Assessment of quality of emergency care services in terms of availability and readiness in public and private tertiary care hospitals in Rawalpindi, Pakistan: a comparative study

Emergency department (ED) serve as critical entry points in healthcare systems, particularly in tertiary care hospitals where complex medical emergencies are managed. In Pakistan, both public and private sector tertiary care hospitals provide emergency care services; however, systematic evidence comparing their quality in terms of service availability and readiness remains limited. The World Health Organization’s Harmonized Health Facility Assessment (HHFA) tool is one such approach that offers a framework to evaluate the quality of health care facilities in terms of service availability and readiness. The current exploratory comparative study was conducted to compare the quality of emergency care services in terms of service availability and readiness between public and private tertiary care hospitals in Rawalpindi, Pakistan. This exploratory comparative cross-sectional study was conducted in six tertiary care hospitals (three public and three private sector hospitals) in Rawalpindi, Pakistan, from September 2024 to December 2024. The availability and readiness of emergency care services were evaluated using an adapted WHO HHFA tool addressing multiple domains: emergency service availability, site condition readiness, equipment readiness, medicines and commodities, diagnostic readiness, and support and quality services. The indicators were scored as available or unavailable, and scores were aggregated to form domain-specific percentage scores. Results were reported as median (IQR), and comparisons between public and private-sector hospitals were performed using the Mann-Whitney U test due to the small sample size. The data were analyzed via a scoring system formulated by HHFA in SPSS version 27. The median daily ED patient volume was 320 (IQR: 300–340) for public hospitals and 210 (IQR: 195–225) for private hospitals, while the median for the number of ED beds was 28 (IQR: 26–30) and 15 (IQR: 15-17.5), respectively. No statistically significant difference was observed between hospital characteristics (p > 0.05). The median overall emergency service availability and readiness score was 76.47 (IQR: 75.29–80.59) for public hospitals and 76.47 (IQR: 75.00-77.06) for private hospitals (p = 0.658). In both sectors, the median readiness for emergency medicines and surgical equipment was 100. The median diagnostic readiness score in public hospitals was 42.86 (IQR: 28.57–64.29), compared to 14.29 (IQR: 14.29-50.00) in private hospitals. However, this difference did not attain statistical significance (p = 0.637). No statistically significant differences were observed between public and private hospitals for all observed domains. This exploratory study found no statistically significant differences in emergency care service availability and readiness between public and private tertiary care hospitals in Rawalpindi. Although minor numerical variations were observed, both sectors demonstrated comparable availability and readiness for emergency care. Persistent deficiencies in diagnostic readiness and support services across both sectors indicate the need for system-level improvements to strengthen emergency care delivery.