ANALISIS FAKTOR YANG BERPENGARUH TERHADAP MORTALITAS PASIEN INTENSIVE CARE UNIT (ICU) DI RSUD Dr. SOEDIRMAN KEBUMEN
Analysis of Factors Influencing Patients Mortality in the Intensive Care Unit (ICU) of Dr. Soedirman Kebumen Regional General Hospital
Abstract
Background: The ICU patient mortality rate is an indicator of hospital service quality. The ICU mortality rate at Dr. Soedirman Kebumen Regional General Hospital over the last five years has been over 40%. This rate is higher compared to the national ICU patient mortality rate in Indonesia, which is 27.6%.
Objective: To identify factors influencing ICU patient mortality and to develop recommendations for an ICU mortality reduction program at Dr. Soedirman Kebumen Regional General Hospital.
Methods: This study employed a mixed-methods research design with a sequential explanatory approach. Quantitative data were obtained from the medical records of ICU patients from July 2024 to December 2024. Qualitative data were gathered through in-depth interviews (management group) and focus group discussions (doctors and nurses). Quantitative data were analyzed using chi-square and Fisher's exact tests, as well as multivariate logistic regression. Qualitative data were analyzed using thematic analysis.
Results: The study included 278 subjects, of whom 126 (45.3%) died in the ICU. Factors identified as significantly influencing ICU patient mortality at Dr. Soedirman Kebumen Regional General Hospital were age (p-value = 0.001), type of diagnosis (p-value = 0.008), Glasgow Coma Scale (GCS) score (p-value <0.001), use of mechanical ventilation (p-value <0.001), and length of stay (p-value = 0.004). The use of mechanical ventilation was the variable with the most significant influence on ICU patient mortality (p = 0.001, OR 43.73, 95% CI 15.84-120.72). Qualitative results suggested several programs to reduce ICU patient mortality, including: re-socialization of ICU admission criteria, activation of palliative care, improvement of human resources competency, multidisciplinary team collaboration, periodic evaluation of Early Warning System (EWS) implementation, evaluation of culture examination procedures, and initiation of High Care Unit (HCU) establishment.
Conclusion: Age, type of diagnosis, Glasgow Coma Scale (GCS) score, use of mechanical ventilation and length of stay are factors influencing ICU patient mortality at Dr. Soedirman Kebumen Regional General Hospital. Given these factors contributing to the high ICU mortality rate, it is crucial for the hospital management to enhance service quality by implementing strategies to reduce ICU patient mortality at Dr. Soedirman Kebumen Regional General Hospital.
Keywords: Intensive Care Unit, ICU, ICU mortality, determinants of ICU mortality, mortality reduction
References
Ababneh, M.A., Al Domi, M., & Rababa’h, A.M. (2022). Antimicrobial use and mortality among intensive care unit patients with bloodstream infections: implications for stewardship programs. Heliyon 8 : 1–9.
Al Khalfan, A.A., Al Ghamdi, A.A., De Simone, S., & Hadi, Y.H. (2021). The Impact of Multidisciplinary Team Care on Decreasing Intensive Care Unit Mortality. Saudi Crit. Care J. 5 : 13–18.
Ardiansyah, F., Widyastuti1, Y., & Jufan, A.Y. (2022). Identifikasi Faktor Risiko Kematian Di ICU RSUP Dr. Sardjito. J. Komplikasi Anastesi 9 : 35–42.
Aslakson, R.;, Curtis, R.;, & Nelson, J.E. (2014). The Changing Role of Palliative Care in the ICU. Crit. Care Med. 42 : 2418–2428.
Astutik, A.W., Annisa, N., Rusli, R., & Ibrahim, A. (2017). Kajian Kesesuaian Pemilihan Antibiotik Empiris Pada Pasien Sepsis Di Instalasi Rawat Inap RSUD Abdul Wahab Sjaharanie Samarinda, in: Proceeding of the 5th Mulawarman Pharmaceuticals Conferences.
Audet, L.A., Bourgault, P., & Rochefort, C.M. (2018). Associations between nurse education and experience and the risk of mortality and adverse events in acute care hospitals: A systematic review of observational studies. Int. J. Nurs. Stud. 80 : 128–146.
Begum, M. (2017). Identification of the Risk Factors Associated with ICU Mortality. Biometrics Biostat. Int. J. 6 : 278–287.
Behal, R., & Finn, J. (2009). Understanding and improving inpatient mortality in academic medical centers. Acad. Med. 84 : 1657–1662.
Campbell, M.J., Jacques, R.M., Fotheringham, J., Maheswaran, R., & Nicholl, J. (2012). Developing a summary hospital mortality index: Retrospective analysis in English hospitals over five years. BMJ 344 : 1–11.
Cecep, C., Maryana, M., & Faizal, K.M. (2023). Pengalaman Perawat dalam Proses Penyapihan Ventilator di Ruang ICU. J. Penelit. Perawat Prof. 5 : 559–572.
D€unser, M.W., Towey, R.M., Amito, J., & M.Mer (2017). Intensive care medicine in rural sub‐Saharan Africa. Anaesthesia 72 : 181–189.
Demass, T.B., Guadie, A.G., Mengistu, T.B., Belay, Z.A., Melese, A.A., Berneh, A.A., et al. (2023). The magnitude of mortality and its predictors among adult patients admitted to the Intensive care unit in Amhara Regional State, Northwest Ethiopia. Sci. Rep. 13 : 1–7.
Djasri, H., & Errisa, B. (2011). Hospital Mortality Reduction Program [WWW Document]. URL http://mutupelayanankesehatan.net/index.php/berita/34-hospital-mortality-reduction-program (accessed 11.16.24).
Edwardson, S., & Cairns, C. (2019). Nosocomial infections in the ICU. Anaesth. Intensive Care Med. 20 : 14–18.
Endeshaw, A.S., Tarekegn, F., Bayu, H.T., Ayalew, S.B., & Gete, B.C. (2022). The magnitude of mortality and its determinants in Ethiopian adult intensive care units: A systematic review and meta-analysis. Ann. Med. Surg. 84 : 1–9.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C.M., French, C., et al. (2021). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 47 : 62.
Fathi, M., Moghaddam, N.M., Balaye Jame, S.Z., Darvishi, M., & Mortazavi, M. (2022). The association of Glasgow Coma Scale score with characteristics of patients admitted to the intensive care unit. Informatics Med. Unlocked 29.
Fatmawati, R., Kusumajaya, H., & Ardiansyah (2023). Faktor-Faktor Yang Berhubungan Dengan Pengetahuan Perawat Dalam Pencegahan Ventilator Associated Pneumonia. J. Penelit. Perawat Prof. 5 : 1377–1386.
Fauziyah, H.T.A., Semedi, B.P., Lestari, P., & Maulydia, M. (2021). Analisis Sistem Skoring APACHE II dan SOFA Terhadap Outcome di Intensive Care Unit RSUD Dr. Soetomo Surabaya. JAI (Jurnal Anestesiol. Indones. 13 : 99–113.
Firmansyah, J., Wahyuni, A., Ratna, M.G., Carolia, N., Abdul, H., Provinsi, M., et al. (2022). Hubungan Sensitivitas Antibiotik Terhadap Luaran Pasien Sepsis di Ruang Intensive Care Unit (ICU) RSUD Dr. H. Abdul Moeloek Provinsi Lampung Tahun 2018-2021. Medula 12 : 231–237.
Friman, O., Bell, M., Djärv, T., & Andreas Hvarfner, G.J. (2018). National Early Warning Score vs Rapid Response Team criteria—Prevalence, misclassification, and outcome. Acta Anaesthesiol. Scand. 63 : 215–221.
Giannasi, S.E., Venuti, M.S., Midley, A.D., Roux, N., Kecskes, C., & San Román, E. (2018). Mortality risk factors in elderly patients in intensive care without limitation of therapeutic effort. Med. Intensiva 42 : 482–489.
Gunawan, A.H. (2016). Analisis Kebutuhan Tenaga Perawat Unit Pelayanan Intensif Berdasarkan Beban Kerja dan Kompetensi di Unit Pelayanan Intensif Rumah Sakit Dr Oen Solo Baru Tahun 2015. J. Adm. Rumah Sakit Indones. 2.
Hailu, A., Kibreab, A., & Gidey (2018). Pattern and Outcome of Medical Intensivve Care Unit Admission to Ayder Càmprehensive Specialised Hospitalised Hospital in Tigray, Etiopia. Ethiop Med J 56 : 31–36.
Hair, J., Black, W., Babin, B., & Anderson, R. (2010). Multivariate Data Analysise, Seventh. ed. New York : Prentice Hall International.
Hariyanto, H., Yahya, C.Q., Cucunawangsih, C., & Pertiwi, C.L.P. (2022). Antimicrobial Resistance and Mortality. African J. Infect. Dis. 16 : 13–20.
Hendra, M., Akhmad Yun, & Widodo, U. (2023). Faktor Risiko Mortalitas Pasien Geriatri Yang Dirawat Di Icu Rsup Dr. Sardjito Yogyakarta. J. Komplikasi Anestesi 10 : 56–67.
Husodo, S.D., Kumala, A.R., & Rahayu, I.N. (2020). Analisis Efisiensi Bangsal ICU/ICCU Dua Rumah Sakit Jawa Tengah Berdasarkan Standar Depkes Dan Barber Johnson. Hang Tuah Med. J. 18 : 100–113.
Iapichino, G., Gattinoni, L., Radrizzani, D., Simini, B., Bertolini, G., Ferla, L., et al. (2004). Volume of activity and occupancy rate in intensive care units. Association with mortality. Intensive Care Med. 30 : 290–297.
Kachingwe, M., Kayambankadzanja, R.K., Mwafulirwa, W.K., Chikumbanje, S.S., & Baker, T. (2022). Factors associated with in-hospital mortality of patients admitted to an intensive care unit in a tertiary hospital in Malawi. PLoS One 17 : 1–13.
Kedir, S., Berhane, A., Bayisa, T., & Wuletaw, T. (2017). Admission Patterns And Outcomes In The Medical Intensive Care Unit Of St. Paul’s Hospital Millenium Medical College, Addis Ababa, Ethiopia. Ethiop Med J . 55 : 19–26.
Kemenkes RI (2011). Keputusan Direktur Jenderal Bina Upaya Kesehatan Nomor HK.02.04/I/1966/11 Tentang Petunjuk Teknis Penyelenggaraan Pelayanan Intensive Care Unit (ICU) Di Rumah Sakit.
Kemenkes RI (2010a). KMK No. 1778 tentang Pedoman Penyelenggaraan Pelayanan ICU di Rumah Sakit.
Kemenkes RI (2010b). Keputusan Menteri Kesehatan Republik Indonesia Nomor: 834/MENKES/SK/VII/2010 Tentang Pedoman Penyelenggaraan Pelayanan High Care Unit (HCU) di Rumah Sakit.
Khasanah, N., Fadillah, N., & Sari, I. (2022). Analisis Deskriptif Indikator Gross Death Rate (Gdr) Dan Net Death Rate (Ndr) Di Rumah Sakit X Pada Tahun 2016-2020. Media Bina Ilm. 16 : 7639–7646.
Kiekkas, P., Tzenalis, A., Gklava, V., Stefanopoulos, N., Voyagis, G., & Aretha, D. (2022). Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis. Biomed Res. Int. 2022.
Kim, S., Kim, G.O., Lee, S., & Kwon, Y.U. (2024). Effects of intensive care unit quality assessment on changes in medical staff in medical institutions and in-hospital mortality. Hum. Resour. Health 22 : 1–11.
Kollef, M.H., Shorr, A.F., Bassetti, M., Timsit, J.F., Micek, S.T., Michelson, A.P., et al. (2021). Timing of antibiotic therapy in the ICU. Crit. Care 25 : 1–10.
Lakbar, I., Medam, S., Ronflé, R., Cassir, N., Delamarre, L., Hammad, E., et al. (2021). Association between mortality and highly antimicrobial-resistant bacteria in intensive care unit-acquired pneumonia. Sci. Rep. 11 : 1–9.
Lalani, H.S., Waweru-Siika, W., Mwogi, T., Kituyi, P., Egger, J.R., Park, L.P., et al. (2018). Intensive care outcomes and mortality prediction at a National Referral Hospital in Western Kenya. Ann. Am. Thorac. Soc. 15 : 1336–1343.
Lenti, M.V., Croce, G., Brera, A.S., Ballesio, A., Padovini, L., Bertolino, G., et al. (2023). Rate and risk factors of in-hospital and early postdischarge mortality in patients admitted to an internal medicine ward. Clin. Med. J. R. Coll. Physicians London 23 : 16–23.
Li, W., Cai, J., Ding, L., Chen, Y., Wang, X., & Xu, H. (2024). Incidence and risk factors of ventilator-associated pneumonia in the intensive care unit: a systematic review and meta-analysis. J. Thorac. Dis. 16 : 5518–5528.
Listyorini, P.I., & Aurista, V.L. (2019). Trend Indikator Pelayanan Intensive Care Unit di RSUD Dr. Moewardi Tahun 2014-2018. J. Ilm. Rekam Medis dan Inform. Kesehat. 9 : 53–62.
Ma, J.G., Zhu, B., Jiang, L., Jiang, Q., & Xi, X.M. (2022). Gender- and age-based differences in outcomes of mechanically ventilated ICU patients: a Chinese multicentre retrospective study. BMC Anesthesiol. 22 : 1–10.
Mawuntu, A.H.P. (2019). Meninjau Kembali Glasgow Coma Scale: Masihkah Relevan? Maj. Kedokt. Neurosains Perhimpun. Dr. Spes. Saraf Indones. 36.
Megawati, S.W., Dewi, T., & Acep Dadang Nurohmat, R.M. (2021). Analisis Mortalitas Pasien di Ruang Intensive Care Unit (ICU). J. Med. Cendekia 7 : 127–135.
Melaku, E., Urgie, B., Dessie, F., Seid, A., Abebe, Z., & Tefera, A. (2024). Determinants of Mortality of Patients Admitted to the Intensive Care Unit at Debre Berhan Comprehensive Specialized Hospital: A Retrospective Cohort Study. Patient Relat. Outcome Meas. Volume 15 : 61–70.
Mercadante, S., Gregoretti, C., & Cortegiani, A. (2018). Palliative care in intensive care units: Why, where, what, who, when, how. BMC Anesthesiol. 18 : 1–6.
Mohammed, S.O., Abdi, O.A., & Getish, B.G. (2017). Clinical outcomes of patients admitted in intensive care units of Nigist Eleni Mohammed Memorial Hospital of Hosanna, Southern Ethiopia. Int. J. Med. Med. Sci. 9 : 79–85.
Morita, K., Matsui, H., Yamana, H., Fushimi, K., Imamura, T., & Yasunaga, H. (2017). Association between advanced practice nursing and 30-day mortality in mechanically ventilated critically ill patients: A retrospective cohort study. J. Crit. Care 41 : 209–215.
Mostafa, M., Hamed, L., Mokhtar, S., & Arafa, M. (2025). Analysis of mortality factors in ICU patients with sepsis and septic shock: a retrospective study. Egypt. J. Crit. Care Med. 12 : 1–5.
Motiejunaite, J., Deniau, B., Blet, A., Gayat, E., & Mebazaa, A. (2022). Inotropes and vasopressors are associated with increased short-term mortality but not long-term survival in critically ill patients. Anaesth. Crit. Care Pain Med. 41.
Mueller, J.T., Thiemann, K.M.B., Lessow, C., Murad, M.H., Wang, Z., Santrach, P., et al. (2020). The Mayo Clinic Hospital Mortality Reduction Project: Description and Results. J. Healthc. Manag. 65 : 122–132.
Mumtaz, H., Saqib, M., Khan, W., Ismail, S.M., Sohail, H., Muneeb, M., et al. (2023). Ventilator associated pneumonia in intensive care unit patients: a systematic review. Ann. Med. Surg. 85 : 2932–2939.
Netzer, G., Liu, X., Shanholtz, C., Harris, A., Verceles, A., & Iwashyna, T.J. (2011). Decreased mortality resulting from a multicomponent intervention in a tertiary care medical intensive care unit. Crit. Care Med. 39 : 284–293.
Nugroho, A.A., Arifin, J., & Satoto, H.H. (2018). Pemeriksan Kultur Sekret sebagai Penunjang Diagnosis untuk Mengetahui Kejadian Ventilator Associated Pneumonia pada Pasien Pasca Pembedahan di Intensive Care Unit RSUP Dr. Kariadi Semarang. JAI (Jurnal Anestesiol. Indones. 10 : 93.
Paramythiotou, E., & Routsi, C. (2016). Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients. World J. Crit. Care Med. 5 : 111–120.
Pinheiro, S., M., F.G.D., Santos, S., Barreto, E., C., Í.D. De, Weiss, C., et al. (2020). Mortality Predictors and Associated Factors in Patients in the Intensive Care Unit: A Cross-Sectional Study. Crit. Care Res. Pract. 2020 : 5–10.
RSUD Dr. Soedirman Kebumen (2024). Profil RSUD Dr. Soedirman Kebumen Tahun 2023.
RSUD Dr. Soedirman Kebumen (2022a). Pedoman Pengorganisasian Instalasi Rawat Intensif RSUD Dr. Soedirman Kebumen.
RSUD Dr. Soedirman Kebumen (2022b). Pedoman Pelayanan Instalasi Rawat Intensif RSUD Dr. Soedirman Kebumen.
Rustini, S.A., Putri, N.M.M.E., Hurai, R., Suarningsih, N.K.A., Susiladewi, I.A.M.V., Kamaryati, N. putu, et al. (2023). Layanan keperawatan intensif (Ruang ICU & OK), PT.Sonpedia Publisihing Indonesia. Jambi : PT. Sonpedia Publishing Indonesia.
Rustiyanto, E. (2010). Statistik Rumah Sakit untuk Pengambilan Keputusan. Yogyakarta : Graha Ilmu.
Sabaz, M.S., Asar, S., Cukurova, Z., Sabaz, N., Doğan, H., & Sertcakacilar, G. (2020). Effect of Delayed Admission to Intensive Care Units from the Emergency Department on the Mortality of Critically Ill Patients. Iran. Red Crescent Med. J. 22.
Semet, C. (2023). The ongoing challenge of ventilator-associated pneumonia: epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit. Infect. Prev. Pract. 5 : 1–7.
Silaban, P.T.G., & Tarigan, E.V.T.B. (2024). Analisis Indikator Rasio Angka Kematian di Ruang ICU / ICCU pada Rumah Sakit 3 : 14–24.
Simpson, A., Puxty, K., McLoone, P., Quasim, T., Sloan, B., & Morrison, D.S. (2021). Comorbidity and survival after admission to the intensive care unit: A population-based study of 41,230 patients. J. Intensive Care Soc. 22 : 143–151.
Subhan, N., Giwangkencana, G.W., Prihartono, M.A., & Tavianto, D. (2019). Implementasi Early Warning Score pada Kejadian Henti Jantung di Ruang Perawatan Rumah Sakit Dr. Hasan Sadikin Bandung yang Ditangani Tim Code Blue Selama Tahun 2017. J. Anestesi Perioper. 7 : 33–41.
Suryadi, T., Taufik, N.H., Pasaribu, A., Sayuntri, & Sovia, C.N. (2021). Analisis Rasio Dokter dan Perawat Terhadap Gross Death Rate dan Net Death Rate Tahun 2013─2016 Di RSUD dr. Zainoel Abidin Banda Aceh. J. Med. Sci. 2 : 28–37.
Suryadilaga, Y., Arifin, J., & Ismail, A. (2015). Jumlah Kematian Pasien di Ruang Perawatan Intensif Berdasarkan Kriteria Prioritas Masuk Di RSUP Dr Dr Kariadi Periode Juli - September 2014. Media Med. Muda 4 : 1561–1568.
Suryaman, R., Widodo, U., & Sari, D. (2020). Perbandingan Luaran Pasien Level Of Care 3 yang Menggunakan Ventilator Sebelum dan Sesudah Operasional Ruang High Care Unit Di RSUP Dr. Sardjito Yogyakarta. J. Komplikasi Anastesi 8 : 7–13.
Susanti, F.T., Eliawati2, U., & Muharni, S. (2023). Prediktor Mortalitas Pasien ICU Yang Terpasang Ventilasi Mekanik Di Ruang ICU RSUD Raja Ahmad Tabib Tanjungpinang. J. Ilmu Kedokt. dan Kesehat. 10 : 936–947.
Susmiarti, Harmayett, D., & Dewi, Y.S. (2015). Intervensi VAP Bundle Dalam Pencegahan Ventilator Associated Pneumonia (VAP) Pada Pasien Dengan Ventilasi Mekanis. J. Ners 1 : 138–146.
Sutrisno (2020). Risiko Ketidakpatuhan Penerapan Early Warning ScoreTerhadap Mortalitas Pasien Di RSUD Wates. Universitas Gadjah Mada.
Tauran, P.M., Djaharuddin, I., Bahrun, U., Nurulita, A., Katu, S., Muchtar, F., et al. (2022). Excess mortality attributable to antimicrobial-resistant bacterial bloodstream infection at a tertiary-care hospital in Indonesia. PLOS Glob. Public Heal. 2 : e0000830.
Tesema, H.G., Lema, G.F., Mesfin, N., Fentie, D.Y., & Arefayne, N.R. (2021). Patterns of Admission and Clinical Outcomes Among Patients Admitted to Medical Intensive Care Unit of a Teaching and Referral Hospital, Northwest Ethiopia. Glob. Adv. Heal. Med. 10 : 0–6.
Utarini, A. (2020). Penelitian Kualitatif Dalam Pelayanan Kesehatan. Sleman : Gadjah Mada University Press.
Walicka, M., Chlebus, M., Śliwczyński, A., Brzozowska, M., Rutkowski, D., Czech, M., et al. (2020). Predictors of in-hospital mortality in nonsurgical departments: A multivariable regression analysis of 2 855 029 hospitalizations. Polish Arch. Intern. Med.
Wijaksana, D.S., Anggraeni, N., & Endriani, R. (2019). Pola Bakteri dan Resistensi Antibiotik pada Pasien Sepsis di Intensive Care Unit (ICU) RSUD Arifin Achmad Provinsi Riau Periode 1 Januari – 31 Desember 2017. J. Ilmu Kedokt. 13 : 46.
Wungo, Setya, C., Setyani, & Rina, F.A. (2022). Faktor-Faktor Yang Berhubungan Dengan Mortalitas Pasien Di Intensive Care Unit Rumah Sakit Panti Rapih Yogyakarta. J. Keperawatan I CARE 3 : 146–157.
Copyright (c) 2025 Diah Ayu Putriyanti
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
