***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To see whether care provided by general practitioners to non-emergency patients in an accident and emergency department differs significantly from care by usual accident and emergency staff in terms of process , outcome , and comparative cost . Design : A r and omised controlled trial . Setting : A busy inner city hospital 's accident and emergency department which employed three local general practitioners on a sessional basis . Patients : All new attenders categorised by the triage system as “ semiurgent ” or “ delay acceptable . ” 66 % of all attenders were eligible for inclusion . Main outcome measures : Numbers of patients undergoing investigation , referral , or prescription ; types of disposal ; consultation satisfaction scores ; reattendance to accident and emergency department within 30 days of index visit ; health status at one month ; comparative cost differences . Results : 4684 patients participated . For semiurgent patients , by comparison with usual accident and emergency staff , general practitioners investigated fewer patients ( relative difference 20 % ; 95 % confidence interval 16 % to 25 % ) , referred to other hospital services less often ( 39 % ; 28 % to 47 % ) , admitted fewer patients ( 45 % ; 32 % to 56 % ) , and prescribed more often ( 41 % ; 30 % to 54 % ) . A similar trend was found for patients categorised as delay acceptable and ( in a separate analysis ) by presenting complaint category . 393 ( 17 % ) patients who had been seen by general practitioner staff reattended the department within 30 days of the index visit ; 418 patients ( 18 % ) seen by accident and emergency staff similarly reattended . 435 patients ( 72 % of those eligible ) completed the consultation satisfaction question naire and 258 ( 59 % of those eligible ) provided health status information one month after consultation . There were no differences between patients managed by general practitioners and those managed by usual staff regarding consultation satisfaction question naire scores or health status . For all patients seen by general practitioners during the study , estimated marginal and total savings were £ Ir1427 and £ Ir117005 respectively . Conclusion : General practitioners working as an integral part of an accident and emergency department manage non-emergency accident and emergency attenders safely and use fewer re sources than do usual accident and emergency staff . Key messages Key messages A study extending this innovation shows that the care provided to non-emergency patients by general practitioners working as an integral part of an accident and emergency department also differs substantially from the care provided by the usual staff in terms of process Compared with the usual accident and emer- gency department staff , general practitioners investigate fewer patients , refer to other hospital services less often , more often refer patients back to their own general practitioners for follow up , admit fewer patients , and prescribe more often General practitioners within an accident and emergency department have no apparent effect on reattendance rates to the department within 30 days , patient satisfaction , or health status one month after the initial attendance As yet there are no explanations for these differ- ences , which warrant further This study sought to evaluate how the addition of a  general practitioner ( GP ) surgery influences the utilization of an emergency department ( ED ) .  An intervention trial with historical control was conducted in a Swedish university hospital ED . A GP surgery was established in the ED by the addition of GP physicians without the addition of other personnel ( nurses , secretaries , aids ) . The number of persons evaluated and managed by the GP physicians and ED physicians were quantified preintervention ( April 1992 to October 1993 ) and postintervention ( April 1994 to October 1995 ) . Further information was obtained by question naires distributed to all physicians and patients during three sample study weeks : 1 week before intervention and 6 and 18 months after the intervention . Patient volume , percentages of inappropriate visits , and types of services were recorded . The addition of GP physicians increased the number of visits to the ED by 27 % ( 4,694 per month to 5,952 per month ) . The percentage of patients managed in the ED who had nonurgent complaints ( primary health care needs ) increased with the intervention from 22 % ( 95 % confidence interval [ CI ] 19 % , 25 % ) to 33 % ( 95 % CI 30 % , 37 % ) . The increased dem and on the ED of patients with nonurgent complaints increased the average waiting time for patients with urgent or emergent complaints from 35 minutes to 40 minutes ( 14 % ) . The introduction of GPs to an ED increased the number and proportion of patients presenting to the ED with nonurgent complaints Background and aim Non-urgent Emergency Department presentations contribute to overcrowding , which can adversely affect patient care . Redirecting patients to a more appropriate service is an option to help address this . We conducted a prospect i ve evaluation of a major Scottish hospital ’s Emergency Department redirection policy to assess its safety . Methods and results Over two months , 620 patients triggered senior assessment for redirection with 444 ( 72 % ) redirected to primary care . Information on presentation was collected with subsequent management and outcome of redirection  provided by the patient ’s general practitioner . Those who required admission within seven days of redirection triggered review . This was carried out independently by an Emergency Department Consultant and a GP Principal to assess the incidence of sub-optimal care or harm as a consequence of redirection . Most patients presented during daytime hours with no significant variation between days . ‘ Patient factors ’ accounted for 74 % of presentations with ‘ convenience ’ ( 20 % ) cited as the most common reason . Twenty-two patients were subsequently admitted , with one case of sub-optimal care ( incidence 0.23 % ) and no cases of harm . Conclusions Our redirection policy provides a safe and effective means of directing patients to more appropriate care . The authors believe this to be in the patient s best interest as Emergency Department clinicians are not specifically trained to manage primary care issues Objectives To assess the proportion of  emergency department ( ED ) attendances that would be suitable for primary care and the inter-rater reliability of general practitioner ( GP ) assessment of primary care suitability . Design of study Survey of GPs ’ agreement of suitability for primary care on a r and om anonymised sample of all ED patients attending over a 1-month period . Setting ED of a UK Hospital serving a population of 600 000 . Method Four GPs independently used data extracted from clinical notes  to rate the appropriateness for management in primary care as well as need for investigations , specialist review or admission . Agreement was assessed using Cohen 's κ . Results The mean percentage of patients that GPs considered suitable for primary care management was 43 % ( range 38–47 % ) . The κ for agreement was 0.54 ( 95 % CI 0.44 to 0.64 ) and 0.47(95 % CI 0.38 to 0.59 ) . In patients deemed not suitable for primary care , GPs were more likely to determine the need for specialist review ( relative risks (RR)=3.5 , 95 % CI 3.0 to 4.2 , p<0.001 ) and admission ( RR=3.9 , 95 % CI 3.2 to 4.7 , p<0.001 ) . In patients assessed as suitable for primary care , GPs would initiate investigations in 51 % of cases . Consensus over primary care appropriateness was higher for paediatric than for adult attenders . Conclusions A significant number of patients attending ED could be managed by GPs , including those requiring investigations at triage . A stronger agreement among GPs over place of care may be seen for paediatric than for adult attenders . More effective signposting of patients presenting with acute or urgent problems and supporting a greater role for primary care in relieving the severe workflow pressures in ED in the UK are potential solutions Objectives : To determine the impact of establishing walk-in centres alongside emergency departments ( EDs ) on attendance rates , visit duration , process , costs and outcome of care . Methods : Eight hospitals with co-located EDs and walk-in centres were compared with eight matched EDs without walk-in centres .  Site visits were conducted . Routine data about attendance numbers and use of re sources were analysed . A r and om sample of records of patients attending before and after the opening of walk-in centres  was also assessed . Patients who had not been admitted to hospital were sent a postal question naire . Results : At most sites , the walk-in centres did not have a distinct identity and there were few differences in the way services were provided compared with control sites . Overall , there was no evidence of an increase in attendance at sites with walk-in centres , but considerable variability across sites was found . The proportion of patients managed within the 4 h National Health Service target improved at sites both with and without walk-in centres . There was no evidence of any difference in reconsultation rates , costs of care or patient outcomes at sites with or without walk-in centres . Conclusions : Most hospitals in this study implemented the walk-in centre concept to a very limited extent . Consequently , there was no evidence of any effect on attendance rates , process , costs or outcome of care We conducted a six-month prospect i ve study of the diagnoses and outcomes of 588 children who were denied care in our emergency department under a new primary -care case management health system for 100,000 indigent patients . The mean patient age was 4.7 years ( 39 % were less than 2 years old ) . The most common presenting complaints were colds , earaches , rash , vomiting , and diarrhea . Nine percent of children presented for trauma , and 10 % had fever of more than 38.2 C. Follow-up was available from the primary care physician for 388 children ( 66 % ) . Of the 60 % of patients who kept their arranged appointment , 42 % received  antibiotics  , 3 % were referred for further evaluation , and two children were hospitalized . Follow-up was available from the parents for 125 children ( 21 % ) . No follow-up information of any kind was available for 111 children ( 19 % ) , and no follow-up regarding the health of the child was available for 265 children ( 45 % ) . This last group included 10 % with a chief complaint of trauma and 6 % with temperature of more than 39 C. Forty-nine percent of patients in this group were less than 2 years old STUDY OBJECTIVE Our objective is to determine whether a point-of-care intervention that navigates willing , low-acuity patients from the emergency department ( ED ) to a Primary Care Clinic will increase future primary care follow-up . METHODS We conducted a quasi-experimental trial at an urban safety net hospital . Adults presenting to the ED for select low-acuity problems were eligible . Patients were excluded if arriving by emergency medical services , if febrile , or if the triage nurse believed they required ED care . We enrolled 965 patients .  Navigators escorted a subset of willing participants to the Primary Care Clinic ( in the same hospital complex ) , where they were assigned a personal physician , were given an overview of clinic services , and received same-day clinic care . The primary outcome was Primary Care Clinic follow-up within 1 year of the index ED visit among patients having no previous primary care provider . RESULTS In the bivariate intention-to-treat analysis , 50.3 % of intervention group patients versus 36.9 % of control group patients with no previous primary care provider had at least 1 Primary Care Clinic follow-up visit in the year after the intervention . In the multivariable analysis , the absolute difference in having at least 1 Primary Care Clinic follow-up for the intervention group compared with the control group was 9.3 % ( 95 % confidence interval 2.2 % to 16.3 % ) . There was no significant difference in the number of future ED visits . CONCLUSION A point-of-care intervention offering low-acuity ED patients the opportunity to alternatively be treated at the hospital 's Primary Care Clinic result ed in increased future primary care follow-up compared with st and ard ED referral practice Objective To compare the initial assessment and management of walk-in emergency department ( ED ) patients between different types of healthcare providers . Setting A large teaching hospital with an annual ED census of 140 000 adult patients . Methods A r and om sample of 384 patients who self-presented to the ED was obtained . A detailed analysis of each patient record was performed by two clinicians . Data were obtained on the presenting condition , and disposition of each patient , either into the ED for further assessment , or discharge . Results GPs were significantly more likely to discharge patients home as compared to emergency nurses . ED senior nurses were more likely than GPs to stream patients into the ED for further assessment . Of the patients referred into the ED for further assessment by senior ED nurses , the majority were discharged home . There were insufficient numbers of emergency physician assessment s for meaningful statistical analysis . Conclusions The clinician groups studied here demonstrated different patterns of discharge and referral , reflecting their training and experience . When planning operational procedures , the training and background of the staff allocated to each area should be considered Objective To assess hospitalisation rate as a proxy for the ability of the  Manchester Triage System ( MTS )  to identify less urgent paediatric patients . We also evaluated general practitioner ( GP ) services to determine if they met patients ' needs compared to emergency department care . Methods Self-referred children triaged as less urgent by the MTS in two emergency departments in the Netherl and s were included in a prospect i ve observational study .  Therapeutic interventions during emergency department consultation , hospitalisation after consultation and determinants for hospitalisation were assessed using logistic regression analysis . Results During emergency department consultation , extensive therapeutic interventions  were performed more often in patients with extremity problems ( n=175 , 19 % ) and dyspnoea ( n=30 , 15 % ) . 191 ( 3.5 % ) of 5425 patients were hospitalised . Age and presenting problem remained statistically significant in multivariable logistic analysis , predicting hospitalisation with ORs of 3.0 ( 95 % CI 2.2 to 4.1 ) for age < 1 year , 2.5 ( 1.5 to 4.1 ) for dyspnoea , 3. 
    Output:
    
Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients ; however , there is little evidence that this frees up emergency department staff to care for the sickest patients .
Distinct primary care services offering increased patient choice may result in provider-induced dem and .