External Vs Internal e-Referrals: Results from a Nationwide Epidemiological Study Utilizing Secondary Collected Data.

Background: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA). Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals. Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25-64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value <0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25-64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50). Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.

Trends and patterns in urgent pediatric otolaryngology inter-hospital referrals in Saudi Arabia.

OBJECTIVES: To assess trends in otolaryngology-head and neck surgery (ORL-HNS) referrals among pediatric patients, and to address common urgent causes of ORL-HNS referrals in this population. Additionally, to give recommendations regarding these causes, and assessing the impacts of coronavirus desease-19 on such referrals. METHODS: A retrospective descriptive study were the data was extracted from the referral system of the Saudi Ministry of Health (Ehalati), from 2019-2020. Pediatric patients from all hospitals across Saudi Arabia with problems related to ORL-HNS who have been referred urgently to other hospitals were included. RESULTS: A total of 1318 urgent ORL-HNS referrals were collected. The average age of the sample was 6.5 years, with the unavailability of specialty being the major cause for referrals. Foreign bodies, recurrent epistaxis, and tracheostomy were also common clinical causes. The average time for accepting referrals was 21 hours. Most cases had medical or surgical intervention prior to referral. The Western region of Saudi Arabia was the most common sender and receiver of all referrals. In 2020, referrals decreased by 18.4%. CONCLUSION: Maternity and pediatric hospitals make up the largest number of referring hospitals for ORL-HNS urgent cases. Expanding ORL-HNS services has been recommended in highly demanding areas. standards for urgent ORL-HNS referrals may limit inappropriate urgent referrals.

Knowledge of non-healthcare individuals towards cardiopulmonary resuscitation: a cross-sectional study in Riyadh City, Saudi Arabia.

BACKGROUND: Most sudden cardiac arrests occur at home, with low rates of bystander cardiopulmonary resuscitation being performed. We aimed to assess knowledge of cardiopulmonary resuscitation among individuals in Riyadh City, Saudi Arabia, who are not involved in health care. METHODS: A community-based cross-sectional study was conducted between January and February 2020 in 4 different areas in Riyadh City: North, South, East, and West. The participants were surveyed using a validated self-administered questionnaire. The Statistical Package for Social Sciences version 25.0 was used for inferential statistics and binary logistic regression analysis. RESULTS: A total of 856 participants completed the questionnaire, 51.8% were unaware of cardiopulmonary resuscitation. Only 4.4% of the participants had attended a formal cardiopulmonary resuscitation training course, 5.1% were campaign attendees, and 38.7% acquired their experience through the media. Having a higher level of education was positively associated with having knowledge of cardiopulmonary resuscitation. The main concern among attendees of cardiopulmonary resuscitation training courses and campaigns was legal issues, whereas inadequate knowledge was the major barrier for those who had learned about cardiopulmonary resuscitation through the media. CONCLUSION: The level of knowledge of cardiopulmonary resuscitation among non-health care individuals in Riyadh City was found to be insufficient. Therefore, coordinated efforts among different authorities should be considered to implement a structured strategy aiming to increase awareness and knowledge of cardiopulmonary resuscitation among non-health care individuals.

Effect of waiting time estimates on patients satisfaction in the emergency department in a tertiary care center.

OBJECTIVES: To examine the influence of emergency department (ED) waiting time estimate provision on the satisfaction of patients.  Methods: This was a randomized controlled trial at King Abdulaziz Medical City, Riyadh, Saudi Arabia between September 2017 and May 2018. It included 18 to 70 years old Arabic-speaking acute care patients. After being divided into 2 groups, the intervention group alone was provided waiting time estimates. Both groups answered 2 questionnaires evaluating their satisfaction and illness perception before and after seeing a doctor. Results: One-hundred patients were included. No significant difference found in waiting time satisfaction scores between groups (intervention (5.92/10±3.13), control (5.45/10±3.38), p=0.476). Demographics and illness perception had an insignificant impact on satisfaction. Waiting time estimate was preferred by most participants (70%). Conclusion: Providing waiting time estimation did not affect satisfaction but was preferred to have in the ED by most.

The impact of crowd control measures on the occurrence of stampedes during Mass Gatherings: The Hajj experience.

BACKGROUND: Mass gatherings present enormous challenges for emergency preparedness. Planners must anticipate and prepare for communicable and non-communicable disease outbreaks, illnesses, and injuries to participants, crowd control, and disaster responses to unforeseen natural or man-made threats. The Hajj, the largest annually recurring mass gathering event on earth. It attracts about 3 million pilgrims from over 180 countries who assemble in Mecca over a 1-week period. METHODS: A literature review was conducted using Medline and OVID, while searching for published data concerning human stampedes and crowd control measures implemented to prevent human stampedes. The review was further extended to include media reports and published numbers and reports about Hajj from the Saudi Arabian government, in both the English and Arabic languages. RESULTS: Because millions of pilgrims undertake their religious ritual within strict constraints in term of space and time; this rigour and strictness have led to a series of large crowd disasters over several years, thus putting pressure on the authorities. In the past few years, the government of Saudi Arabia have put an enormous effort to solve this difficulty using state of the art innovative scientific means. The use of crowd simulation models, assessment of the best ways of grouping and scheduling pilgrims, crowd management and control engineering technologies, luggage management, video monitoring, and changes in the construction of the transport system for the event. CONCLUSIONS: A large gathering such as the Hajj still holds an increasing risk for future disasters. International collaboration and continued vigilance in planning efforts remains an integral part of these annual preparations. The development of educational campaigns for pilgrims regarding the possible dangers is also crucial. Lessons gleaned from experiences at the Hajj may influence planning for mass gatherings of any kind, worldwide.