INDIKATOR MUTU R

NO UNIT

1 IGD

2 POLIKLINIK
3 KEPERAWATAN
BANGSAL

4 OK
5 RADIOLOGI
6 LABORATURIUM
7 FARMASI

8 GIZI
9 REKAM MEDIK

10 KEUANGAN

11 HD
12 AMBULANCE
13 CS

14 LAUNDRY

15 KEPEGAWAIAN
16 PPI
 INDIKATOR MUTU RS LESTARI 2017
INDIKATOR STANDAR

1. Kematian Pasien ≤ 24 jam di Gawat Darurat ≤ 2 perseribu

2. Waktu Tanggap Pelayanan Dokter Di Gawat darurat ≤ 5 menit
1. Waktu Tunggu di Rawat Jalan ≤ 60 menit
1. Kejadian Infeksi Pasca Operasi ≤ 1,5 %
2. Kematian Pasien > 48 jam ≤0,24 %
3. Kejadian Pulang Paksa ≤5%
4. Tidak Adanya Kejadian Pasien Jatuh 100%

1. Waktu Tunggu Hasil Pelayanan Laboraturium ≤ 140 menit

(manual)
1. Waktu Tunggu Pelayanan Obat Jadi ≤ 30 menit
2. Waktu Tunggu Pelayanan Obat Racikan ≤ 60 menit
1. Tidak Adanya Kesalahan Dalam Pemberian Diet 100%
1. Waktu Penyediaan Dokumen Rekam Medik Pelayanan Rerata ≤10
Rawat Jalan menit

1. Ketepatan Waktu Pengurusan Gaji dan pemberian 100%

imbalan (insentif ) sesuai kesepakatan waktu

2. Kecepatan Waktu Pemberian Informasi Tentang Tagihan ≤ 2 jam

Pasien Rawat inap

1. Kejadian Terlepasnya Jarum Vena 0%

1. Waktu Pelayanan Ambulance 24 jam
1. Kecepatan Waktu Menanggapi Kerusakan Alat ≤ 15 menit
2. Waktu Tanggap Pelayanan Pemulasaraan Jenazah ≤ 2 jam
1. Ketepatan Waktu Penyediaan Linen Untuk Ruang Rawat 100%
Inap jam 12.30
1. Ketepatan Waktu Kontrak Kerja 100%
1. Tersedia APD disetiap Instalasi 60%
2. Kepatuhan Penggunaan APD dan Cuci Tangan 100%
RS LESTARI 2017
TARGET JANUARI FEBRUARI MARET DATA PER 3bln APRIL MEI

100% 100% 100% 100% 100% 100% 95%

100% 100% 95% 100% 98% 95% 100%
80% 84% 80% 82% 82% 84% 82%
100% 100% 100% 100% 100% 95%
100% 100% 100% 100% 100% 95%

95% 100% 95% 97% 95% 95%

80% 80% 80% 80% 80% 80% 80%

100% 100% 100% 100% 100% 95% 100%
100% 100% 100% 100% 100% 100% 100%
100%
100% 100% 100% 100% 100% 100%
100%
100% 100% 100% 100% 100% 100%
100%
100% 100% 100% 100% 100% 100%
100%
100% 100% 100% 100% 100% 100%
0% 100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%
80%
100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%

100% 100% 100% 100% 100% 100%

100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%
JUNI DATA PER JULI AGUSTUS SEPTEMBER DATA PER
3bln 3bln

100% 98% 100% 95% 100% 98%

100% 98% 95% 100% 100% 98%
82% 83% 84% 82% 82% 83%
100% 98% 100% 100% 100% 100%
100% 98% 100% 95% 100% 98%

95% 95% 95% 95% 95% 95%

80% 80% 80% 80% 80% 80%

100% 98% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%

100% 100% 100% 100% 100% 100%

100% 100% 100% 100% 100% 100%

100% 100% 100% 100% 100% 100%

100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%

100% 100% 100% 100% 100% 100%

100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%
100% 100% 100% 100% 100% 100%
OKTOBER NOVEMBER DESEMBER DATA PER
3bln

100% 95% 100% 98%

95% 100% 100% 98%
84% 82% 82% 83%
100% 100% 100% 100%
100% 95% 100% 98%

95% 95% 95% 95%

80% 80% 80% 80%

95% 100% 100% 98%
100% 100% 100% 100%
100% 100% 100% 100%

100% 100% 100% 100%

100% 100% 100% 100%

100% 100% 100% 100%

100% 100% 100% 100%
100% 100% 100% 100%
100% 100% 100% 100%
100% 100% 100% 100%

100% 100% 100% 100%

100% 100% 100% 100%
100% 100% 100% 100%
100% 100% 100% 100%