patients with STEMI who were treated with the CODE STEMI program (p <0.001, p <0.001, and p = 0.009, respectively). In addition, there was a likely decrease in major adverse cardiac event incidence and mortality rate after the implementation of CODE STEMI. The hospital and patients expressed their satisfaction with the CODE STEMI program. The program proved to have good efficacy, effectiveness, optimality, acceptability, legitimation, and equity. It also met the marketing mix principles, which included increasing the total number of patients with cardiovascular diseases as well as increasing levels of public trust in STEMI management. In conclusion, the CODE STEMI program has a positive impact on quality care and hospital marketing strategy.

CODE STEMI Program Improves Clinical Outcome in ST Elevation Myocardial Infarction Patients: A Retrospective Cohort Study.

PURPOSE: One of the most frequent causes of cardiac mortality is ST elevation myocardial infarction (STEMI). Delay in the management of STEMI patients is a cause of high mortality and morbidity. This study aims to determine the effect of the implementation of the CODE STEMI program on major adverse cardiac events (MACE) and mortality of STEMI patients at Dr. Cipto Mangunkusumo General Hospital. PATIENTS AND METHODS: This was a retrospective cohort study that enrolled 207 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) in 2015-2018. The patients were divided into two groups. The first group was treated prior to establishing the CODE STEMI program. The other group was treated according to the program, which was implemented in January 2017. Data were collected from medical records, and we retrospectively analyzed all in-hours, MACE, and mortality of STEMI patients from both groups as primary outcomes. Data analysis was done using the Mann-Whitney and chi-square test. RESULTS: There were 72 and 135 patients in the pre-CODE STEMI and CODE STEMI groups, respectively. D2BT was significantly reduced by 130 min (288±306 vs 158±81, P< 0.001) since the implementation of CODE STEMI program. There were trends to lower in-hospital mortality rates (8.3% vs 4.4%, RR = 0.53) and MACE at 30 days (48.61% vs 37.78%, RR = 0.77). CONCLUSION: Implementation of the CODE STEMI program can reduce door-to-balloon time and decrease the MACE and mortality rate in STEMI patients in general hospitals.