***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 
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    Input: We recently published the results of a r and omised controlled trial of a  nurse telephone consultation service in primary care out of hours.1 The new service , operating at evenings and weekends , significantly reduced  general practitioners ’ workload and was at least as safe as the existing out of hours service . Contacts diminish sharply after about 10 pm,2 and , anecdotally , a higher proportion of night calls necessitate consultation with a general practitioner . We report here a parallel trial aim ed at establishing whether  nurse telephone consultation was equally effective in managing workload at night 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 OBJECTIVE To determine the safety and effectiveness of  nurse telephone consultation in out of hours primary care by investigating adverse events and the management of calls . DESIGN Block r and omised controlled trial over a year of 156 matched pairs of days and weekends in 26 blocks . One of each matched pair was r and omised to receive the intervention . SETTING One 55 member general practice cooperative serving 97 000 registered patients in Wiltshire . SUBJECTS All patients contacting the out of hours service or about whom contact was made during specified times over the trial year . INTERVENTION A nurse telephone consultation service integrated within a general practice cooperative . The out of hours period was 615 pm to 1115 pm from Monday to Friday , 1100 am to 1115 pm on Saturday , and 800 am to 1115 pm on Sunday . Experienced and specially trained nurses received , assessed , and managed calls from patients or their carers . Management options included telephone advice ; referral to the general practitioner on duty ( for telephone advice , an appointment at a primary care centre , or a home visit ) ; referral to the emergency service or advice to attend accident and emergency . Calls were managed with the help of decision support software . MAIN OUTCOME MEASURES Deaths within seven days of a contact with the out of hours service ; emergency hospital admissions within 24 hours and within three days of contact ; attendance at accident and emergency within three days of a contact ; number and management of calls in each arm of the trial . RESULTS 14 492 calls were received during the specified times in the trial year ( 7308 in the control arm and 7184 in the intervention arm ) concerning 10 134 patients ( 10.4 % of the registered population ) . There were no substantial differences in the age and sex of patients in the intervention and control groups , though male patients were underrepresented overall . Reasons for calling the service were consistent with previous studies . Nurses managed 49.8 % of calls during intervention periods without referral to a general practitioner . A 69 % reduction in telephone advice from a general practitioner , together with a 38 % reduction in patient attendance at primary care centres and a 23 % reduction in home visits was observed during intervention periods . Statistical equivalence was observed in the number of deaths within seven days , in the number of emergency hospital admissions , and in the number of attendances at accident and emergency departments . Conclusions Nurse telephone consultation produced substantial changes in call management , reducing overall workload of general practitioners by 50 % while allowing callers faster access to health information and advice . It was not associated with an increase in the number of adverse events . This model of out of hours primary care is safe and effective The authors examined the effect of after-hours telephone access to physicians and physician access to computerized medical records on hospitalizations and emergency room ( ER ) visits in an inner-city , adult , general medicine clinic . Patients were r and omly assigned to a control ( C ) and two study groups ( S1 and S2 ) . Patients in study groups S1 and S2 had after-hours telephone access to physicians . Computerized medical records were accessible to physicians only for callers in study group S2 . During the initial 18 months of study , only 7.6 % of eligible patients called the after-hours service , a rate of 6 calls/1,000 patients / month ( 200 calls/1,849 patients /18 months ) . Repeated promotion of the service was subsequently undertaken , and 19.4 % of the patients used the service during the final 12 months of study , a rate of 24.1 calls/1,000 patients /month ( 467 calls/1,616 patients /12 months ) . There were no significant differences in hospitalizations or ER visits among the control and two study groups A r and omized clinical trial of pediatric protocol s administered by health assistants demonstrated an alternate method of  h and ling telephone complaints in a large emergency room . The new system advised a higher medical examination rate than the current system in the emergency room probably bacause the current system has deficits with respect to collecting necessary information and making explicit decisions . This higher rate of recommended visits demonstrated in the emergency room was not confirmed in the two pediatric primary -care setting s in which the protocol system was also tested . In addition to this use , the telephone protocol s may also be useful in training medical and nursing students , in h and ling telephone complaints similar to a poison control center , in triaging problems in a rural or emergency medical service , and in providing a record of the telephone call BACKGROUND After-hours telephone calls are a stressful and frustrating aspect of pediatric practice . At the request of private practice pediatricians in Denver , a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care . This system , the After-Hours Program ( AHP ) , uses specially trained pediatric nurses with st and ardized protocol s to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians , representing 56 practice s. OBJECTIVES This report describes the AHP , presents data from 4 years ' experience with the program , and describes results of our evaluation of the following aspects of the program : subscribing physician satisfaction , parent satisfaction , the accuracy and appropriateness of telephone triage , and program costs . METHODS After-Hours Program records ( including quality assurance data ) for all 4 years of operation were retrospectively review ed , tabulated , and analyzed . The results of two subscribing physician surveys and one parent caller satisfaction survey are presented . A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP . An analysis of the total cost of this program to 10 r and omly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians . RESULTS In 4 years , 107,938 calls have been successfully managed without an adverse clinical outcome . Minor errors in using protocol s occurred in one call out of 1450 after-hours calls . After-hours phoen calls necessitated an after-hours patient visit 20 % of the time and generated one after-hours hospital admission out of every 88 calls . Just over half of the patients were managed with home care advice only , and 28 % were given home care advice after-hours and seen the next day in the primary physician 's office . Of all patients directed by the telephone triage nurses to be seen after hours , 78 % were determined to have a condition necessitating after-hours care . Data are presented regarding call volumes by time of day , day of week , patient age , and patient 's initial complaint . The 6 most common complaints accounted for more than one half of the calls , and 38 complaints accounted for more than 95 % of all after-hours calls . Utilization by subscribing physicians is described . Satisfaction among subscribing pediatricians was 100 % , and among parents was 96 % to 99 % on a variety of issues . The total cost to participating Denver pediatricians ( which includes revenues " given up " as a result of not seeing patients after hours ) ranged from 1 % to 12 % of their annual net income , depending on a variety of factors . CONCLUSIONS Large-scale after-hours telephone coverage systems can be effective and well-received by patients , parents , and primary physicians . Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage . Controversies associated with this type of program are discussed . Suggestions are made regarding the direction of future programs and research The purpose of this research was to determine whether a specialized telephone service could cut down on unscheduled visits to ambulatory care and improve satisfaction with care .  Patients who were to receive care ( N=561 ) were assigned r and omly to a specialized telephone service or a control group . They were measured with regard to satisfaction with care before being assigned and 6 months later . The number of scheduled and unscheduled visits also were monitored for a 1-year follow-up period . The telephone service , which provided a triage system for referrals as well as a source of central contact for scheduling or for complaints , helped to improve satisfaction and reduce the number of unscheduled visits within 6 months . Such a service also may have application in other problem areas in the delivery of quality ambulatory care STUDY OBJECTIVES We sought to compare triage design ations derived from in-person and telephone interviews and systematic ally examine the effect of visual cues , vital signs , and complaint-based protocol s on the triage process . METHODS We conducted a 2-phase , prospect i ve , observational study employing a r and omized , crossover design in a university teaching hospital emergency department . In both phases , every eligible patient underwent sequential in-person and telephone triage interviews conducted by certified ED triage nurses . After taking a history , each nurse chose 1 of 5 hypothetical triage design ations and , after being told the patient 's vital signs , again selected a design ation . Phase 1 design ations were based solely on nurses ' clinical expertise . In phase 2 , both nurses used complaint-based protocol s. RESULTS Agreement between telephone and in-person design ations was poor ( percent agreement , 43.1 % to 48.8 % ; kappa,.19 to.26 ; taub,.34 to.45 for the 4 primary comparisons ) . Knowledge of vital signs and use of protocol s did not improve agreement or increase identification of patients requiring admission to hospital . CONCLUSION These data establish that telephone and in-person triage are not equivalent and suggest that visual cues may play an important role in the triage process . It is unclear whether telephone triage is an adequate method of assigning patients to an appropriate level of care 
    Output:
    
Although telephone consultation appears to have the potential to reduce GP workload , questions remain about its effect on service use .