Patient abandonment is a burden on patient’s perspective as well as hospital itself at a point of time. Since others non-abandoned patients may not obtain the same optimum care that they need resulting access block and increase ED overcrowding [8].

The study has reported that majority of adult patients aged 40 to 59 years with medical illness showed longer length of hospital stay and were the primary cause of death in ED [9].  The study reported from Bir hospital of Nepal had already started allocating beds for abandoned patients who were left in the ED for longer period of time. At the same time the hospital had been providing a free medical service to the abandoned, helpless and poor patients [10].

The AVPU scale which is a simplified 4-part (alert, verbally responsive, painfully responsive and unresponsive) scale and is well described the level of patient’s consciousness was expected to be associated with patient’s outcome [11]. Surprisingly, 80% of the patient expired who were alert (A) expired and 71.4% were discharged who were responsive to (P) painful stimuli (Table 2). This was possible by the staffs of ED organising plan and management strategies by themselves to take care of these patients until their disposition (Figure 3, 4).

Unlikely study done in western countries, the current study did not observe any investment for the poor who have been left behind, struggling daily to acquire food, shelter, healthcare, and other necessities of life [12]. In the study more than $200 has been seen invested who are taken care by charitable organizations hospital whereas, less than USD fifty ($50) was invested by BPKIHS to abandoned patients. These disparities could be because of underdevelopment of infrastructure and its legislative initiatives of hospital. In March 2013, the government of Nepal had expanded its program and has allocated about 7 % (percent) of its budget to the Ministry of Health and Population that offers free medical care to such patients [13]. According to National Population and Housing Census 2011 and The World Bank 2019, Nepal has an estimated population of about 26.5 million people, and about 39 % (percent) of the population live in poverty [14,15]. Due to unaffordable cost of medical care for longer period of time most of the families are bound for abandoning their patient at emergency doorsteps.

Whatever the circumstances, the treating physicians feel that they have no choice but to keep this patient until a further plan can be made or their family member can be traced. One study reported from India that apart from treatment of an abandoned patient, the doctors’ efforts were successful to trace their family member [16].

Our study has a few limitations. The sample was small and single centred. More researches needed to find out the factors associated with abandonment of patients in tertiary hospitals of Nepal. Both local and central government of Nepal should launch a separate budget program for services provided to uninsured, low-income and abandoned patients (uncompensated care costs) that include all types of medical payments annually for the better health care system. The efforts of healthcare workers of emergency department as well as inter-department consultants are appreciative for going above and beyond their duties and even at their best going out their way to help these abandoned cases in all Emergency Department of tertiary care centre of Nepal.