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

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 a series of observations on the appropriateness of the tool itself and its use in a higher-resourced system. Methods: All areas of the MTC that impact emergency care capacity were studied, with multiple key informants (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 between May and September 2024, over an ED transition in July 2024, with the extension to the original ED of an additional 12-cubicle resuscitation unit and associated infrastructure. Results: The HEAT-ECCS showed higher availability ratings both overall, and in each of the 5 parameters: Infrastructure; Diagnostics; Human Resources; Clinical Services and Signal Functions. 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.