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Avanzar en el acceso a la atención de emergencia para lesiones cerebrales traumáticas en Indonesia: un programa
Bryan Gervais de Liyis1, Francisco Rivera2, Muhammad Kusdiansah1
1Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, Jakarta, Indonesia.
Resumen
Indonesia está entrenando a cirujanos generales para realizar procedimientos craneales de emergencia, abordando la escasez de neurocirujanos. Esta iniciativa de reparto de tareas tiene como objetivo mejorar el acceso a la atención neuroquirúrgica crítica en regiones desatendidas.
Área de la Ciencia:
- Salud Global La salud global.
- La neurocirugía es la neurocirugía.
- Educación quirúrgica Educación quirúrgica.
Sus antecedentes:
- Acceso neuroquirúrgico limitado en países de ingresos bajos y medios (LMICs) debido a la escasez y la mala distribución.
- Indonesia se enfrenta a desafíos únicos: geografía archipelágica, largos tiempos de transferencia y altas tasas de lesión cerebral traumática y accidente cerebrovascular.
- Las brechas existentes en la cobertura neuroquirúrgica requieren soluciones innovadoras para la atención de emergencia.
Objetivo del estudio:
- Describir el fundamento lógico, el marco regulatorio y el diseño educativo del programa piloto nacional de distribución de tareas neuroquirúrgicas de Indonesia.
- Para esbozar el desarrollo colaborativo que involucra al Ministerio de Salud y las universidades quirúrgicas.
- Detallar la trayectoria de capacitación basada en competencias y el alcance de la práctica para los cirujanos generales participantes.
Principales métodos:
- Un programa de capacitación basado en competencias en tres fases que integra la simulación (VR, modelos 3D), la experiencia operativa supervisada y la cirugía de emergencia tele-proctorada.
- Autorización ministerial formal y criterios de elegibilidad definidos para hospitales y cirujanos.
- Alcance operativo limitado: craneotomía descompresora para hematomas y craniectomía descompresora para accidentes cerebrovasculares.
Principales resultados:
- El programa piloto nacional se inició a finales de 2025.
- La implementación está en curso; los datos de resultados clínicos aún no están disponibles.
- Este manuscrito proporciona un relato descriptivo del diseño del programa y el plan de implementación.
Conclusiones:
- La iniciativa de compartir tareas de Indonesia representa un nuevo enfoque para mitigar las limitaciones de acceso a la atención neuroquirúrgica.
- El programa tiene como objetivo mejorar la capacidad neuroquirúrgica de emergencia en los distritos que carecen de cobertura especializada.
- Los estudios futuros se centrarán en la gobernanza, la evaluación de las competencias y los resultados clínicos.
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