Background: Mental illness affects an estimated 25% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2%, yet 86.1% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics. Objectives: This study aims to analyze Saudi Arabia’s novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making. Methods: This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020‐2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions. Results: Analysis of 10,033 psychiatric e-referrals revealed that 58.99% (n=5918) were for patients aged 18‐44 years, 63.93% (n=6414) were for men, and 87.10% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. “Unavailable subspecialty” was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020. Conclusions: This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems.

Background/Objectives: Intensive care unit (ICU) e-referrals are an important indicator for exploring potential deficiencies in critical care resources. This study aimed to examine the epidemiology and patterns of ICU e-referrals across all regions of Saudi Arabia during the COVID-19 pandemic using routinely collected data from April 2020 to December 2021. Methods: This descriptive epidemiological study analyzed data from the Saudi Medical Appointments and Referrals Centre (SMARC). This study reveals novel regional ICU e-referral patterns for critical cases using national unique digital health data, adding insights beyond the existing literature. Variables included age, sex, referral timing, reason, specialty, and region of origin. Descriptive statistics and mapping of administrative areas were performed based on e-referral request rates per 10,000 population. Results: During the study period, 36,619 patients had ICU e-referral requests. The mean age was 54.28 years, with males constituting 64.81% of requests. Out-of-scope e-referrals comprised 71.44% of requests. Referrals related to medical specialties, such as cardiology and pulmonology, were the most common (62.48%). Referral patterns showed peaks in July–August 2020 and May 2021. The Northern Border and Albaha areas had the highest request rates per population, potentially reflecting a higher proportion of severe cases requiring ICU-level care compared to other regions. Conclusions: The temporal pattern and geographic distribution of ICU e-referrals mirrored previously reported critical COVID-19 cases in Saudi Arabia. Preventive measures and vaccination programs contributed to a significant decline in ICU e-referral requests, suggesting a positive impact on controlling severe COVID-19 cases. Population-adjusted analysis revealed regional disparities, highlighting the importance of considering population size in healthcare resource management and policy.

Background and Objective: Mental disorders significantly impact quality of life and life expectancy, representing a leading cause of global disease burden. Healthcare systems worldwide face challenges in meeting mental health service demands, particularly due to specialist shortages and geographical barriers. Saudi Arabia has implemented an innovative nationwide electronic referral system (SMARC) as part of its digital health transformation strategy to enhance mental healthcare accessibility. This study examined SMARC’s effectiveness in facilitating mental health service access by analyzing patient transfer acceptance rates between healthcare facilities and identifying factors influencing these rates. Methods: This retrospective cross-sectional study analyzed 9722 mental health electronic referrals within SMARC from January 2020 to December 2021. Descriptive statistics characterized referral patterns, while bivariate and multivariable logistic regression analyses identified factors associated with referral acceptance, calculating adjusted odds ratios (aORs) and 95% confidence intervals. Results: The system achieved an overall acceptance rate of 82.5%, with different patterns across age groups and regions. Lower acceptance rates were observed for ages 15– 25 years (aOR = 0.84; 95% CI = 0.70– 0.99) and 46– 65 years (aOR = 0.83; 95% CI = 0.70– 0.99) compared to ages 26– 35 years. Life-saving referrals showed the highest acceptance (aOR = 2.60; 95% CI = 1.51– 4.48), while psychiatrist availability significantly influenced acceptance rates (aOR = 1.36; 95% CI = 1.17– 1.58). External referrals were half as likely to be accepted as internal ones (aOR = 0.51; 95% CI = 0.42– 0.64). Conclusion: SMARC demonstrates effectiveness in optimizing mental healthcare access through strategic matching of patient needs with available resources. The system’s selective acceptance patterns reflect its capability to prioritize care based on clinical urgency and resource availability. These findings provide valuable insights for policymakers to keep enhancing digital health infrastructure and mental healthcare delivery. The SMARC model offers a promising framework for implementing similar digital referral systems globally to improve mental healthcare coordination and accessibility.

Objectives: Out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system. Methods: A retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR. Results: A total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively. Conclusion: T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers’ locations could improve T-CPR performance.

Background/Objectives: Saudi Arabia implemented the Saudi Medical Appointments and Referrals Centre (SMARC) e-referral system to coordinate patient transfers and enhance healthcare access across the country. This nationwide system was established to improve coordination between healthcare facilities and provide timely access to specialized services. SMARC operates as a centralized coordination hub connecting secondary and tertiary care facilities across all specialties nationwide. This study evaluates SMARC’s evolution since 2020–2021 and efficiency improvements through 2023–2024 after major expansion efforts. Methods: This retrospective analysis examined 755,145 e-referrals across all 13 administrative regions of Saudi Arabia during 2023–2024. The study analyzed data extracted from the SMARC database covering two consecutive years. Outcomes assessed included acceptance rates, referral destinations (internal within the same region vs. external to other regions), and factors associated with system performance. Results: The total volume of e-referrals through SMARC increased substantially by 19.34% to 755,145 in 2023–2024. Acceptance rates for referrals improved markedly from 74.13% to 90.19% over this period. The proportion of internal referrals increased from 80.13% of total referrals to 87.52%. In contrast, external referrals to other regions declined from 19.87% to 12.48% of the total. Critical care referrals (ICU, CCU, NICU, PICU) decreased from 12.39% to 9.91%. Referrals for life-saving emergency conditions showed a noticeable decrease from 6.65% to 2.18%. Referrals to hospital outpatient departments (OPD) also showed an increase from 48.07% to 66.66% of total referrals. Conclusions: SMARC demonstrated considerable improvements in key metrics including referral acceptance rates and growth in regional self-sufficiency. This progress is associated with the Kingdom’s goals for advancing its healthcare system under Vision 2030 initiatives. The system has enabled more effective care coordination and access to specialized services across regions. These achievements were observed during a period of significant healthcare infrastructure expansion documented during this period, including growth in specialized centers, increased ICU bed capacity following governmental regulation after the COVID-19 pandemic, and expansion of trained medical subspecialists.

Background/Objectives: The demand for Emergency Medical Services (EMS) has increased over the past few years, increasing the EMS burden. Public utilization of EMS for non-emergency cases is a major global issue contributing to this burden. This study explores the public’s ability to accurately recognize emergency situations and appropriately request ambulance services. Methods: This cross-sectional study utilized a survey to explore public awareness among residents of Riyadh, Saudi Arabia. The survey was developed from the relevant literature and panel discussions, followed by validation through a pilot study. Recruitment was conducted in different publicly accessible places to capture the diverse demographics of the residents. The sample size was statistically calculated using the Raosoft sample size calculator to identify significant differences. Results: This study included 522 respondents, predominantly females (79%) aged 18–34 (42%) and 35–54 (41%) years. Both males and females correctly identified around two-thirds of the total emergency cases, with means of 6.49 (SD = 1.27) and 6.55 (SD = 1.32), respectively. Appropriate ambulance requests were made in less than one-third of the emergencies by both males and females, with means of 2.29 (SD = 1.29) and 2.38 (SD = 1.32), respectively. Stroke and older adults with hip pain were the most accurately recognized emergency cases at 92.5% and 90%, respectively, while mild chest pain and child head hematoma were the least accurately recognized at 36.6% and 38.5%. Women in labor and objects in the ear canal were the most misidentified as emergencies at 97.3% and 87.7%, respectively. Conclusions: This study highlights the prevalence of unrecognized emergency situations and the underutilization of EMS for real emergency cases. The findings recommend the need for national training programs and provide valuable insights for EMS dispatcher training programs regarding public perceptions of emergency and non-emergency situations. While the findings provide insights into targeted preventive measures to alleviate the EMS burden, they also demonstrate the critical role of public awareness in enhancing public health safety concerning emergency situations.