**3. Qatar experience in emergency health access**

Qatar is a small country and has a special population distribution. Around 80% of the population is concentrated in the capital city Doha and its immediately neighboring district of Al Rayyan [11]. For a long time, before the rapid expansion of the country in the last 15 years, there was only one ED, in Hamad Medical Corporation (HMC) Hamad General Hospital (HGH), situated in Doha. Patients needed to come from distant places for any medical emergency. This was challenging for many people, especially during nighttime and weekends, as the road network was limited. The Chairman of the HGH Emergency Department, at that time, lead a project to have an emergency room in selected primary healthcare centers. The basis for this decision was to bring emergency services closer to people and decrease unnecessary visits to the main ED in Doha, especially as more than 50% of emergency cases were of low acuity and did not need clinical investigations or admission. The project started during early October 1999 in one center. The services provided were considered a success and these minor emergency rooms were developed in nine primary healthcare centers in the following few years according to the population distribution as illustrated in **Figure 1**. They were called Adult Urgent Care Centers (AUCC).

**Figure 1.** *Population distribution in Qatar in the year 2000.*

#### *Healthcare Access*

The AUCC emergency room in each of the Primary Healthcare Centers included the following:


The AUCCs distributed around Qatar collectively received around 6,000 patients per month. About 97% were treated directly by the AUCC staff and discharged home with the possibility of a referral to the outpatient clinics according to the patients' complaint and needs. Only 3.% were referred and transported to the ED by ambulance.

**Table 1** provides the detailed distribution of patients seen and transferred across all the AUCCs over a period of 1 month in 2014.

The project was run by the HMC Emergency Department in collaboration with the primary healthcare centers and the HMC Ambulance Service from 1999 to 2016. By 2016, several new hospitals each with their own ED had opened throughout Qatar to serve major urban areas such as Al Khor, Al Wakra, and Dukhan. Moreover the PHCC started their own urgent care project called "Primary Urgent Care", and the AUCCs' responsibility transferred to PHCC.

Over the duration of the project, a number of goals were achieved:

1.Emergency services were brought closer to patients hence saving travel time and expenses.


2.Only about 3% of patients needed to be transferred by ambulance from the AUCCs to the ED in Doha.

**Table 1.**

*Sample of AUCC patient encounters corresponding to October 2014.*


Patient transfers to the emergency department from primary healthcare centers after 2016 was 10% (personal contact).
