***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 Objectives : To describe the proportion of patients attending an accident and emergency department for whom blood analysis at the point of care brought about a change in management ; to measure the extent to which point of care testing result ed in differences in clinical outcome for these patients when compared with patients whose sample s were tested by the hospital laboratory . Design : Open , single centre , r and omised controlled trial . Blood sample s were r and omly allocated to point of care testing or testing by the hospital 's central laboratory . Setting : The accident and emergency department of the Bristol Royal Infirmary , a large teaching hospital which cares for an inner city population . Subjects : Representative sample of patients who attended the department between April 1996 and April 1997 and who required blood tests . Data collection was structured in 8 hour blocks so that all hours of the day and all days of the week were equally represented . Main outcome measures : The proportion of patients for whom point of care testing  brought about a change in treatment in which timing was considered to be critical to clinical outcome . Mortality , the length of stay in hospital , admission rate , the amount of time spent waiting for results of blood tests , the amount of time taken to decide on management plans , and the amount of time patients spent in the department were compared between patients whose sample s were tested at the point of care and those whose sample s were sent to the laboratory . Results : Sample s were obtained from 1728 patients . Changes in management in which timing was considered to be critical occurred in 59 out of 859 ( 6.9 % , 95 % confidence interval 5.3 % to 8.8 % ) patients in the point of care arm of the trial . Decisions were made 74 minutes earlier ( 68 min to 80 min , P<0.0001 ) when point of care testing was used for haematological tests as compared to central laboratory testing , 86 minutes earlier ( 80 min to 92 min , P<0.0001 ) for biochemical tests , and 21 minutes earlier ( −3 min to 44 min , P=0.09 ) for analyses of arterial blood gases . There were no differences between the groups in the amount of time spent in the department , length of stay in hospital , admission rates , or mortality . Conclusion : Point of care testing reduced the time taken to make decisions on patient management that were dependent on the results of blood tests . It also brought about faster changes in treatment for which timing was considered to be critical in about 7 % of patients . These changes did not affect clinical outcome or the amount of time patients spent in the department . Key messages Point of care testing reduced the amount of time doctors spent waiting for results of blood tests when compared to the time spent waiting for results from the hospital laboratory in an accident and emergency department The time taken to decide on a management plan was also reduced as a result of the shorter time spent waiting for results of point of care tests About 7 % of patients who needed urgent blood testing had changes in treatment in which timing was considered to be critical when point of care testing was used Patients did not spend less time in the accident and emergency department even when test results were available more quickly and patient management decisions were made more quickly . This suggests that the availability of test results is not the factor which slows down the arrangement of further care Improvements in process , such as a reduction in the time doctors wait for test results and the ability to make clinical decisions more quickly , do not seem to improve clinical outcome in this sample of Patients with isolated limb injuries are often required to wait a long time for treatment and investigation in emergency departments . It was hypothesized that allowing triage nurses to initiate X-rays would reduce transit times for these patients . A prospect i ve , r and omized comparison trial of 175 patients was conducted , comparing transit times between a group of  patients who had X-rays initiated at triage and a  group which did not .  No statistically significant reduction in transit time was demonstrated by this change in practice , either for a group who had sustained fractures or for one which had not . Despite this finding , staff and patient satisfaction with this change in procedure was high . This justifies continuation of the practice and further research 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 The aim of this study was to determine the effectiveness of  ' fast-tracking '  in an academic emergency department ( ED ) during a period of limited re sources and space constraints . This was a prospect i ve , double-blind , comparative clinical trial . Fast-tracking was applied every other day between 08.00 and 17.30 hours . Patients meeting fast-tracking criteria , which were determined as allergy , dyspepsia , hypertension , urinary tract infection , urolithiasis , gastroenteritis , upper airway infection , minor lacerations , and soft tissue injuries with no sign or symptom of life-threatening illness or acute abdomen , were treated by a design ated fast-tracking team . In the alternate days fast-tracking was not done , and the patients having the same criteria were recorded and followed as the control group . ED length of stays were determined for each patient , and at time of discharge a question naire was applied to determine patient satisfaction . Follow-up was performed by telephone survey at the 5th day of discharge . The median length of stay was 36 minutes for the fast-tracked group compared with 63 minutes for the control group . The application of fast-tracking decreased ED length of stay and improved patient satisfaction in patients presenting with allergy , dyspepsia , upper airway infection , minor laceration , and soft tissue injury , but not in patients with gastroenteritis , urinary tract infection , hypertension , and urolithiasis . The rate of follow-up was 81 % ( n = 217 ) , and there were no complications or hospitalizations to another hospital . It is concluded that fast-tracking is an applicable and useful system in an academic ED with limited re sources , and decreases ED length of stay and improves patient satisfaction in a selected group of patients . Determination of fast tracking criteria must be individualized for each hospital according to re sources . Additionally , fast-tracking seems to be safe when performed under strict criteria for patient selection OBJECTIVE --To evaluate whether waiting time in accident and emergency ( A&E ) departments is shortened when experienced nurses request peripheral limb radiographs before a patient is assessed by a doctor . DESIGN --Simultaneous prospect i ve trial in four A&E departments in the United Kingdom with doctors and nurses requesting radiographs ; 2000 patients were r and omly allocated to either a " Nurse First " or " Doctor First " category . SUBJECTS-- Patients older than 5 years presenting with recent peripheral limb injuries . MAIN OUTCOME MEASURES --Timing of the various stages of a patient 's passage through the A&E department comparing the orthodox route with a group of patients in whom an experienced A&E nurse had the option of requesting a radiograph before a medical assessment . RESULTS --There was a significant reduction in the time spent in A&E when no radiograph was requested ( P < < 0.001 ) . The mean time saved in the  " Doctor First "  ( DF ) group was 51 min , and in the " Nurse First " ( NF ) group 36 min . For those who were sent for an x ray 14 min was saved by getting the patient to see the nurse first . However , because the overall referral rate for x rays was greater in the NF group , ( 78 % of patients compared with 74 % of the DF group , a significant 4 % increase ( P = 0.05 ) this potential benefit was largely lost . Overall the average waiting time in the DF group of 92.5 min ( 95 % confidence interval : 89.2 to 96.1 min ) was reduced to 88.5 min ( 95 % CI:85.2 to 91.8 min ) in the NF group , a non-significant saving of 4 min . There was no overall difference between the proportion of relevant abnormalities reported by the radiologists for the DF or NF groups ( G2 = 0.739 , 1df , P = 0.30 ) ; however , there was a significant association between the number of relevant abnormalities reported by the radiologists and the different hospitals ( G2 = 9.7626 , 3df , P = 0.02 ) . Hospital C had the highest abnormality rate reported by the radiologists in both the DF ( 45 % ) and the NF ( 51 % ) groups . The most time saved in A&E was in the DF category when comparing those who did not have an x ray [ 58 ( CI 54 - 63 ) min ] with those who did [ 109 ( CI 104 - 114 ) min ] , a saving of 51 min . The corresponding time saved in the NF category between those who did not have an x ray [ 59 ( CI 53 - 65 ) min ] and those who did [ 95 ( CI 91 - 99 ) min ] was 36 min . CONCLUSIONS --14 min can be saved by getting the patient to see the nurse first ; however , because nurses in three out of four hospitals requested more radiological examinations than doctors , overall only 4 min waiting time was saved when peripheral limb radiographs were requested by nurses . The findings are somewhat against expectations but do identify that specific training and constant monitoring is essential if nurses are to request peripheral limb radiographs , as reflected in hospital C results We prospect ively investigated whether routine use of a point-of-care testing ( POCT ) device by nonlaboratory operators in the emergency department ( ED ) for all patients requiring the available tests could shorten patient length of stay ( LOS ) in the ED . ED patient LOS , defined as the length of time between triage ( initial patient interview ) and discharge ( released to home or admitted to hospital ) , was examined during a 5-week experimental period in which ED personnel used a h and -held POCT device to perform Na , K , Cl , glucose ( Gluc ) , and blood urea nitrogen ( BUN ) testing . Preliminary data demonstrated acceptable accuracy of the h and -held device . Patient LOS distribution during the experimental period was compared with the LOS distribution during a 5-week control period before institution of the POCT device and with a 3-week control period after its use . Among nearly 15 000 ED patient visits during the study period , 4985 patients ( 2067 during the experimental period and 2918 during the two control periods ) had at least one Na , K , Cl , BUN , or Gluc test ordered from the ED . However , no decrease in ED LOS was observed in the tested patients during the experimental period . Median LOS during the experimental period was 209 min vs 201 min for the combined control periods . Stratifying patients by presenting condition ( chest pain , trauma , etc . ) , discharge/admit status , or presence/absence of other central laboratory tests did not reveal a decrease in patient LOS for any patient subgroup during the experimental period . From these observations , we consider it unlikely that routine use of a h and -held POCT device in a large ED such as ours is sufficient by itself to impact ED patient LOS BACKGROUND Triage liaison physicians ( TLPs ) have been employed in overcrowded emergency departments ( EDs ) ; however , their effectiveness remains unclear . OBJECTIVES To evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting . METHODS A six-week TLP clinical research project was conducted between December 9 , 2005 , and February 9 , 2006 . A TLP was deployed for nine hours ( 11 AM to 8 PM ) daily to initiate patient management , assist triage nurses , answer all medical consult or transfer calls , and manage ED administrative matters . The study was divided into three two-week blocks ; within each block , seven days were r and omized to TLP shifts and the other seven to control shifts . Outcomes included patient length of stay , proportion of patients who left without complete assessment , staff satisfaction , and episodes of ambulance diversion . RESULTS TLPs assessed a median of 14 patients per shift ( interquartile range , 13 - 17 ) , received 15 telephone calls per shift ( interquartile range , 14 - 20 ) , and spent 17 - 81 minutes per shift consulting on the telephone . The number of patients and their age , gender , and triage score during the TLP and control shifts were similar . Overall , length of 
    Output:
    
Scientific evidence on the effect of fast track on waiting time , length of stay , and left without being seen was moderately strong .
The effect of team triage on left without being seen was relatively strong , but the evidence for all other interventions was limited or insufficient .
Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time , shorter length of stay , and fewer patients leaving without being seen .
Team triage , with a physician in the team , will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen .
There is only limited scientific evidence that streaming of patients into different tracks , performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay