Utilization of Operating Room in Buleleng Regency Hospital based on Utilization Theory in 2020

Each hospital has an operating room as a central surgical service unit. In this case it should be noted that the central surgical service unit has a different contribution from the inpatient room so it is necessary to maintain the use of this operating room in hospital services. The research objective was to determine the Utilization of Operating Rooms in Buleleng Regency Hospital based on Utilization Theory. This research method is observational analytic with crossectional design. The study population was patients who received services at IRD and CSI with a sample of 106 respondents taken by purposive sampling with criteria. The results of this study are predisposing, enabling and need factors where predisposing factors have a dominant influence on the patient's decision to use the operating room with a p-value of 0,000 showing <of α 0.05 which indicates an influence. The conclusion of this research is that there is a relationship between Predispoding variable and Enabling Facto variable on the utilization of operating room based on ultilization theory, the result of p-value shows <of α 0.05, which shows that there is an influence. And there is no relationship between variable Need Factor to operating room utilization results p-value results>> α 0.05 which shows no influence. So it is suggested that the Use of Operating Rooms in Buleleng Regency Hospital is based on Utilization Theory and applies to other rooms.


INTRODUCTION
The hospital has several service units that synergize with one another. Each service unit has a different contribution both in the type of service and the benefits generated. Therefore management that is applied in every service can also be different.
The Central Surgical Installation (CSI) is a service unit in a hospital that requires coordination with other units to carry out operations. CSI patients come from Emergency Department (ED) patients, Outpatient Installation (OI) and Inpatient Installation (II) indicated by doctors to undergo surgery. In general, if IGD, OI and II patients increase, CSI patients also increase. The following is a table regarding the number of ED, OI and II patients in Buleleng Hospital (herein after referred to as Buleleng Hospital).
Utilization of CSI in Buleleng Hospital is now experiencing an increase. Hospital management also continues to make improvements in the management of CSI in an effort to offset the increased use of CSI in Buleleng Regional Hospital. One of the improvements made by the management is the addition of specialized doctors, initially the Buleleng Regional Hospital did not have a specialist in urology, but now there is a specialist in urology who practices at the Buleleng Regional Hospital.
The operating room must be managed well because operating activities require maintenance costs, operating costs (costs) and the cost of resources (resource) is expensive. When inefficiencies occur in the operating room, spending increases from normal conditions. Expenditures for activities in the operating room by 40% of total hospital expenses. The amount of operating costs is due to the large amount of resources used to carry out operations including staff (for example: anaesthetists, surgeons, nurses, etc.), equipment and facilities (for pre-operative, perioperative and post-operative) (Fugener et al., 2015) . The research problem raised in this study is the suboptimal use of operating rooms in Buleleng Hospital which is 54% of optimal capacity in the period 2014 to 2016. Every hospital has an operating room as a central surgical service unit. In this case it should be noted that the central surgical service unit has a different contribution from the inpatient room so it is necessary to maintain the use of this operating room in hospital services. The research objective was to determine the Utilization of Operating Rooms in Buleleng Regency Hospital based on Utilization Theory.

METHODS
The design in this study was an observational study with analytic design using survey methods and questionnaires as a means of assistance. Data collection was carried out using a cross sectional approach. With a sample size of 106, the independent variable consisted of predisposing factors, enabling factors, need factors.
While the dependent variable, consisting of: the patient's decision to use the operating room; doctor's direction to the patient to make use of the operating room; operating room utilization. Data were processed and Univariate Analysis on the frequency distribution for variable characteristics, Bivariate Analysis for the Test of the influence of categorical data using chi square and logistic regression tests were used to determine the effect.

RESULTS
Research on the Relationship between Operation Room Utilization in Buleleng District Hospital based on Utilization Theory was carried out at Buleleng Regional Hospital. The study was carried out in Buleleng District Hospital which is located at Jalan Ngurah Rai No. 30 Singaraja, Kab. Buleleng, Province of Bali. Buleleng Regency Hospital has 8 operating rooms, 2 operating rooms in the emergency room that are used for Emergency / Urgent surgery, 6 operating rooms are in CSIT for elective / planned surgery. The number of visits or the average number of maternity patients per month is an average of 45 mothers / month. Buleleng Regency Hospital is an accredited teaching hospital B, is a referral hospital located in the center of the city of Singaraja which has an area of 10 hectares. high contagious and not contagious.  The results of univariate analysis found that the enabling factor is the fig of paying patients for health services in the operating room mostly using government BPJS guarantees as many as 55 respondents (51.9%). In the mileage to hospital services most of the distance is more than 6 KM by 85 respondents (80.2%) and the waiting time to get service in the operating room is mostly less than 1 week by 91 respondents (85.8%) and Patients' perceptions of facilities and infrastructure in the operating room mostly have medium perception as many as 49 respondents (46.2%) and perceptions of doctors and nurses in operating rooms are mostly medium as many as 59 respondents (55.7%). Univariate analysis results found that the Need factor is that most respondents have the perception that the severity of the disease is severe as many as 65 respondents (61.3%) and the perception of patients' needs in the operating room most say 88 respondents (83%). Univariate analysis results found that the dependent variable most of the patients had the decision "yes" to use the operating room as many as 82 respondents (77.6%) with the direction of doctors and nurses in the operating room correctly as many as 60 respondents (56.6%) and the realization of utilization operating rooms obtained from secondary data that the majority of operations performed in the operating room of Buleleng Regional Hospital were 64 respondents (60.4%).

Bivariate Analysis The Relationship of Predisposing Factors to the Utilization of Operating Rooms in Buleleng
Regency based on Utilization Theory. Based on the table that the cross tabulation of most of the characteristics of respondents can use the operating room. That the logistic regression test selection shows the results of the p-value on a statistical test that the education, and the income of respondents affect the utilization of the operating room and experience and knowledge do not significantly influence the utilization of the operating room.   The results of the cross tabulation analysis of the Need Factor variable include the perception of the severity of the disease and the perception of the patient's needs in the Operating Room of the District Hospital. Buleleng there is no significant relationship with p-value> 0.05 including the perception of the severity of the patient's disease 0.261 and the perception of the patient's needs 0.549 A multivariate test will then be conducted to find out the factors that influence the Utilization of Operating Rooms in Buleleng Regency Hospital based on Utilas Theory through a logistic regression statistical test after the syyat test logistic variables are met. Based on data analysis with statistical tests that the use of operating rooms based on the theory of utilization analyzed in the researchers include predisposing factors, enabling and need factors where predisposing factors have a dominant influence on patient decisions in the use of operating rooms with the results of p-value 0,000 showing <of α 0 , 05 which shows there is influence. Likewise with the influence of doctors and nurses, there is a close relationship with the p-value of 0.004, showing <of α 0.05, while in the operating room utilization itself there is no significant relationship because the pvalue of 0.855 shows> of α 0.05. That the predisposing factor has an All Old Ratio (AOR) of 0.300 which means that the predisposing factor 3 times has the opportunity to have a relationship in terms of decision making, accepting doctor's direction and utilizing the operating room at CSI Hospital Buleleng. The enabling factor that the results of the p-value on the patient's need is 0.002 shows <of α 0.05 which means there is a close relationship between the enabling factors on patient decisions and the influence of doctors and nurses direction on the use of the operating room based on the theory of p-value utilization results. 0.002 shows <of α 0.05. That the enabling factor has an All Old Ratio (AOR) of 0.500 which means that the predisposing factor is 5 times as likely to have a relationship in terms of decision making, receiving doctor's direction and utilizing the operating room at CSI Buleleng Hospital.
In Need factors that do not have a close relationship with operating room utilization based on the results of the p-value on the patient's decision 0.068, doctor and nurse directives 0.438 and operating room utilization 0.113 shows> from α 0.05 That the factors need factors have All Old Ratio (AOR) ) 0.019 which means that the need factor has a very small chance of 0.1 times the chance to have a relationship in terms of decision making, receiving doctor's direction and utilizing the operating room at CSI Buleleng Regional Hospital.

A. Predispoding variables for operating room users
The results showed that there was a relationship between the variables of the respondents' characteristics in the research which were categorized in the Predispoding variable including education, income, experience and knowledge of the disease in the operating room in Buleleng Regency in 2019 to the operating room beneficiary in Buleleng Regional Hospital. That the operating room utilization is based on the theory of utilization analyzed in the researchers including predisposing, enabling and need factors where the predisposing factor has a dominant influence on the patient's decision to use the operating room with a p-value of 0,000 showing <from α 0.05 which indicates an influence . Similarly, the influence of doctors and nurses is closely related to the p-value of 0.004 showing <of α 0.05 while in the use of the operating room itself there is no significant relationship because the p-value of 0.855 shows> of α 0.05 has an All Old Ratio (AOR) of 0.300 which means that predisposing factors are 3 times as likely to have a relationship in terms of decision making, receiving doctor's direction and utilizing operating room at CSI Buleleng Regional Hospital.

B. Variable Enabling Factors towards operating room utilization
The results showed there was a relationship between the Enabling Variables including how to pay for patients, patient distance to access to the hospital, perception of facilities in the operating room, perception of doctor and nurse services and waiting time. Regarding the use of operating rooms in Buleleng Regency Regional Hospital in 2019.
In the enabling factor that the results of the p-value on the patient's need is 0.002 showing <of α 0.05 which means there is a close relationship between the enabling factors on patient decisions and the influence of doctor and nurse directives on the operating room utilization based on the theory of pvalue utilization results 0.002 shows <of α 0.05 has an All Old Ratio (AOR) of 0.500 which means that the predisposing factor is 5 times as likely to have a relationship in terms of decision making, accepting doctor's direction and utilizing the operating room at CSI Hospital Buleleng.

C. Variable Need Factors for operating room utilization
The results showed there was no relationship between the Need Factor Variables including the perception of the severity of the disease and the perception of the patient's needs in the Operating Room of the District Hospital. Buleleng in 2019 that the Need factor is that most of the respondents have the perception that the severity of the disease is severe as many as 65 respondents (61.3%) and the perception of patients' needs in the operating room mostly stated that they were 88 respondents (83%). In Need, the factors that do not have a close relationship with the use of operating rooms based on the results of the p-value on the patient's decision 0.068, referral of doctors and nurses 0.438 and the use of the operating room 0.113 shows> of α 0.05 has an All Old Ratio (AOR) 0.019 which means need factors have a very small chance of 0.1 times the chance to have a relationship in terms of decision making, receiving doctor's direction and utilizing the operating room at CSI Buleleng Regional Hospital.
The results of a statistical analysis that states Ho is accepted that there is no need factor relationship to the operating room utilization, or in other words there is no close relationship between the need factor to the operating room utilization, this is from the opinion of the researcher and the results are descriptive (qualitative) that the questions related to the need factor regarding the severity of the disease by the patient, although the doctor has explained but the patient and family will be more silent and say they don't know. So the statistical results do not show a significant value.

CONCLUSION
Based on the results of data analysis of 106 respondents that the conclusions can be described as follows: a. There is a relationship between Predispoding variables to operating room utilization based on ultilisation theory, the results of p-value showed <from α 0.05, which shows that there is an influence 3 times the opportunity to use operating room based on ultilisation theory. b. There is a relationship between the Enabling Factor to the operating room utilization results the p-value shows <from α 0.05 which shows that there is an influence 5 times the opportunity to use the operating room based on ultilization theory c. There is no relationship between variable Need Factor to operating room utilization results pvalue results>> α 0.05 which shows that there is a small chance of 0.1 times the opportunity to use operating room based on ultilization theory