Table_1_Showcasing the Saudi e-referral system experience: the epidemiology and pattern of referrals utilising nationwide secondary data.docx

IntroductionReferrals are an integral part of any healthcare system. In the Kingdom of Saudi Arabia (KSA) an electronic referral (e-referral) system known as the Saudi Medical Appointments and Referrals Centre (SMARC) began formally functioning in 2019. This study aims to showcase the Saudi experience of the e-referral system and explore the epidemiology of referrals nationally.
MethodsThis retrospective descriptive study utilised secondary collected data between 2020 and 2021 from the SMARC system. Cross tabulations with significance testing and colour-coded maps were used to highlight the patterns across all regions.
ResultsThe study analysed over 600,000 referral requests. The mean age of patients was 40.70 ± 24.66 years. Males had a higher number of referrals (55.43%). Referrals in 2021 were higher than those in 2020 (56.21%). Both the Autumn and Winter seasons had the highest number of referrals (27.09% and 27.43%, respectively). The Surgical specialty followed by Medicine had the highest referrals (26.07% and 22.27%, respectively). Life-saving referrals in the Central region were more than double those in other regions (14.56%). Emergency referrals were also highest in the Southern regions (44.06%). The Central and Eastern regions had higher referrals due to unavailable sub-speciality (68.86% and 67.93%, respectively). The Southern regions had higher referrals due to both unavailable machine and unavailable beds (18.44% and 6.24%, respectively).
ConclusionThis study shows a unique system in which referrals are between secondary, tertiary, and specialised care. It also highlights areas of improvement for equitable resource allocation and specialised care in slightly problematic areas as well as the use of population density in future planning.

引言
转诊是所有医疗体系不可或缺的组成部分。沙特阿拉伯王国（KSA）于2019年正式启用了沙特医疗预约与转诊中心（Saudi Medical Appointments and Referrals Centre，SMARC）电子转诊（e-referral）系统。本研究旨在展现沙特电子转诊系统的实践经验，并探究全国范围内转诊的流行病学特征。

方法
本研究为回顾性描述性研究，采用2020至2021年SMARC系统的二次采集数据。研究通过显著性检验交叉表与配色地图，清晰呈现各区域的转诊模式。

结果
本研究共分析超60万条转诊请求。患者平均年龄为40.70±24.66岁。男性转诊量占比达55.43%，高于女性。2021年转诊量占总分析量的56.21%，高于2020年。秋季与冬季的转诊量均为全年最高，分别占比27.09%与27.43%。外科专科转诊量居首（26.07%），其次为内科专科（22.27%）。中部区域的救命性转诊量是其他区域的两倍以上，占比达14.56%；南部区域的急诊转诊占比最高，达44.06%。中部与东部区域因亚专科资源不足产生的转诊占比分别为68.86%与67.93%，位列各区域前列。南部区域因设备短缺与床位不足产生的转诊占比分别为18.44%与6.24%，居各区域首位。

结论
本研究揭示了一套独特的转诊体系，其转诊流转覆盖二级、三级与专科医疗服务层级。同时，本研究指出了部分区域在资源公平分配与专科医疗服务方面存在的改进空间，并建议在未来规划中纳入人口密度因素以优化布局。