Evaluation of Dengue Hemorrhagic Fever Reporting in the Hospital Early Warning System in Indonesia

Abstract

Dengue Hemorrhagic Fever (DHF) remains a major public health concern in endemic countries and requires timely surveillance to support early outbreak detection and response, with hospitals playing a key role in identifying and reporting confirmed cases through early warning systems such as the Hospital Early Warning System (Kewaspadaan Dini Rumah Sakit, KDRS). This qualitative study at RSUD Panembahan Senopati, Bantul Regency, Indonesia, involved nine purposively selected informants (two physicians, three nurses, three ward administrative staff members, and one surveillance officer. Data were collected through in-depth interviews in June 2025 and analyzed using open, axial, and selective coding within the data reduction, data display, and conclusion drawing/verification framework described by Miles and Huberman to explore reporting timeliness, documentation completeness, coordination, and operational barriers. The findings indicate that physician-dependent diagnostic confirmation and authorization are central to reporting processes, as reporting is typically initiated only after a definitive diagnosis is established, despite earlier availability of laboratory results. High clinical workload, manual documentation, requirements for physical signatures, and coordination challenges were reported to contribute to delays relative to the 24-hour reporting target, while surveillance personnel used electronic medical records to verify incomplete reporting information. Overall, DHF reporting through KDRS is strongly influenced by physician authority and hospital workflow, which may hinder timely notification, highlighting the need for clearer procedures, improved integration between electronic medical records and KDRS, and streamlined workflows to reduce administrative barriers while maintaining data validity and strengthening early warning capacity.