Medical workers arrange hospital beds at a COVID-19 hospital in the Wisma Atlet Kemayoran apartment complex in Jakarta on March 23. The hospital can accommodate up to 3,000 patients. Antara/Kompas/Heru Sri Kumoro/Pool
Medical workers arrange hospital beds at a COVID-19 hospital in the Wisma Atlet Kemayoran apartment complex in Jakarta on March 23. The hospital can accommodate up to 3,000 patients. Antara/Kompas/Heru Sri Kumoro/Pool

The emergence of new COVID-19 cases in Jakarta, the first national epicenter of the outbreak, is showing no signs of slowing down despite claims that the capital was far more prepared for the disease thanks to improvements in its healthcare system.

Jakarta now has 67 referral hospitals to treat COVID-19 patients, with a total capacity of 4,555 beds and 659 intensive care (ICU) rooms, according to the city’s health agency.

It has come a long way from having only eight referral hospitals with 904 beds and 80 ICUs in March when the first two cases were officially announced in Indonesia.

In the early days of the epidemic, hospitals were operating beyond their capacity and patients had to wait for hours to receive treatment; many were even rejected.

Jakarta Governor Anies Baswedan has said that in March and April, the city would not have been able to treat 6,000 patients at the same time — considered the worst-case scenario — because it did not have an “adequate system”.

But the capital has made notable improvements in its healthcare system, having sped up the referral process and monitoring of medical workers and inventory.

“[The improvements] helped speed up treatment for patients and ensured that everyone coming into our health facilities would get fast and proper treatment without a long wait,” Anies told The Jakarta Post in a recent interview.

One innovation that helped with the improvement is the information dashboard on dkitanggapcovid.id, which integrates data from the 67 referral hospitals, said Sulung Mulia Putra, head of referral health services at the Jakarta Health Agency.

The monitoring system, accessible only to health agency officials and hospitals, has improved the monitoring of COVID-19 patients, medical workers and availability of personal protective equipment in hospitals, he said.

The improved system was not without flaws when it was launched in April, he added, largely because of hospitals’ limited capacity.

“Patient inflow was exceptionally high [at the time].”

But the system’s effects on hospitals were increasingly seen.

Dian Ekowati, president director of city-owned Tarakan Hospital in Central Jakarta, said the system helped the hospital quickly refer patients to other facilities when it had yet to install a dedicated operating room for COVID-19 patients.

And while the idea of integrating hospital data had been around for the past few years, it was only after COVID-19 hit the country that hospitals became more disciplined in reporting or sharing their information, said Mohammad Syahril, president director of the Sulianti Saroso Infectious Diseases Hospital in North Jakarta.

He said it used to be common to refer patients to other hospitals without first informing the destination facility, which would delay treatment.

“They were either full or didn’t have the [necessary] equipment, so patients would have to be referred to other hospitals.”

But with the onset of the outbreak, there was no more room for delays as officials worked to quickly suppress death rates.

Jakarta has officially recorded 658 COVID-19 deaths, but the probable number of total deaths reached 2,152 on Monday, according to data from corona.jakarta.go.id.

The city health agency and hospitals have started evaluating existing referral systems, namely the Referral Integrated System (Sisrute) and the Integrated Emergency Management System (SPGDT) that was developed by the Health Ministry, Syahril said.

With these platforms, hospitals must first submit information on the patient as well as a reason for their referral to other facilities. Then, they wait, he said.

But now, hospitals regularly update data on patients, human resources and the availability of medical equipment through the ministry’s RS Online app.

The city's COVID-19 dashboard has been integrated with RS Online, said Sulung from the Jakarta Health Agency.

The Indonesian Hospital Association's (PERSI) Jakarta chapter chairman, Koesmedi Priharto, warned against complacency now that the city was forging “new norms” rather than ushering in a “new normal”.

He said COVID-19 still left so much to be learned, while standard operating procedures for the treatment of the disease continued to evolve.

As one solution, Koesmedi urged the Jakarta administration to start mapping hospitals for COVID-19 patients and those for patients seeking other forms of treatment, so that the latter would not be worried about seeking medical attention.

“Prepare hospitals for non-COVID-19 patients, because they’ll have to carry out triage [and emergency assessment for sorting patients] upfront,” he said.

“If patients have COVID-19 symptoms, then the hospital must refer them to the [appropriate facility]. In this case, preparing a referral system becomes very important.”

Sulung said his agency did not rule out the possibility of improving its existing monitoring system for hospitals under its authority, which includes facilities reserved for non-COVID-19 patients.

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