Using the WHO Hospital Emergency Unit Assessment Tool to assess changes in Emergency Care Capacity in a United Kingdom Major Trauma Centre

Abstract Background We reviewed a Major Trauma Centre (MTC) in the UK over an Emergency Department (ED) transition using the World Health Organization (WHO) Hospital Emergency Unit Assessment Tool (HEAT). HEAT has previously been used in low- and middle-income countries. This is the first time it has been used to explore resource constraints and predict potential barriers to emergency care capacity in a higher-income country. Our primary outcome was to find any difference in emergency care capacity with a change in emergency care resources. Secondary outcomes included qualitative data collected by key informant (KI) interviews both on the suitability of the tool itself and on its use in a higher-resourced system. Methods All areas of the MTC that impact emergency care capacity were studied, with multiple KIs in each area interviewed. The HEAT-adjusted Emergency Care Capacity Score (HEAT-ECCS) was used for quantitative analysis of the MTC’s emergency care capacity. Qualitative data was collected for analysis of barriers to availability of emergency care. Data collection was before and after an ED transition in 2024, with the extension to the original ED of an additional 12-cubicle resuscitation unit and associated infrastructure. Results The overall HEAT-ECCS improved from 77% to 83%. Each of the 5 parameters also showed higher availability ratings, with biggest parameter improvements found in Infrastructure (83% to 93%) and Human Resources (61% to 72%). KI comments on the applicability of HEAT to this setting fell into 4 themes: 1. Equipment / process in this context. 2. Skill in this context. 3. Question clarity. 4. Streaming Conclusions This study provides context to barriers to availability of emergency care and suggests some solutions may be found through similar ED transitions. By exploring emergency care systems from a global health perspective, using tools such as HEAT, we believe that learning can be shared between higher and lower-resourced systems, and strategies found to strengthen them. Trial registration This study received local Research and Innovation approval, and registered as a health improvement project (reference 24HIP31) to hold interviews, store and analyse anonymised KI responses and disseminate findings through publication and conference presentation.