Emergency unit assessment of seven tertiary hospitals in Nepal using the WHO tool: a cross‐sectional study

Emergency unit assessment of seven tertiary hospitals in Nepal using the WHO tool: a cross‐sectional study

Emergency care, Nepal, Global health, Emergency assessment, Hospital care, Acute care

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 func-
tions 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 had 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 the current emergency care capacity at representative ter-
tiary 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 Nepal 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.

Ramu Kharel1*, Ghan B. Thapa2

, Tamara Voor3

, Samriddha R. Pant4

, Samir K. Adhikari5

, Bimal S. Bist6
,

Pryanka Relan7

, Timmy Lin1

, Derek Lubetkin1

, Giovanna Deluca1

, Olita Shilpakar4

, Sanu K. Shrestha8
,

Yagya R. Pokharel9

, Santosh Paudel10, Ajay S. Thapa11, Yogendra M. Shakya4

, Achyut R. Karki12,

Nishant Dhakal13 and Adam R. Aluisio1

https://doi.org/10.1186/s12245-023-00484-2

2023

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