Emergency Unit Assessment of Seven Tertiary Hospitals in Nepal using the WHO Tool: A cross-sectional study

Background: In 2021, the Nepal national emergency care system’s assessment (ECSA) identified 39 activities and 11 facility specific goals to improve care. To support implementation of the ECSA facility-based goals, this pilot study used the World Health Organization’s (WHO) Hospital Emergency Unit Assessment Tool (HEAT) to evaluate key functions of emergency care at tertiary hospitals in Kathmandu, Nepal. Methods This cross-sectional study used the standardized HEAT assessment tool. Data on facility characteristics, human resources, clinical services, and signal functions were gathered via key informant interviews conducted by trained study personnel. Seven tertiary referral centers in the Kathmandu valley were selected for pilot evaluation including governmental, academic and private hospitals. Descriptive statistics were generated and comparative analyses were conducted. Results All facilities had continuous emergency care services, but differed in the extent of availability of each item surveyed. Academic institutions had the highest rating with greater availability of consulting services and capacity to perform specific signal functions including breathing interventions and sepsis care. Private institutions were found to have the highest infrastructure availability and diagnostic testing capacity. Across all facilities, common barriers included lack of training of key emergency procedures, written protocols, point of care testing, and ancillary patient services. Conclusion This pilot assessment demonstrates that current emergency care capacity at representative tertiary referral hospitals in Kathmandu, Nepal is variable with some consistent barriers which preclude meeting the ECSA goals. The results can be used to inform emergency care development within the region studied and demonstrate that the WHO HEAT assessment is feasible and may be instructive in systematically advancing emergency care delivery at the national level if implemented more broadly.