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?