The document summarizes the current emergency service landscape in Qatar. It notes there is one major tertiary hospital, three district general hospitals, and emergency departments at other specialty hospitals. There are also walk-in clinics, workers clinics, and private providers. The document discusses centralization of services for trauma, stroke, and infectious disease. It identifies current difficulties like lack of inpatient beds, poor facilities, recruitment issues, and suboptimal training programs. Recommendations include improving coordination between emergency services, accrediting emergency departments and practitioners, developing national guidelines, and centralizing high-risk services with good evidence like trauma, stroke, and STEMI based on volume and skills maintenance needs.

2. CURRENT SERVICE LANDSCAPE
One Major Tertiary Hospital
 >1300 visits
Three “District General Hospitals”
 Significant presentations (approx 500 + 4-500 + 100)
“Emergency Departments” at
 NCCR
 Heart Hospital
 Womens

3. CURRENT LANDSCAPE (CONT)
Walk in Clinics
Workers clinics/Red Crescent
Private providers
PECs – relationship?
PHC – relationship?
 “urgent care” and unscheduled care

4. CURRENT LANDSCAPE (CONT)
Centralised trauma/major emergencies
 Stroke
 AMI
 Infectious disease
Extensive use of short stay medicine
 > 50% of medical admissions
Efficient see and treat model
 Potential capacity issues
Disaster planning
 HGH central to plans

5. CURRENT SERVICE LANDSCAPE (CONT)
HMC
All doctors EM Board
 Or trainee
Moving to Board + fellowship
Subspecialities developing
 Toxicology
 Crit care
 Disaster
 Prehospital etc
Non HMC?
Nurses?

6. PRESENT DIFFICULTIES
Lack of capacity – inpatient beds
Poor/inadequate facilities
 Due to rapid development
Recruitment Poor
Suboptimal postgraduate training programs
 Changing rapidly
 Need adequate clinical material/supervision for this to occur

7. PRESENT DIFFICULTIES
Security
 Staff safety
Poor clinical decision making
Care of elderly/terminally ill
Expectations of local community
 Male/female/children
 Wait times
 Personalised service….

8. FUTURE SERVICE LANDSCAPE
Insurance
 Emergency casemix
 Short stay
 Emergency admits
 Chance for “cherry picking”
Alternate Providers
 Red Crescent
 Private Clinics
 Private Hospitals
 Sidra
 Mass Casualty Hospital

9. FUTURE SERVICE LANDSCAPE
Dangers
 Lack of skilled labour
 New services “cannibalise” services already here
 Inflation of wages
 Lack of 24/7 specialties (spread too thin across entities)
 Lack of clinical exposure for specialists
 Over-servicing for profit
 Lack of coordination between services
 Unrealistic expectations from Nationals

10. RECOMMENDATIONS FOR FUTURE SERVICE
IMPROVEMENT
Need Critical Clinical Mass for major emergencies
 Present population only 2mil
Coordination between emergency services
 Matrix of services provided
 Integrated across Qatar
 Clinical pathways for Trauma/stroke/STEMI etc
Accreditation of EDs
Accreditation of practitioners
Quality framework for reporting
 Registries of key conditions
National Guidelines for high risk/common conditions
Standardised Signage

11. EVIDENCE BASE
Centralisation of services for serious conditions
 Good evidence
 Trauma
 Stroke
 Cardiac Arrest
 STEMI
 Specific elements of clinical pathways
 Volume, clinical exposure, skills maintenance
 Some evidence
Specialised Training for EM
Short Stay Medicine
Standards for facilities
 Infection control
 Privacy
 Equipment
 Space
Trauma – paeds centre vs high volume adult trauma centre?