Journal of Emergency Medicine, Trauma and Acute Care - 1 - Qatar Health 2022 Conference abstracts, يناير ٢٠٢٢

Welcome to this special issue of JEMTAC dedicated to the selection of 74 abstracts submitted to the Qatar Health 2022 online conference. The years are passing and the COVID-19 pandemic situation has not changed much globally. Although new vaccines have been developed and several restrictive measures have been rolled out in most countries to protect people, thousands are still succumbing to the effects of COVID-19^1,2. Similar to the Qatar Health 2021 conference³, among the abstract submissions, there is still much emphasis on how healthcare systems and services are dealing with the situation to mitigate the spread of the disease among patients and healthcare professionals, while still trying to deliver physical or mental care to those in need^4–6. It is also important to point out that the same needs and concerns apply to both the general public as well as the healthcare workforce^7,8. From a preparedness point of view, continuing professional development and testing of new processes and facilities are key to ensuring clinicians are ready to take on new roles in new environments, and that technology can play a significant role in a pandemic context^9–11. This is not only true in relation to clinical facilities, but as Qatar prepares to host the 2022 World Cup, it is also highly relevant to sporting events, during which multiple agencies need to work together collaboratively and as a multidisciplinary team as per the theme of Qatar Health 2022 and the 2^nd Qatar Public Health Conference^12–13.

The online conference has again been organized into four parallel tracks. It is dedicated to showcasing the work and opinions of leaders in their respective domains as well as the 112 abstracts that have been accepted for oral or poster presentation. The abstract themes are summarized in Table 1, and most of the corresponding abstracts are published in this special issue of JEMTAC. Submissions related to mass gatherings and sporting events were shy again this year, but it is expected to be a highly prominent topic for the next edition of the conference, after the 2022 World Cup. We hope you enjoy this early content preview of the conference and that it will make it even more engaging for everyone at the time of the question and answer sessions and on the poster boards. See you all online on the 10^th-12^th of February 2022!

Background: Hosting 2022 FIFA World Cup (WC2022) in Qatar is a mega event that can shape a country's development¹. Partnerships as preparedness efforts for mass gatherings within the health system can ensure a safe and efficient practice in hosting countries^2,3. This work aims to provide an analysis of the existing literature around partnership frameworks to inform the development of an innovative partnership framework for Primary Health Care Corporation (PHCC). In addition, it also discusses the preparedness plan at PHCC for the WC2022 to promote staff and national resilience. Methods: Various databases such as Academic Search Complete, Education Research Complete, Medline and Web of Science were used to search for relevant studies from 2010 to 2021. The search strategy consisted of search terms including partnership, framework and health. Moreover, searching was conducted by title, abstract, and full texts, and was limited to studies in English language. The content analysis was performed to analyze the relevant publications. Results: A total of 18 studies were considered. The related literatures were analyzed to present the emerging themes which revealed four major themes: collaboration, engagement, transformation, and risk mitigation. Leveraging the current primary care partnership framework will influence the ability of healthcare professionals to adapt and respond to the upcoming mass gathering. National and international partners must recognize and embrace the need for diverse training programs during the WC2022. The preparedness for the WC2022 calls upon clear assessments from various stakeholders at PHCC that are tied to the needs for emerging roles and services. Conclusion: This work offers a new perspective on the current PHCC partnership framework and provides some recommendations for infrastructure, commissioning, and engagement pathways among future public and private partners. Leveraging PHCC partnership framework and transforming it into a holistic framework of national resilience during mass gathering is of significance.F0001 F0002a F0002b F0002e F0002d F0002e

Background: International sporting events such as the World Athletics (WA) competition require proper medical coverage to ensure the wellbeing of athletes, support teams, and spectators¹. Several factors may have an impact on people's requirements for medical attention such as the climate, altitude, and intensity of the sporting competition on the athletes^2,3. The International Association of Athletics Federations (IAAF) held its 2019 competition in Doha, Qatar, and this study reports on the medical resources deployed to cover the event based on risk assessment. Case presentation: Although the competition was held for 10 days across two venues. The medical cover started 3 days earlier and also encompassed warm-up/training venues and official hotels (Table 1). It involved multiple healthcare organizations providing equipment, manpower, medical tents/clinics, and vehicles in case of transportation to the hospital was required. Results: Resources were allocated to various locations based on the risk assessment (Table 1) and depending on the number of people competing, training, or attending, and the size of the venue. Environmental factors were accounted for with the provision of cold-water immersion recovery baths at multiple locations and ample manpower with rostering of clinical staff from various relevant healthcare professions (Table 2). All resources were deployed on a rotational shift basis in the official locations well ahead of the start of each event until an hour or two after the completion of the event. Conclusion: Proper planning, communication, and collaboration among organizers, hosts, medical services providers, and other authorities play a vital role in the safety of athletes, support team members, and spectators. Such large events impose huge strain on the resources which can impact aspects of daily healthcare delivery to the rest of the community and hence need to be carefully considered. It is worth noting that the medical coverage provided was not overwhelmed by patient demand, hence; the medical coverage was appropriate.

Background: Sudden Cardiac Arrest (SCA) is defined as the abrupt loss of heart function as an occurrence without physical contact (absent commotio cordis). SCA's morbidity ratio is 1:50,000 of all deaths. The published estimates on SCA suggest that 11% of all victims have a normal heart. Current screening investigations include electrocardiography (ECG), echography, 24-hour ECG monitoring, eliciting stress history, and cardiac Magnetic Resonance Imaging. Some cardiac pathologies screened have never been detected. Athletes who experienced SCA had a survival rate of 50-60% over 30-days, and this rate might reach up to 80-89% in some cohort studies. The survival factors are based on regular and thorough screening checks, and better observation that enables quicker pickups. Players vary in cardiopulmonary resuscitation (CPR) performance and are emotionally involved, as was reported recently with footballer Christian Eriksen in the 2021 European Championship¹. However, anyone trained in CPR, not just medical professionals, can assist in resuscitation (Figure 1). Evidence-based studies show that Basic Cardiac Life Support (BCLS) is more effective on the sports field than Advanced Cardiac Life Support². The objective of this literature review is to make recommendations to effectively respond to SCA during football tournaments. Methods: PubMed database was used to retrieve articles published in English between 2018 and 2021 related to SCA during football games. Results: There are limited publications in this specific domain. Reports from 67 countries account for 617 players (mean age 34 ± 16 years, 96% men) suffering from SCA or traumatic sudden death during football activities between 2014 - 2018, of whom 142 players (23%) survived¹. CPR resulted in a survival rate of 85% with the use of an automated external defibrillator (AED) compared to 35% without. Conclusion: Key recommendations from this literature review are listed in Table 1. These are important steps needed to improve survival chance from SCA³. Qatar, hosting the Football World Cup 2022, can put in place additional measures to promote effective SCA resuscitation and ensure the safety of all players.

Background: Regular physical activity (PA) is an effective preventative measure for diverse health risks among all age groups ¹. Global PA guidelines provide recommendations on the required levels for active lifestyle based on evidence-based behavioral benchmarks to increase awareness and reduce overall morbidity and mortality rates ². The Qatar National Physical Activity Guidelines (QNPAG) were first developed in 2014. The recently released QNPAG-2021 provides an updated evidence-based practical guide on PA prescription for practitioners, physicians, educators, and individuals who wish to engage in regular PA. This review aims to provide a summary of how the second QNPAG was developed. Methods: QNPAG was developed by Aspetar Orthopaedic and Sports Medicine Hospital in collaboration with key stakeholders in Qatar; such as the Ministry of Public Health, Qatar University, Hamad Bin Khalifa University, Hamad Medical Corporation, Primary Health Care Corporation, Naufar and others. The steering committee formed a technical advisory group of local and international sport medicine scientists, epidemiologists, and public health experts. Recent literature and global guidelines were evaluated and synthesized. Specific health outcomes and population groups were then proposed taking into consideration the prevalence of diseases, culture, and geographical location. Results: Three main chapters were added on PA benefits and sedentary behavior-associated risks for healthy population; people with medical conditions; and people with special challenging conditions. QNPAG 2021 included additional sections on pandemics, outbreaks and quarantine; humidity and air pollution; substance use; and locations for PA in Qatar. Other topics were added targeting obesity, osteoporosis, cancer, disabilities, mental health disorders, and down's syndrome. Detailed exercise prescription (Frequency/Intensity/Time/Type), and relevant examples were provided together with safety tips. Conclusion: The updated QNPAG is expected to raise awareness and help increase PA levels in Qatar. However, more emphasis on PA recommendations and strategical implementation is required through promotion, practice, and policies within the different sectors in the country.

Background: Inter-professional education (IPE) highlights collaborative practices aimed at promoting the working relationship between two or more healthcare professions¹. IPE achieves together more than what individuals can achieve to improve healthcare practices at an organizational level¹. In order to reduce the risk of injury during positioning and transfers of children admitted in the Almaha units, nursing, physical therapy, and occupational therapy professionals designed and implemented a competency training program to improve safe handling and mobilization of children.

The novelty in this program is that the training was conducted in the wardrooms with the children where the actual practice occurs². This context-specific training was designed after careful assessment of the real-time environment, complex needs of our children, and the presence of cumbersome life-saving equipment connected to their bodies. The education was delivered by rehabilitation professionals on five topics for a total of 134 nurses in Almaha units. Each session lasted 60 minutes with hands-on practice with a real patient. Methods: A pre-test/post-test design was used on a convenience sample of nurses for this pilot study. An observation-based checklist was designed by the authors to measure the nursing competencies in five tasks: Chair positioning, Bed positioning, Bed-to-chair and Chair-to-bed transfers, splint application, and utilizing powered wheelchairs. A rehabilitation professional completed the checklist for all participants by observation before the education. The same checklist was completed for 30 nurses, 6 months after the training. Results: The mean percentage scores improved for all tested patient handling competencies (Table 1; Figure 1). The mean percentage in improvement was 61.2% for the task of bed positioning. No further statistical tests were performed due to the small sample size. Conclusion: Inter-professional education provided in real-life settings was found to be effective in improving the safe handling and mobilization of children with complex needs.

Background: Complementary medicine therapies are used globally. Around 88% of the countries that are members of the World Health Organization (WHO) reported using such practices while there is no information reported from the remaining 12% of countries ¹. Cupping therapy is an ancient therapy trending to be used among athletes ². Other complementary medicine therapies such as chiropractic are also used in sports medicine ³. This narrative review aims to provide an update on the current status of complementary medicine therapies used in sports medicine. Methods: A comprehensive search using three medical databases (PubMed, Cochrane, TRIIP) was conducted using this search Boolean: (“cupping therapy” + “sports medicine”), (“complementary medicine” +” Sports medicine”), (“cupping therapy” + “athletes”), (“complementary medicine” + ”athletes”) from inception to June 2021. Inclusion criteria were: articles in English language, systematic reviews, reviews, and clinical trials which are in direct relation to the aim of this narrative review. Results: From the 725 retrieved results, only 17 articles were included in this narrative review after excluding duplicates, non-relevant articles, and applying inclusion/exclusion criteria (Figure 1). Cupping therapy, chiropractic, and acupuncture were identified for their use in sports medicine (Table 1). Complementary medicine therapies were used among a variety of sports such as football, basketball, and martial art players for treating pain, musculoskeletal disorders, and rehabilitation. The use of complementary medicine modalities for sports performance had controversial results. Conclusion: Complementary medicine modalities such as cupping therapy, acupuncture, and chiropractic are used by a variety of athletes with promising effects. The current evidence is still limited. Hence; conducting high-quality clinical trials is highly encouraged.

Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in a global health emergency. With incomplete vaccination and incomplete protection of the vaccinated population, there remains an urgent need to develop drugs to treat COVID-19. Our previou in silico analysis suggested vulnerability of SARS-CoV-2 to inactivation by the endogenous reactive metabolite, methylglyoxal (MG), by modification of arginine residues in the functional domains of viral spike and nucleocapsid proteins^1–3. In this study, the antiviral activity of MG against wild-type SARS-CoV-2 using in vitro assays was evaluated. Methods: Wild-type SARS-CoV-2 with titers of multiplicities of infection (MOI) 0.8, 0.2, 0.02, and 0.01 were incubated with 2-fold serial dilutions of MG (7.8 μM to 500 μM) in infection medium for six hour. MG-treated and untreated control SARS-CoV-2 were incubated with confluent cultures of Vero cells in vitro for one hour, cultures were washed and then incubated in a fresh infection medium at 37°C for 4 - 5 days until 70% of virus–infected cells displayed cytopathic effect (CPE). The antiviral activity of MG was judged by assessing virus replication using quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and median tissue culture infectious dose (TCID50) assays. Results: MG inhibited virus replication as measured by PCR and CPE of SARS-CoV-2 in vitro, with TCID50 increasing with increasing MOI. MG was most potent at MOI 0.02 and 0.01 where EC50 of MG was 49.6 ± 4.7 μM and 28.5 ± 1.3μM; respectively. Similar findings were also found for a shorter incubation period (3 hours) of MG and virus. Conclusion: MG has inhibitory activity against wild-type SARS-CoV-2 for virus exposure in the cell-free systems at low MOI. However, the antiviral activity of MG against other SARS-CoV-2 variants including alpha- and beta-variants is being investigated. Drugs increasing cellular concentration of MG to viricidal levels may have anti-COVID-19 activity.

Background: Coronavirus Disease 2019 (COVID-19) was first discovered in China and resulted in a pandemic crisis.^1,2 Many agents were investigated with inconclusive outcomes.³ This study was conducted to compare the efficacy and safety outcomes of darunavir-cobicistat versus lopinavir-ritonavir in the treatment of patients with COVID-19. Methods: This retrospective, multicenter, observational study was conducted on adult patients hospitalized in COVID-19 facilities in Qatar. Patients were included if they had pneumonia and received darunavir-cobicistat or lopinavir-ritonavir for at least three days as part of their COVID-19 treatment. Data were collected from patients’ electronic medical records. The primary outcome was a composite endpoint of time to clinical improvement and/or virological clearance. Data were analyzed descriptively and inferential statistics were applied at alpha level of 0.05. Results: A total of 400 patients’ medical records were analyzed, of whom 100 received darunavir-cobicistat and 300 received lopinavir-ritonavir. The majority of patients were male (92.5%), with a mean (SD) time from symptoms onset to start of therapy of 7.57 days (SD 4.89). Patients who received lopinavir-ritonavir had a significantly faster time to the primary composite endpoint of clinical improvement and/or virological clearance than patients who received darunavir-cobicistat (4 days [IQR 3-7] vs. 6.5 days [IQR 4-12]; HR 1.345 [95%CI: 1.070–1.691], p = 0.011) [Figure 1]. Patients who received lopinavir-ritonavir had a significantly faster time to clinical improvement (5 days [IQR 3-8] vs. 8 days [IQR 4-13]; HR 1.520 (95%CI: 1.2–1.925), p = 0.000), and slower time to virological clearance than those who received darunavir-cobicistat (25 days [IQR 15-33] vs. 21 days [IQR 12.8-30]; HR 0.772 (95%CI: 0.607-0.982), p = 0.035) [Figure 2]. No significant difference in adverse events incidence or severity was observed. Conclusion: In patients with COVID-19, early treatment with lopinavir-ritonavir was associated with faster time to reach the primary composite endpoint of clinical improvement and/or virological clearance than treatment with darunavir-cobicistat. Future trials are warranted to confirm these findings.

Background: COVID-19 infection is caused by a novel coronavirus. It was identified initially in late 2019 as the cause of a cluster of pneumonia cases in Wuhan, China. It spread worldwide causing a pandemic. Since the start of the COVID-19 pandemic, multiple complications have been linked to COVID-19 infections, one of them being pleural effusion. To the best of our knowledge, only a few case reports have discussed the incidence of candida empyema in COVID-19 patients^1,2. Case Presentation: This work is reporting on a case of COVID-19 pneumonia, in a 52-year-old previously healthy male patient, who developed ARDS 2 days after diagnosis of COVID-19 pneumonia and was attached to mechanical ventilation. Unfortunately, he continued to progress with refractory hypoxemia despite the maximum support. Ultimately, the patient required veno-venous ECMO with ultra-protective lung ventilation until the gas exchange in his lungs has normalized. The patient received multiple treatments based on our local protocol that have immunosuppressive effects. Due to worsening pneumonia, bronchoscopy was done. The Bronchoalveolar lavage (BAL) showed Candida Albicans, which was complicated with left-sided candida empyema. The later was treated by antifungal, chest tube insertion, and finally with decortication. However, despite the maximum interventions, the patient has unfortunately passed away 2 weeks after the decortication due to sepsis and multi-organ failure, while he was on ECMO during the whole period. Recommendation: Given the immunosuppressive effect of many of the medications used for the treatment of COVID-19 infection, atypical and opportunistic infections should be carefully considered within the clinical context. Conclusion: Candida pneumonia/empyema is not very common in a healthy host, however, it is a serious and rare condition, commonly seen in immunocompromised patients and associated with a high mortality rate³. The immunosuppressive therapies that are used in COVID-19 are not completely safe and more atypical infectious agents have been considered as not suitable in several typical locations causing adverse outcomes.

Background: Paramedics are subjected to high levels of stress, which increase their risk of depression, burnout, quitting the profession, or even committing suicide.¹ Some recent studies have focused on the coping strategies used by nurses in response to the COVID-19 pandemic², but little is known regarding paramedics. This study explored the potential coping strategies used by Hamad Medical Corporation Ambulance Service (HMCAS) paramedics and critical care paramedics (referred to as “Paramedics”) in Qatar to manage the stress associated with their work before and during the COVID-19 pandemic. Methods: An online survey combining a validated tool (an adapted tool from the COPE [Coping Orientation to Problems Experienced] Inventory³) with additional questions were sent to all HMCAS emergency Paramedics (n = 1,100) in early 2021 with text message reminders, with the aim of recruiting 285 participants based on a sample size calculation with a 95% Confidence Interval. Results: Only the responses from staff who had started to work in Qatar before December 2019 were considered for inclusion in the study. As such, 274 valid responses were analyzed. The results show that the staff has used a variety of coping strategies that differed slightly before and during the pandemic (Figure 1). The percentage of paramedics using coping strategies due to work-related stress was 75.9% before COVID-19 and only 54.4% during the pandemic. This reduction is presented in Figure 2. Moreover, the results showed that the observed differences in coping strategies adopted before and during the pandemic were not always statistically significant. Conclusion: The use of coping strategies among HMCAS Paramedics generally decreased during the COVID-19 pandemic, especially those related to going out, meeting up with friends and relatives, and practicing a sport. This can probably be explained by their increased working hours during the pandemic and the precautionary measures limiting group activities and interactions, but regrettably, this can only exacerbate their level of stress.

Background: People respond to stressful situations differently based on their ethnicity.¹ This study explored the impact of ethnicity on coping strategies used to deal with work-related stress among Hamad Medical Corporation Ambulance Service (HMCAS) paramedics in Qatar before and during the COVID-19 pandemic. It is based on the associated work conducted by the same team.^2,3Methods: An online survey combining validated tools with additional demographic questions was sent to all HMCAS paramedics (n = 1,100) between January and May 2021. The survey collected demographic information and data regarding the coping strategies they used before and during the COVID-19 pandemic. Results: 274 valid responses were received and categorized into 5 ethnic groups. For statistical analysis purposes, only the three main groups with a sufficient number of participants could be considered; Arabian (n = 151), South Asian (n = 45), and Southeast Asian (n = 60) (Total n = 256). The other ethnic groups were represented by too few participants. Overall, stress levels were higher for all ethnicities during the pandemic compared to before (Table 1). However, stress levels were lower in the Southeast Asian subgroup before and during the pandemic as compared to South Asian and Arabian counterparts (Table 1). The usual coping strategies such as visiting the cinema, spending time with friends, and playing team sports decreased for all study subgroups during the pandemic (Table 2); likely due to restrictions imposed to control the pandemic. The practice of religious rituals as a coping strategy showed a significant decrease in the South Asian and Southeast Asian subgroups during the pandemic. Although not statistically significant, subgroup Arabian staff have reported smoking more cigarettes or shisha as a coping strategy during the pandemic and consumed more alcohol or recreational drugs than the other two groups. Conclusion: This study demonstrated that ethnicity has impacted the perceived work-related stress. Further, the coping strategies among the various ethnic groups also differed. Additional studies with larger sample sizes and in different settings are important to inform policy design related to work stress potentially considering staff ethnicity.

Background: Paramedics are at risk of burnout which represents a concern for the healthcare system and public health¹. In Italy, about 20% of health practitioners were infected, and some died during their work fighting against the COVID-19 pandemic², but little is known regarding paramedics. This study assessed the level of stress associated with the work of Hamad Medical Corporation Ambulance Service (HMCAS) paramedics in Qatar before and during the COVID-19 pandemic. Methods: An online survey combining validated tools including the Workplace Stress Scale³, with additional questions, was sent to all HMCAS frontline staff (n = 1,100) between January and May 2021 with text message reminders. The items upon which the level of stress of paramedics was determined before and during the pandemic are presented in Table 1. The level of stress was determined based on the responses to 9 questions. Results: 274 valid responses were received. The level of stress was then split into five categories, from low to dangerous. Based on the paramedics’ responses, their reported level of stress was in the moderate range before the pandemic and reached the severe level during the pandemic (Table 2). Conclusion: The reported level of stress among HMCAS paramedics was significantly higher during the COVID-19 pandemic compared to prior levels of stress. This can probably be explained by the very nature of their profession as frontline clinicians responding to emergency calls and being potentially exposed to the viral infection. Strategies need to be put in place to effectively mitigate the effects of increased stress levels experienced, so that paramedics remain safe and able to provide effective medical care rather than succumb to mental and physical illness related to stress.

Background: Internationally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, causing corona virus disease (COVID-19), has increased the demand on healthcare services and resources¹. The proper use of personal protective equipment (PPE) by paramedics has recently become apparent². The risk of COVID-19 transmission has increased during prehospital life-saving procedures generating aerosols such as non-invasive ventilation, tracheal intubation, and external chest compressions, especially when working in a confined ambulance compartment³. Paramedics are encouraged to increase body-surface-isolation by donning additional PPE (high-filtration facemasks/face shields/surgical gowns/surgical hoods) during all patient encounters². This study aimed to better understand paramedics’ knowledge, attitude, and practice of PPE utilization in the State of Qatar during the COVID-19 pandemic. Methods: This prospective and quantitative study focused on the collection of descriptive data utilizing a purpose-designed online survey. Around 1300 frontline paramedics employed by Hamad Medical Corporation Ambulance Service (HMCAS) were invited via email to participate in the study. Results: 282 paramedics completed the survey. 90.4% were male and 78.7% had a bachelor's degree. 97.1% completed the mandatory HMCAS online infection control training program, 82.9% completed an N95 mask fit test in the last 5 years, and 91.5% completed the hand hygiene training program. The study found paramedics to be knowledgeable about COVID-19 and its transmission (98.2%) (Table 1). Paramedics’ attitude was mainly positive towards the use of PPE to prevent the spread of the virus which was synchronous with their practice. Conclusion: An effective model to curb the spread of COVID-19 amongst healthcare workers must consider the knowledge, attitude, and practice of first responders. This sample demonstrated a strong knowledge of COVID-19 and its transmission. Their overall positive attitude and good infection control practices were a demonstrative effort to mitigate risks associated with the spread of the virus in the prehospital setting.

Introduction: The COVID-19 pandemic had a significant impact on medical and maternity services across the world. The reported increase in maternal and neonatal morbidity and mortality is not only attributable to the disease itself but also the disruptions in the health services during lockdowns^1,2. Qatar maintained continuity of maternity services during the peak of the pandemic by telephone consultations³. It played a vital role in minimizing the community's spread of the disease. This study is a review to determine the frequency of patient contacts/visits during the COVID-19 pandemic and assessed pregnancy outcomes. Methods: A retrospective chart review was conducted at Al-Wakra Hospital using the electronic records of women who delivered between February-July 2020, during the peak of the pandemic in Qatar. COVID-19 positive patients were excluded. Data on the number of visits at Primary Health Care Corporation (PHCC) centers, Emergency Departments (ED), and Outpatient departments (OPD/Telephone consultations were collected. Pregnancy outcomes were noted and then compared with women who delivered pre-pandemic during a similar timeframe in the preceding year. Odds ratio was evaluated using MedCalcs’ online software. Results: A 40% increase in the number of births and an increase in patient visits to PHCC by 39.34% and ED by 44.04% were noted during the pandemic. Nearly all OPD consultations (3572) were performed by telephone in the study period during the pandemic (Figure 1). Rates of miscarriages and preterm birth, were unchanged (p>0.05). There were fewer admissions to Neonatal Intensive Care Unit (p < 0.05) as compared to the pre-pandemic period (Figure 2). Despite an increase in the number of births, there was no negative impact outcomes noted on neonatal during the pandemic. Conclusion: During the COVID-19 pandemic, poor pregnancy outcomes were noted across the world. In Qatar, the services were adapted to provide continuity of care. This presented challenges but there was no increase in adverse neonatal outcomes.

Background: In response to the declaration of COVID-19 reaching pandemic status, Mesaieed General Hospital (MGH) was commissioned in record time¹. A multidisciplinary team of healthcare professionals effectively worked together to confront the challenges and changing demands that arose due to the crisis². This work aims to describe the systematic approach used in our newly opened hospital in preparation for the national surges of COVID-19 cases. Methods: This is a clinical audit of MGH's preparation as a COVID-19 facility during the first and second waves of the pandemic in Qatar, utilizing the Comprehensive Hospital Agile Preparedness (CHAPs) tool³. The six essential domains of the tool are: workforce, infrastructure, supply and equipment, service reconfiguration, data and information technology, and communications (Table 1). Results: During the first wave, the multidisciplinary team and leaders encountered challenges in all domains of the CHAPs tool. These six key areas in preparing the hospital and the systems from the previous surge benefited us in managing the second wave which demonstrated significant improvements in five domains except for the workforce (Table 2). Despite having Corporate Nursing workforce in charge of the manpower pool from various facilities, temporary COVID-19 Registered Nurses and newly hired overseas staff have different nursing educational backgrounds, experience, and levels of expertise. This remains a challenge since most of the patients in the second wave were sicker and more critically-ill. It is essential to provide upskilling programs for nurses to improve their knowledge and abilities. Conclusion: This clinical audit concludes that the experiences and lessons learnt through MGH's COVID-19 pandemic preparation from the first to second wave have taught the team significantly to proactively address concerns to mitigate for similar pandemic situations in the future, particularly in preparation for the 2022 World Cup where influx of delegates and guests are expected to visit the country amidst the ongoing pandemic.

Background: Due to the COVID-19 pandemic, all out-patients clinics shifted to telehealth visits¹. However some patients still needed to be seen as face to face visit², mostly through the new urgent referrals which were overbooked in the clinics due to the limited availability of slots³. The aim of this quality improvement project was to decrease the percentage of re-booked urgent referrals for in-person visits in the general paediatric clinics from 60% to 30% within 2 months. Methods: An intervention study started in October 2020 until present at the Out-patient Paediatric Department, Hamad General Hospital, Qatar. It included all general paediatric clinics, targeting urgent referrals. The intervention was to standardize the triaging process of urgent referrals (Figure 1) to guide the general paediatric team for booking patients to in-person visits within two weeks. Patients were contacted to confirm the date, time, and location of their visits. Results: A total of 48 overbooking referrals in 11 clinics were screened with an average of 3 patients per clinic. 69% of the referral were re-booked to the next clinics. Implementing the above intervention methods, the number of re-booked urgent referrals went down to 28% (1 patient/clinic) within a 2-month period (Figure 2). Conclusion: During the unprecedented time of the pandemic, patients still need to access healthcare services safely and in a timely manner. This study showed that using a standardized pathway, the target of decreasing the need to re-book urgent visits for in-person evaluations was achieved. Standardization reduces wastes in processes (Figure 1) and decreases variations that may lead to overutilization of the limited resources and negatively affects patient care. Continuous monitoring and evaluation of the outpatient referrals processes are critical in ensuring the delivery of high-quality care.

Background: The COVID-19 pandemic changed the way we deliver primary health care services for good. The need to protect staff and patients from the spread of infection while still providing essential healthcare services to the public was challenging but ignited innovations to facilitate healthcare delivery. International research supports the action of containing the spread of a virus by limiting the number of people co-located, if possible¹. The implementation of telephone and video consultations started in March 2020 in Qatar, within 4 weeks of COVID-19 being detected in the community, to support patient safety and provide primary health care services. Methods: Qatar's Primary Health Care Corporation (PHCC) implemented telephone consultations at 27 health care centers across general and specialty services to meet patients’ demands. Video consultations swiftly followed within an inbound community call center and 10 health care centers for general medicine, dental, and ophthalmology services. The latter then expanded to include, dermatology, and physiotherapy services. Results: Patients quickly adapted to attending telephone consultations as they understood the safety aspects of staying home unless a face-to-face consultation was absolutely necessary. The implementation of telephone and video consultations within PHCC has been successful as over 1,000,000 telephone consultations and more than 2,000 video consultations have been completed in one year. At the climax of the pandemic (around June 2020) approximately 50% of consultations were held virtually (Table 1: Telephone consultations versus in-person visits from April to July 2020). Conclusion: The implementation of telephone and video consultation services within PHCC, imposed by the pandemic, changed the way to connect and deliver services to patients. As the pandemic continues, this offers an alternative to face-to-face visits and is widely accepted by the public as a model of care delivery. The use of telephone and video consultations are widely implemented across the globe and both patients and clinicians have adapted well to such new ways of working^2,3.

Background: Since the 2020 COVID-19 Pandemic struck the healthcare industry, there has been a rapidly evolving and escalating situation across the globe that lead healthcare organizations to embrace changes at an accelerated rate¹. Hamad Medical Corporation (HMC) had to cope with an overwhelming number of patients being admitted to Acute Care areas during early 2021. When four HMC tertiary and secondary care hospitals were already at full capacity with COVID-19 patients, there was a need for another hospital like Al Wakra Hospital (AWH) to step up. AWH was a multi-specialty hospital attending to patients from all age groups with varying intensity levels in its Outpatient, Inpatient, and Critical Care Units. This article encompasses the journey of AWH from an acute care hospital to a COVID-19 facility receiving adult and obstetric COVID-19 patients from April 5th, 2021. Methods: The preparation involved rigorous risk assessment, brainstorming, and modification of patient care pathways and services (Table 1). A Series of Risk Assessment rounds were conducted.

The transformation encompassed areas inclusive of, but are not limited to, the creation and implementation of clinical pathways, drop off and pick up points for ambulances, wayfinding creation, online/point-of-care/face-to-face education, installation of antigen testing/Sharps box/wall-mounted hand rubs/ACRYLIC screens, staff exposure interviews and test scheduling, personal protective equipment (PPE) availability, H2O2 vapor disinfection, and healthcare-associated infections surveillance². Clinical pathways were well thought out to ensure the prevention of cross-contamination between patients³. Results: This transformation (Table1) demonstrated that successful change ensuring patient and staff safety can be achieved in a matter of days based on an organization's determination and comprehensive strategic planning, redesigning strategies that are effective, efficient, and befitting the need of time. Conclusion: A well-formulated infrastructure, prompt reallocation of resources, staff dedication, teamwork, proactive risk assessment, and continuous collaborative efforts paved the road to the successful clinical transformation of AWH.

Background: As the number of coronavirus disease (COVID-19) patients has rapidly increased around the world, the World Health Organization (WHO) declared the COVID-19 outbreak as a global pandemic in March 2020.¹ The pandemic created a global crisis affecting all countries, business sectors, and citizens around the world in their everyday lives.² Qatar's national policies and strategies focus on protecting the lives and the recovery of livelihoods. In line with this and to minimize the adverse impact on people's health and the environment, all types of wastes needed to be properly managed ³, especially at the time of a pandemic when everything might be contaminated. Methods: The Environmental Safety Section (ESS) under the Occupational Health and Safety (OHS) Department conducted a series of meetings with Hamad Medical Corporation (HMC) waste contractor and concerned departments to discuss the proper management of COVID-19 wastes generated from isolation and quarantine facilities. ESS staff provided training for nursing and housekeeping staff on the proper COVID-19 waste management from segregation, packaging, labeling, collection, and transport, and to strictly implement the System-Wide Incident Command Center (SWICC) memo.³Results: There was an increase in COVID-19 wastes from March to May 2020, with the highest amount recorded in the month of May as shown in Figure 1 due to the increase in COVID-19 patients, new COVID-19 facilities, improper segregation, and lack of training for the new staff and contractors. Conclusion: ESS-OHS collaborated with the COVID-19 management facilities for the proper waste collection and transportation. All applied strategies were effective and helped gradually to reduce the waste generated starting from August 2020.