• N Darkaoui, V De Brouwere, A Zayyoun, H Filali, R Belouali, F Gouaima, J Van der Vennet, and B Dujardin.
• Institut National d'Administration Sanitaire, Collège de Santé, Rabat, Maroc.
• Rev Epidemiol Sante. 1999 Oct 1;47 Suppl 2:2S53-64.

BackgroundUtilisation of emergency department (ED) for non-urgent problems, usually dealt with in first line health services (FLHS), has an impact both in terms of efficiency (ED care is more expensive than primary health care) and in terms of quality of care (due to ED overcrowding). This study describes the utilisation pattern of the ED at the Children's Hospital of Rabat (CHR) and assesses the appropriateness of ED utilisation.MethodsDuring a whole week in September 1991, 24 h/24, information about every child admitted in the ED was collected by outside investigators, using a questionnaire. This questionnaire was divided into two sections. One section, filled out at admission of the child, consisted of the following items: time of arrival, health problem, health seeking pattern and identification of child (name, age, gender and address). The second section was filled out at the medical consultation and consisted primarily of a judgement about the relevance of ED utilisation (urgent/non-urgent condition, need for hospital-based equipment, subjective assessment of delay).ResultsDuring the week under study, 1,544 children were admitted at the ED: 904 at the medical ED and 640 at the surgical ED. At the medical ED, the proportion of urgent cases was 38%; among them, 65% needed hospital-based equipment and among the latter 72% arrived on time. It means that only 18% of the children utilised the ED in an appropriate way. At the surgical ED, the proportion of urgent cases was 56%; among them, 41% needed hospital-based equipment and among the latter 86% arrived on time. It means that only 20% of the children appropriately utilised the surgical ED. Appropriate utilisation is not associated with gender. The proportion of cases judged as urgent was associated neither to hour of admission--at least for the medical ED--nor to distance (less than 15 km). However, the proportion of urgent cases varied according to the day of the week.ConclusionResults confirmed the opinion of the CHR staff: most children admitted to the ED had health problems that should have been cared for at FLHS. Rationalisation of ED utilisation will depend on the health system's ability to supply acceptable and accessible care at FLHS.

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