ANALISIS WASTE TAHAP PRA-PEMERIKSAAN TERHADAP TURN AROUND TIME DAN PENOLAKAN SPESIMEN DARAH DI RUMAH SAKIT DUSTIRA CIMAHI
Abstract
Penolakan spesimen darah merupakan salah satu indikator mutu pelayanan laboratorium yang sebagian besar disebabkan oleh kesalahan pada tahap pra-pemeriksaan dan berdampak pada perpanjangan waktu pelayanan. Ketidakefisienan proses atau waste pada tahap tersebut turut memengaruhi kualitas spesimen serta ketepatan Turn Around Time (TAT). Penelitian ini bertujuan untuk menganalisis waste dan TAT tahap pra-pemeriksaan terhadap penolakan spesimen darah di Laboratorium Rumah Sakit Dustira Cimahi. Penelitian menggunakan desain deskriptif observasional dengan pendekatan Lean Hospital melalui tahapan Define, Measure, Analyze, dan Improve (DMAI). Sampel dipilih menggunakan teknik total sampling terhadap seluruh spesimen darah dan aktivitas proses pra-pemeriksaan yang diamati selama periode penelitian. Data diperoleh melalui observasi langsung terhadap proses pra-pemeriksaan, pengukuran TAT pada spesimen yang ditolak, serta data rekapitulasi penolakan spesimen periode 3 Maret–13 Mei 2026. Hasil penelitian menunjukkan bahwa dari 50.358 spesimen darah yang diperiksa, sebanyak 83 spesimen (0,16%) mengalami penolakan, dengan penyebab terbanyak berupa volume spesimen kurang (34,94%), spesimen beku (32,53%), hemolisis (31,33%), dan salah tabung (1,20%). Teridentifikasi tujuh jenis waste, yaitu defect, overprocessing, waiting, motion, transportation, inventory, dan human potential, dengan defect sebagai waste paling dominan (22,80%). TAT tahap pra-pemeriksaan pada spesimen yang ditolak berkisar 38–90 menit dengan rata-rata 59,8 menit, melebihi target ≤45 menit dengan rata-rata pemanjangan 14,9 menit. Disimpulkan bahwa waste pada tahap pra-pemeriksaan berkontribusi terhadap penolakan spesimen darah dan pemanjangan TAT, sehingga diperlukan peningkatan kepatuhan terhadap SOP, pelatihan flebotomi secara berkala, serta monitoring mutu laboratorium yang berkesinambungan. Blood specimen rejection is one of the laboratory service quality indicators that is largely caused by errors during the pre-analytical phase and contributes to prolonged service time. Process inefficiency, or waste, at this stage also affects specimen quality and the accuracy of Turnaround Time (TAT). This study aimed to analyze waste and pre-analytical TAT in relation to blood specimen rejection at the Laboratory of Dustira Hospital, Cimahi. A descriptive observational design employing the Lean Hospital approach through the Define, Measure, Analyze, and Improve (DMAI) stages was used. The sample was selected using a total sampling technique covering all blood specimens and pre-analytical process activities observed during the study period. Data were obtained through direct observation of the pre-analytical process, TAT measurement of rejected specimens, and specimen rejection recapitulation data for the period of 3 March–13 May 2026. The results showed that of 50,358 blood specimens examined, 83 specimens (0.16%) were rejected, with the leading causes being insufficient specimen volume (34.94%), clotted specimens (32.53%), hemolysis (31.33%), and incorrect tubes (1.20%). Seven types of waste were identified—defect, overprocessing, waiting, motion, transportation, inventory, and human potential—with defect being the most dominant (22.80%). The pre-analytical TAT for rejected specimens ranged from 38 to 90 minutes, averaging 59.8 minutes, exceeding the ≤45-minute target with an average delay of 14.9 minutes. It is concluded that waste in the pre-analytical phase contributes to blood specimen rejection and prolonged TAT, so that strengthened SOP compliance, regular phlebotomy training, and continuous laboratory quality monitoring are needed.Keywords
Waste, Penolakan Spesimen Darah, Pra-Pemeriksaan, Turnaround Time, Lean Hospital
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