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The ICU is one of the largest clinical cost centers in hospitals due to its high demand for human resources, medical equipment, and operational costs. This situation emphasizes that intensive care unit efficiency is a multidimensional issue that cannot be assessed solely from a single aspect. This study aims to analyze the efficiency of the intensive care unit at Ciremai Hospital, Cirebon City, using the Data Envelopment Analysis (DEA) model to determine resource optimization. Analytical quantitative study with a cross-sectional design. The population in this study consisted of personnel in the ICU of Ciremai Hospital from 2023 to 2025, with total sampling applied. The input variables included the number of physicians, nurses, beds, monitors, and ventilators, while the output variables consisted of BOR, LOS, and recovered patients. The ICU input variables remained stable during the study period, while output variables fluctuated with a declining trend in BOR and LOS. The results of the Data Envelopment Analysis (DEA) indicated that all study periods achieved an efficiency score of 1.00 (efficient), with a slack value of 0.00 across all input variables.

Abstract: One of the most common harmful bacteria, particularly in hospitals, is Pseudomonasaeruginosa, which is also the most frequent cause of wound infections. Because it leads to antibioticresistance and persistent infections, one of the most significant virulence factors it produces isbiofilm. The goal of the current study is to prevent P. aeruginosa isolates from wound patients fromforming biofilms by using plantaricin, which is a peptide with broad-spectrum antibiotic generated byLactobacillus plantarum. In order to produce plantaricin, so that Lactobacillus plantarum isolates from rawbuffalo milk were screened. The plantaricin was then purified using ammonium salts and a gelfiltration column, with a final 40% recovery. The isolates of P. aeruginosa with more production tobiofilm from wound infections were tested for the inhibitory impact of pure plantaricin. The resultsshowed that the plantaricin reduced the development of biofilms in a dose-dependent manner, with alarger percentage of biofilm inhibition reaching 46–68% at 150 µg/ml.

The healthcare sector is increasingly confronted with a VUCA environment (Volatility, Uncertainty, Complexity, and Ambiguity), requiring hospitals to adopt adaptive, resilient, and innovative strategies. This study aims to systematically review the evidence on smart hospital strategies in responding to uncertainty, particularly in improving service quality, operational efficiency, and patient satisfaction. A systematic literature review was conducted using major academic databases, including Scopus-indexed sources, Google Scholar, and Semantic Scholar, covering publications from 2020 to 2026. Articles were selected based on predefined inclusion criteria focusing on hospital management strategies in dynamic and uncertain environments. A total of 10–15 relevant studies were included and analyzed using thematic synthesis. The findings indicate that key strategies in addressing VUCA challenges include digital transformation (e.g., electronic medical records and telemedicine), adaptive and transformational leadership, agile management approaches, and patient-centered care. Digital technologies significantly improve efficiency and decision-making processes, while agile and adaptive leadership enhances organizational responsiveness and resilience. However, several studies highlight that technological advancement alone is insufficient without integrating humanistic values such as empathy, communication, and trust. In conclusion, the most effective hospital strategies in a VUCA world are those that integrate technological innovation with human-centered care. Hospitals must develop flexible, data-driven, and patient-oriented systems to ensure sustainability and competitiveness in uncertain environments. Future research should focus on longitudinal and experimental designs to strengthen causal evidence and explore the integration of digital systems with humanistic healthcare values.

Compliance with clinical pathways is a critical component in ensuring quality of care, patient safety, and cost efficiency in hospitals. However, its implementation continues to face challenges related to management systems and the work behavior of Healthcare Providers (HCPs). This study aimed to analyze the effect of performance-based remuneration systems and organizational support on clinical pathway compliance, with work discipline serving as an intervening variable among HCPs at Cabangbungin Regional General Hospital.This research employed a quantitative approach with an explanatory research design. Data were collected using structured questionnaires and analyzed through Structural Equation Modeling (SEM) with a Partial Least Squares (PLS) approach, supported by the three-box method analysis. The findings indicate that performance-based remuneration systems and work discipline have a significant positive effect on clinical pathway compliance. Furthermore, work discipline was found to strengthen the relationship between performance-based remuneration and compliance, confirming its mediating role. In contrast, organizational support did not show a significant direct or indirect effect on clinical pathway compliance.The study concludes that compliance with clinical pathways is more strongly influenced by performance control mechanisms and clinical work discipline than by general organizational support. These findings provide evidence-based insights for hospital management in designing sustainable strategies and policies to enhance clinical pathway adherence and improve service quality.

Drug stockouts in hospitals pose significant risks to service quality, patient safety, and operational efficiency. This study aimed to analyze how drug demand planning and procurement processes at Johar Baru Regional General Hospital contribute to stockout occurrences and to develop data-driven recommendations based on supply chain management principles. A qualitative descriptive design was employed using data triangulation. Data were collected through in-depth interviews with the Head of the Pharmacy Installation, procurement staff, and warehouse pharmacists, complemented by direct observation and analysis of 2024 planning and procurement documents. Thematic analysis was conducted with the support of NVivo software to identify patterns and relationships among key variables, including drug demand planning, procurement, and inventory management.Findings reveal that stockouts stem from interconnected weaknesses in planning accuracy, procurement coordination, and inventory control systems. Effective stock management depends not only on increasing supply but also on improving data quality, integrating inventory information systems with operational workflows, and enhancing cross-functional collaboration. Recommended strategies include implementing a minimum stock alert system integrated with the Hospital Management Information System (HMIS), strengthening standard operating procedures for stockout response and procurement confirmation, improving integration between HMIS, the National Formulary, and budgeting systems, and applying consumption based planning methods combined with ABC VEN analysis to optimize inventory control.

Work motivation is one of the important factors influencing time management and nurses’ performance in providing nursing care. Good time management enables nurses to complete tasks in a timely, efficient, and effective manner. This study was conducted to determine the relationship between work motivation and time management among staff nurses at ML Hospital in 2025. This research used a quantitative approach with a cross-sectional design. A total of 40 staff nurses were selected using a total sampling technique. The instruments used were questionnaires on work motivation and time management. Data were analyzed using the Spearman Rank statistical test with a significance level of < 0.05. The results showed that most respondents had good work motivation (62.5%), while the majority demonstrated a moderate level of time management (75%). The Spearman Rank test yielded a p-value of 0.005, indicating a significant relationship between work motivation and time management among staff nurses. In conclusion, there is a significant relationship between nurses’ work motivation and time management, in which higher work motivation is associated with better time management. It is recommended that hospitals enhance nurses’ motivation through managerial support and a positive work environment.

Background: Most premature infants experience feeding difficulties, including difficulty getting food into their mouths, limited oral capacity, and impaired tongue movement in transferring the bolus toward the posterior part of the oral cavity. This condition underscores the need for special attention in the care of premature infants, particularly in meeting their nutritional needs, which play a crucial role in supporting growth and survival. Purpose: To implement oral motor stimulation interventions for premature infants with feeding problems in the Perinatology Room of Charitas Hospitals Palembang. Method: This case study was conducted on 3 premature infants who received oral motor stimulation interventions for 3 days, with a training frequency of 2 times a day, morning and evening, for 15 minutes. Results: After oral motor stimulation interventions were performed on the three premature infants, good improvement data were obtained, namely in the strength of sucking and swallowing reflexes, and improvement in sucking movements as preparation for the transition from enteral to oral feeding. Conclusion: Providing oral motor stimulation interventions to premature infants helps improve their feeding abilities by enhancing sucking and swallowing reflexes and supporting optimal nutritional intake.

Tambak Mother and Child Hospital experienced a 15% decline in patient visits in 2024, involving both new and returning patients. This decline highlights the importance of patient loyalty, as loyal patients are more likely to continue using hospital services and recommend the hospital to others. This study aims to examine the effects of social media marketing and patient experience on patient loyalty, with patient engagement as a mediating variable.This study employed a quantitative causal research design. Data were collected from 190 patients using purposive sampling. Partial Least Squares–Structural Equation Modeling (PLS-SEM) was used to analyze the relationships among variables.The results indicate that social media marketing, patient experience, and patient engagement simultaneously have a significant effect on patient loyalty. Individually, social media marketing, patient experience, and patient engagement each show a positive and significant influence on patient loyalty. In addition, social media marketing and patient experience positively affect patient engagement. The findings further confirm that patient engagement mediates the relationships between social media marketing and patient loyalty, as well as between patient experience and patient loyalty.These findings suggest that hospital management should strengthen interactive communication through social media platforms, particularly Instagram, improve service efficiency by increasing staffing levels, and enhance service quality through friendly staff behavior and faster service processes. Future research is recommended to include broader samples across Mother and Child Hospitals and incorporate additional variables such as patient satisfaction, service quality, and trust.

Rapid global environmental changes, especially due to advances in technology and information, have had a significant impact on various sectors of life, including the health sector. In the context of modern health services, hospitals are no longer just places of healing, but also institutions that are required to provide high-quality services, based on patient safety, and are able to adapt to the dynamics of community needs. This change requires a transformation in human resource management, especially related to the interpersonal and psychosocial competencies of nurses as the spearhead of medical services.Purposes:​ to analyze the effect of effective communication and Assertive Attitude on Nurses' Work Productivity in hospitals, with Work Fatigue as a mediating variable.Methods: This type of research is quantitative, using statistical figures to measure the influence of independent variables on dependent variables. The research design is a cross-sectional study.Results: The results of this study indicate that effective communication, assertiveness, and job fatigue collectively significantly influence nurses' work productivity. Communication and assertiveness positively contribute to job fatigue, which in turn affects productivity. Job fatigue is also shown to be a significant mediator in the relationship between communication and assertiveness on work productivity .Conclusion : The importance of strengthening effective communication as a strategy to increase productivity. Organizations need to design communication systems that support openness, transparency, and clarity of information and culture-based assertiveness training, so that employees can express their opinions appropriately without causing resistance in the team.

RS at Kemayoran continues to experience low conversion of antenatal care (ANC) patients to delivery services, with a conversion rate of 6.9% in 2024. The maternity ward Bed Occupancy Rate (BOR) also remains below national standards. Preliminary assessments indicate dissatisfaction with the hospital’s healthscape, low mimetic desire reflected in limited recommendations, and suboptimal perceived value. This study examines the effects of healthscape and mimetic desire on childbirth location decisions, with perceived value tested as a mediating variable.Methods: A quantitative cross-sectional study was conducted using Structural Equation Modeling (SEM). Data were collected from 210 ANC patients at RSUD Kemayoran through structured questionnaires. Variables included healthscape, mimetic desire, perceived value, and delivery location decision. All instruments met validity and reliability criteria.Results: Healthscape and mimetic desire significantly influenced the decision to choose RSUD Kemayoran for childbirth. Healthscape did not significantly affect perceived value, whereas mimetic desire showed a significant effect. Perceived value had a significant direct effect on delivery decisions but did not mediate the relationships between healthscape or mimetic desire and delivery choice. Healthscape emerged as the most influential determinant.Conclusion: Physical healthcare environments play a critical role in childbirth location decisions. Improving healthscape quality and strengthening professional and social recommendations may enhance ANC-to-delivery conversion rates in public hospitals.

Covid-19 referral hospitals were studied and it was found that their operational costs had increased. However, their income had actually decreased. This was because there were not many general patients. In addition, asset utilisation was also hampered by the Covid-19 pandemic, which affected the economy. This study sought to find out whether there had been an increase or decrease due to Covid-19. The study used a quantitative method, namely calculating the effectiveness and efficiency ratios. This study uses a descriptive method. The results will be explained in detail. This study compares the conditions before and during Covid-19. The results show that effectiveness in 2019 was 114%. Then, in 2023, it rose to 128%, or an increase of 14%. Meanwhile, efficiency in 2019 was 88%. In 2023, it was 107%. This means there was a decrease of 19%. In conclusion, the budget was well prepared and very effective in 2019 and 2023. However, the use of operational costs during Covid-19 was less efficient. From being quite efficient in 2019, it became inefficient in 2023.

Pneumonia remains a leading cause of morbidity and mortality worldwide, particularly in resource-limited settings and among elderly populations, where timely diagnosis and continuous monitoring are often constrained by limited clinical infrastructure. This study presents an edge–cloud–integrated framework for early pneumonia risk monitoring, leveraging multimodal wearable sensors and deep learning to support continuous short-duration monitoring. The proposed system is designed to operate in near real time under simulated deployment conditions, continuously acquiring and analyzing physiological signals (respiratory rate, heart rate, SpO₂, and body temperature) alongside event-driven acoustic biomarkers (cough sounds) within a distributed architecture. A lightweight edge module performs local signal preprocessing and anomaly triage, selectively transmitting salient information to a cloud-based multimodal deep learning model for refined risk estimation and interpretability analysis. The framework was evaluated using a multi-source dataset comprising public repositories (MIMIC-III and Coswara) and a clinically supervised wearable study conducted in two Nigerian hospitals, resulting in 718  hours of quality-controlled multimodal monitoring data. In a pooled multi-source evaluation, the system achieved an AUC of 0.95, while in a clinically realistic local-only evaluation, the AUC was 0.86, reflecting a consistent but preliminary diagnostic signal. These results highlight the importance of local data adaptation for real-world applicability and suggest that multimodal AI can provide meaningful early risk indicators under resource constraints. Beyond predictive performance, this work demonstrates the feasibility of integrating multimodal learning, edge–cloud computation, and explainable analytics into a deployment-aware, privacy-preserving monitoring framework for low-resource healthcare environments.

This study identified the use of abbreviations in Medical Treatment Consent Forms (SPTK) at X Hospital Indonesia. A quantitative cross-sectional descriptive approach was applied to 76 SPTKs in September 2024, and questionnaires were administered to 30 patient-responsible physicians (DPJP). The results showed that 75% of SPTKs contained abbreviations, even though 97% of respondents understood the risk of miscommunication to patient safety. The state of the art includes accreditation standards that prohibit the use of abbreviations in informed consent, with global orthopedic studies reporting a decrease from 54% to 22% after educational interventions, as well as Indonesian regulations, namely Peraturan Mentri Kesehatan (Permenkes) Republik Indonesia No. 24/2022, which emphasizes that medical records must be complete. The novelty lies in the first empirical analysis in Indonesian hospitals to reveal the disparity between high physician knowledge and low documentation compliance, contributing to the development of evidence-based monitoring for patient safety. These findings support recommendations for daily review of SPTK, ongoing socialization, and integration of digital checklists to reduce medical errors.

Currently, patients experiencing early symptoms of skin disease caused by the exanthema virus are unable to immediately consult a dermatologist due to the high cost and limited time available for specialists in hospitals. Therefore, the author needs to develop an expert system application that can address this issue. Through this application, users can consult with the system, much like an expert, to diagnose their symptoms and find solutions to their problems. This expert system is designed to provide answers based on whether the symptoms are correct or not, or to provide several recommended answer choices based on the symptoms. To diagnose skin disease caused by the exanthema virus, the author used the Case-Based Reasoning method. The CBR method is a weighting technique that compares new cases with previous cases. The diagnosis is based on data provided by the patient and expert, which is then analyzed using case-based reasoning and stored as a knowledge database in the expert system. Therefore, this expert system can help identify solutions for problems experienced by patients suffering from skin disease caused by the Exanthema Virus.

Diabetes mellitus is the second leading cause of death worldwide after cardiovascular disease. This condition causes physical and psychological burdens. Quality of life is influenced by various aspects, including the ongoing special needs of diabetes mellitus patients. Family support is a form of assistance provided by family members to provide physical and psychological comfort when someone is ill. This study aims to determine the relationship between family support and quality of life of diabetes mellitus patients at Santa Elisabeth Hospital Medan in 2024. This type of research is quantitative with a correlational design and a cross-sectional approach. The sampling technique used purposive sampling with a sample size of 80 respondents. Inclusion criteria included patients who had been diagnosed with diabetes mellitus for more than one year, were accompanied by their family, and were able to communicate in Indonesian. Data collection was conducted using the HDFSS questionnaire and the DQOL questionnaire. The results showed high family support and a high quality of life for diabetes mellitus patients. The Spearman statistical test produced a p-value of 0.048 and a correlation of 0.222. Thus, there is a positive relationship between family support and quality of life for diabetes mellitus patients. This means that the higher the family support, the better the patient's quality of life. Based on the results of this study, hospitals are advised to provide education regarding the importance of family support in influencing the quality of life of diabetes mellitus patients.

Oxygen is vital therapy where delivery accuracy is crucial, especially for infant patients, to ensure treatment effectiveness and prevent the risks of hypoxia or toxicity. With the implementation of the mandatory Domestic Product Utilization Policy (TKDN+BMP ≥ 40%), evaluating the quality of local products has become an urgent necessity. This study aims to test and analyze the quality and accuracy of domestically produced infant oxygen flowmeters compared to an imported product. The method used was experimental testing, measuring three brands of domestic products and one brand of foreign product at flow rate settings of 0.5, 1, 1.5, and 2 liters per minute (LPM). Each setting point was measured 10 times using a standardized calibrator to ensure data reliability. The measurement results were analyzed to identify the deviation level of each product. The findings of this study are expected to provide an objective conclusion on the quality equivalence of domestic products with imported ones and to identify which product has the lowest deviation rate. This can serve as scientific consideration for hospitals in selecting high-quality infant oxygen flowmeters, thereby supporting the domestic product policy.

Background: Patient safety in hospitals is a crucial aspect in efforts to prevent unwanted events (KTD) that can endanger patients. Unwanted events (KTD) often occur during the patient transfer process in hospitalized patients. Objective: To determine nurses' compliance with the implementation of the sbar method in patient transfers to improve patient safety. Method: This study is a quantitative study with a descriptive approach. The study was conducted in the inpatient ward of Murni Teguh Hospital Medan. The population, namely 252 implementing nurses and 50 samples were obtained. Sampling was carried out using purposive sampling. Analysis was carried out univariately in a frequency distribution table. Results: This study shows that the characteristics of nurses at Murni Teguh Hospital Medan are mostly female (92.0%), aged 20-35 years (52.0%), with a Bachelor's degree in Nursing (76.0%). Nurses' compliance in carrying out SBAR communication during patient transfers at Murni Teguh Hospital Medan is in the compliant category (60.0%), fairly compliant category (34.0%), and less compliant category (6.0%). Conclusion: Nurses are compliant in implementing the SBAR method during patient transfers to improve patient safety. Suggestion: Nurses at Murni Teguh Hospital Medan are advised to continue to improve their competence in using SBAR communication, especially in critical patient transfer situations.

Leadership management plays a crucial role in developing nursing career paths in hospitals. An effective career path system not only enhances nurses' competence and professionalism but also contributes to job satisfaction and retention. However, scientific evidence regarding the influence of leadership management on nurses' career paths remains scattered and shows varying findings. This systematic review aims to synthesize scientific evidence related to the influence of leadership management on nursing career path development in hospitals. This study used a systematic review design following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A literature search was conducted through PubMed and Google Scholar for articles published between 2015 and 2024. Articles were selected based on inclusion and exclusion criteria, resulting in 13 articles for analysis. Data synthesis was conducted using a thematic synthesis approach. The review identified five main themes: leadership style, managerial support, organizational systems and policies, the impact of career paths, and barriers to implementation. Transformational and participatory leadership has been reported to have a positive influence on nurses' career development. Managerial support through coaching, mentoring, and ongoing training strengthens career readiness, increases job satisfaction, and reduces nurse turnover intentions. Leadership management has a significant influence on nursing career development in hospitals. Integrating effective leadership with a clear and transparent career development system is necessary to enhance professionalism, job satisfaction, and the sustainability of the nursing workforce.

The implementation of patient safety culture in hospitals remains a significant challenge, often leading to adverse events. Establishing a strong patient safety culture requires effective interprofessional collaboration among healthcare professionals to deliver patient-centered care. However, factors such as organizational distrust and job dissatisfaction continue to hinder collaborative efforts and negatively affect the quality of care and patient safety outcomes.This study aims to examine the influence of organizational trust and job satisfaction on patient safety culture, with interprofessional collaboration serving as an intervening variable at MP hospital.  This quantitative associative research used a causal approach involving 93 inpatient nurses as respondents. Primary data were obtained through questionnaires using an ordinal scale based on a 4–1 Likert scale. Data processing employed the three-box method, and data analysis was conducted using Structural Equation Modeling (SEM).The results revealed that organizational trust, job satisfaction, and interprofessional collaboration simultaneously and partially influence patient safety culture. Moreover, interprofessional collaboration was found to mediate the relationship between organizational trust, job satisfaction, and patient safety culture.The study concludes that enhancing patient safety culture can be achieved by strengthening organizational trust and job satisfaction through effective interprofessional collaboration. Hospitals should develop supportive systems that foster care and concern among staff, enhance conflict management, improve performance appraisal mechanisms, and promote open, effective communication across all professional groups involved in patient care. These strategies can create a safer, more collaborative, and high-quality healthcare environment

Toxoplasma gondii (T. gondii), intracellular parasite that cause abortion in infected pregnant women with the parasite. Aim of the study: the present investigation aimed to assessment the prevalence of T. gondii in aborted women and evaluated level of interferon- gamma, Toll-like receptor 2 (TLR2) and lactoferrin. Materials and methods: From September 2024 to May 2025, we examined 90 women, 70 of them spontaneous abortion, while an additional 20 blood samples were obtained from healthy individuals serving as controls, in Tikrit Teaching hospital and many private hospitals in Tikrit city. Result: The incidence of parasite infection in aborted women was 56 (80%) out of a total of 70%. The level of IFN, TLR2, and Lactoferrin in the group of aborted women infected with T. gondii (45.4 ±7.1, 17.04 ±2.28, 59.6±12.6), as compared with control group (19.4 ±2.12, 8.2 ±2.1, 29.2±9.4). Conclusion: The present study concluded increase prevalence of toxoplasma gondi in aborted woman may indicate the main cause of abortion. Furthermore, increase level of immunological parameters that may indicate resolve the parasite infection.