***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: STUDY OBJECTIVE We sought to develop and vali date st and ardized clinical criteria to identify patients presenting to the emergency department whose care may be safely deferred to a later date in a nonemergency setting . METHODS Using a modified Delphi process , a 17-member multidisciplinary physician panel developed explicit , st and ardized , deferred-care criteria . In a prospect i ve cohort design , emergency nurses at a tertiary care Veterans Administration ( VA ) Medical Center , using the criteria , screened 1,187 consecutive ambulatory adult patients presenting with abdominal pain , musculoskeletal symptoms , or respiratory infection symptoms . Patients meeting deferred-care criteria  were offered the option of an appointment within 1 week in the ambulatory care clinic at the study site ; all other patients were offered same-day care . As outcome measures , we assessed nonelective hospitalizations for related conditions occurring within 7 days of evaluation at our facility or any other VA facility within a 300-mile radius , and we assessed 30-day all-cause mortality . RESULTS Two hundred twenty-six ( 19 % ) patients met screening criteria for deferred care . Patients meeting deferred-care criteria experienced zero ( 95 % confidence interval , 0 % to 1.2 % ) related nonelective VA hospitalizations within 7 days of evaluation , and none died within 30 days . By contrast , 68 ( 7 % ) of 961 ( 95 % confidence interval , 5.5 % to 8.9 % ) patients who did not meet deferred-care criteria were hospitalized nonelectively for related conditions , and 5 ( 0.5 % ) died . CONCLUSION By using hospitalization and 30-day mortality as safety gauges , st and ardized clinical criteria can identify , at presentation , VA ED users who may be safely cared for at a later date in a nonemergency setting . These guidelines apply to a significant proportion of VA ED users with common ambulatory conditions . These criteria deserve testing in other ED setting Objective To evaluate effectiveness , safety and cost-effectiveness of Computerised Clinical Decision Support ( CCDS ) for paramedics attending older people who fall . Design Cluster trial r and omised by paramedic ; modelling . Setting 13 ambulance stations in two UK emergency ambulance services . Participants 42 of 409 eligible paramedics , who attended 779 older patients for a reported fall . Interventions Intervention paramedics received CCDS on Tablet computers to guide patient care . Control paramedics provided care as usual . One service had already installed electronic data capture . Main Outcome Measures Effectiveness : patients referred to falls service , patient reported quality of life and satisfaction , processes of care . Safety Further emergency contacts or death within one month . Cost-Effectiveness Costs and quality of life . We used findings from published Community Falls Prevention Trial to model cost-effectiveness . Results 17 intervention paramedics used CCDS for 54 ( 12.4 % ) of 436 participants . They referred 42 ( 9.6 % ) to falls services , compared with 17 ( 5.0 % ) of 343 participants seen by 19 control paramedics [ Odds ratio ( OR ) 2.04 , 95 % CI 1.12 to 3.72 ] . No adverse events were related to the intervention . Non-significant differences between groups included : subsequent emergency contacts ( 34.6 % versus 29.1 % ; OR 1.27 , 95 % CI 0.93 to 1.72 ) ; quality of life ( mean SF12 differences : MCS −0.74 , 95 % CI −2.83 to + 1.28 ; PCS −0.13 , 95 % CI −1.65 to + 1.39 ) and non-conveyance ( 42.0 % versus 36.7 % ; OR 1.13 , 95 % CI 0.84 to 1.52 ) . However ambulance job cycle time was 8.9 minutes longer for intervention patients ( 95 % CI 2.3 to 15.3 ) . Average net cost of implementing CCDS was £ 208 per patient with existing electronic data capture , and £ 308 without . Modelling estimated cost per quality -adjusted life-year at £ 15,000 with existing electronic data capture ; and £ 22,200 without . Conclusions Intervention paramedics referred twice as many participants to falls services with no difference in safety . CCDS is potentially cost-effective , especially with existing electronic data capture . Trial Registration IS RCT N Register IS RCT Objective : To investigate the potential impact for ambulance services of telephone assessment and triage for callers who present with non-serious problems ( Category C calls ) as classified by ambulance service call takers . Design : Pragmatic controlled trial . Calls identified using priority dispatch protocol s as non-serious were allocated to intervention and control groups according to time of call . Ambulance dispatch occurred according to existing procedures . During intervention sessions , nurses or paramedics within the control room used a computerised decision support system to provide telephone assessment , triage and , if appropriate , offer advice to permit estimation of the potential impact on ambulance dispatch . Setting : Ambulance services in London and the West Midl and s. Subjects : Patients for whom emergency calls were made to the ambulance services between April 1998 and May 1999 during four hour sessions sample d across all days of the week between 0700 and 2300 . Main outcome measures : Triage decision , ambulance cancellation , attendance at an emergency department . Results : In total , there were 635 intervention calls and 611 controls . Of those in the intervention group , 330 ( 52.0 % ) were triaged as not requiring an emergency ambulance , and 119 ( 36.6 % ) of these did not attend an emergency department . This compares with 55 ( 18.1 % ) of those triaged by a nurse or paramedic as requiring an ambulance ( odds ratio 2.62 ; 95 % CI 1.78 to 3.85 ) . Patients triaged as not requiring an emergency ambulance were less likely to be admitted to an inpatient bed ( odds ratio 0.55 ; 95 % CI 0.33 to 0.93 ) , but even so 30 ( 9.2 % ) were admitted . Nurses were more likely than paramedics to triage calls into the groups classified as not requiring an ambulance . After controlling for age , case mix , time of day , day of week , season , and ambulance service , the results of a logistic regression analysis revealed that this difference was significant with an odds ratio for nurses : paramedics of 1.28 ( 95 % CI 1.12 to 1.47 ) . Conclusions : The findings indicate that telephone assessment of Category C calls identifies patients who are less likely to require emergency department care and that this could have a significant impact on emergency ambulance dispatch rates . Nurses were more likely than paramedics to assess calls as requiring an alternative response to emergency ambulance despatch , but the extent to which this relates to aspects of training and professional perspective is unclear . However , consideration should be given to the acceptability , reliability , and cost consequences of this intervention before it can be recommended for full evaluation 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 evaluate the benefits of paramedic practitioners assessing and , when possible , treating older people in the community after minor injury or illness . Paramedic practitioners have been trained with extended skills to assess , treat , and discharge older patients with minor acute conditions in the community . Design Cluster r and omised controlled trial involving 56 clusters . Weeks were r and omised to the paramedic practitioner service being active ( intervention ) or inactive ( control ) when the st and ard 999 service was available . Setting A large urban area in Engl and . Participants 3018 patients aged over 60 who called the emergency services ( n=1549 intervention , n=1469 control ) . Main outcome measures Emergency department attendance or hospital admission between 0 and 28 days ; interval from time of call to time of discharge ; patients ' satisfaction with the service received . Results Overall , patients in the intervention group were less likely to attend an emergency department ( relative risk 0.72 , 95 % confidence interval 0.68 to 0.75 ) or require hospital admission within 28 days ( 0.87 , 0.81 to 0.94 ) and experienced a shorter total episode time ( 235 v 278 minutes , 95 % confidence interval for difference −60 minutes to −25 minutes ) . Patients in the intervention group were more likely to report being highly satisfied with their healthcare episode ( relative risk 1.16 , 1.09 to 1.23 ) . There was no significant difference in 28 day mortality ( 0.87 , 0.63 to 1.21 ) . Conclusions Paramedics with extended skills can provide a clinical ly effective alternative to st and ard ambulance transfer and treatment in an emergency department for elderly patients with acute minor conditions . Trial registration IS RCT N27796329 Aims Overcrowding at pediatric emergency departments ( EDs ) may result in delayed clinical management and higher risks of medical error . This study was design ed to prospect ively evaluate what parents of sick children seek emergency care for and how these patients are being assessed and managed . Methods Patients aged 0 to 17 years seeking ED care at an urban Swedish university hospital , from 8 AM to 9 PM on 25 consecutive days , were included .  Clinical urgency and further level of medical care were determined by experienced nurses based on individual clinical signs and vital parameters . Information on presenting problem , medical priority , gender , age , waiting time , day of week , time of day , and further management was recorded . Results Among 1057 included children , two thirds were assessed by physicians , whereas one third were referred directly by nurses for other ED ( n = 54 ) or primary care ( n = 114 ) , or sent home with medical advice ( n = 176 ) , more often during evenings and weekends . Of primarily referred patients , 7.6 % returned within 72 hours , and three of them were admitted . Young infants , patients with respiratory or neurological problems , and sicker patients with fever or infections were mainly assessed by physicians , within desired priority time . Discussion More than one fourth of pediatric ED patients might rapidly , appropriately , and safely be referred for primary care or sent home by experienced pediatric nurses soon after arrival , thereby facilitating management of urgent and more appropriate patients . Evaluations by physicians were primarily required in young infants and for urgent medical conditions dem and ing qualified pediatric skills Background : A scheme to train paramedics to undertake a greater role in the care of older people following a call for an emergency ambulance was developed in a large city in the UK . Objectives : To assess the cost effectiveness of the paramedic practitioner ( PP ) scheme compared with usual emergency care . Methods : A cluster r and omised controlled trial was undertaken of  PP  compared with usual care . Weeks were allocated to the study group at r and om to the PP scheme either being active ( intervention ) or inactive ( control ) . Re source use data were collected from routine sources , and from patient-completed question naires for events up to 28 days . EQ-5D data were also collected at 28 days . Results : Whereas the intervention group received more PP contact time , it reduced the proportion of emergency department ( ED ) attendances ( 53.3 % vs 84.0 % ) and time in the ED ( 126.6 vs 211.3 minutes ) . There was also some evidence of increased use of health services in the days following the incident for patients in the intervention group . Overall , total costs in the intervention group were £ 140 lower when routine data were considered ( p = 0.63 ) . When the costs and QALY were considered simultaneously , PP had a greater than 95 % chance of being cost effective at £ 20 000 per QALY . Conclusion : Several changes in re source use are associated with the use of PP . Given these economic results in t and em with the clinical , operational and patient-related benefits , the wider implementation and evaluation of similar schemes should be considered Objective . To examine the effects of transferring nonurgent 911 calls to a telephone consulting nurse .  It was hypothesized that the telephone referral program would result in fewer basic life 
    Output:
    
Conclusion There was no conclusive evidence regarding the impact of diversion strategies on ED utilisation and subsequent healthcare utilisation .