It worked well for me in this one because I thought I was being set up for either "mental hospital run be evil people" or "haunted mental hospital" or a combination of both.
Without knowing the twist at the time, the staff's indifference toward Kristen's reasonable questions about why people were disappearing was very sinister. Even if they had said "she's no longer in this hospital, but we can't discuss another patient's case without their permission" or something like that it would have seemed halfway reasonable.
The fact that this particular ward was very small (but in a huge hospital) but they never replaced the missing patients seemed odd, too. It had me thinking that maybe some sort of expreiment was going on. Maybe the drugs they were given were causing an altered state of consciousness which caused a greater openness to the spirit world. Maybe the staff knew they had killed the other girl and was letting the ghost get her revenge. Until the last ten minutes there were several directions it could have gone.
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