Abstract
BACKGROUND: Emergency and critical care (ECC) services are essential for reducing preventable mortality from acute illness and injury. Evidence on hospital readiness for ECC in India remains limited. This study assessed facility-level readiness using the World Health Organization’s Hospital Emergency Unit Assessment Tool (HEAT). METHODS: A nationwide cross-sectional survey was conducted between December 2024 to March 2025 across 50 hospitals representing tertiary, secondary, and district-level facilities in India. Multiple healthcare providers and administrators from each hospital were interviewed to triangulate facility-level availability of ECC resources (total respondents = 600). The hospital was the primary unit of analysis. ECC readiness was assessed across four domains—staff, supplies & equipment, clinical services, and systems & space—using HEAT tracer items scored on a three-point scale (1 = generally unavailable, 2 = partially available, 3 = adequately available). Domain and overall readiness scores were calculated as the proportion of tracer items rated as adequately available, expressed on a scale from 0 to 1. RESULTS: The median overall ECC readiness score was 0.46 (IQR: 0.38–0.58) on a 0–1 scale, where higher values indicate greater readiness. Tertiary hospitals demonstrated higher readiness (0.62) than secondary (0.50) and district hospitals (0.40). Clinical services had the highest domain score (0.55), while supplies & equipment had the lowest (0.40). Frequently reported barriers included personnel shortages (72%), stock-outs of essential supplies (68%), lack of training (66%), and infrastructure limitations (56%). CONCLUSION: The findings indicate moderate ECC readiness among the participating hospitals, with notable gaps at district and secondary levels. Strengthening workforce capacity, supply systems, and infrastructure may improve emergency care delivery. Further nationally representative assessments are needed to guide policy and system-wide planning. CLINICAL TRIAL NUMBER: Not applicable.