Jabatan Kecemasan Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) menerima kedatangan pesakit yang
ramai pada setiap hari menyebabkan jabatan ini kerap berdepan dengan masalah kesesakan. Justeru, objektif kajian ini
adalah mengenal pasti model pengoptimuman terbaik untuk menambahbaik sumber bagi meningkatkan tahap kecekapan
Jabatan Kecemasan PPUKM dan menyelesaikan masalah kesesakan jabatan. Kaedah simulasi digunakan bagi membina
model jabatan kecemasan dengan pemboleh ubah yang digunakan dalam pemodelan simulasi ini adalah dikhususkan
berdasarkan zon atau ruang rawatan. Alternatif penambahbaikan yang dicadangkan ini mengandungi konfigurasi bilangan
sumber jabatan yang baru. Enam model gabungan yang digunakan terdiri daripada Model CCR dan Set Rujukan, Model
BCC dan Set Rujukan, Model CCR dan Kecekapan-Super, Model BCC dan Kecekapan-Super, Model Bi-Objektif MCDEACCR dan Kecekapan Silang dan Model Bi-Objektif MCDEA-BCC dan Kecekapan Silang. Model Bi-Objektif MCDEA-BCC
merupakan lanjutan kepada Model Bi-Objektif MCDEA-CCR daripada kajian terdahulu. Keputusan kajian menunjukkan
Model Bi-Objektif MCDEA-BCC yang dibina telah memberikan bilangan alternatif penambahbaikan cekap yang paling
kecil berbanding model-model gabungan lain. Melalui model gabungan ini juga satu alternatif penambahbaikan yang
optimum yang telah dicadangkan dapat mengurangkan masa menunggu pesakit di Zon Hijau sebanyak 51% manakala
peratusan penggunaan tenaga kerja sumber berjaya ditambahbaik agar lebih munasabah. Alternatif ini memerlukan
susun atur kembali kedudukan sumber tanpa melakukan perubahan yang besar ke atas sistem asal.
Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)