***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: 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 BACKGROUND Telephone working is an increasingly important way of managing general practice workload , particularly out of hours . The role of telephone triage , however , in managing acute consultations during the day has not been adequately research ed . AIM To determine the impact of telephone triage , conducted by a practice nurse , on the management of same day consultations in a general practice . METHOD A general practice of 11,300 patients in South Tyneside collected prospect i ve telephone and surgery consultation data over three months .  Patient satisfaction , for those who had received only telephone advice , was measured using a postal question naire . Four outcomes were measured : changes in doctor and nurse workload ; repeat consultations with the same problem ; prescriptions issued ; and patient satisfaction with the service . RESULTS In three months , 1263 consultations were recorded . Doctor workload fell by 54 % , from 1522 to 664 consultations , compared with the previous three months . A total of 325 ( 26 % ) telephone requests to see the doctor were managed by the nurse on the telephone without them visiting the surgery . Also , 273 ( 21 % ) patients saw the nurse in the surgery , 565 ( 45 % ) saw the doctor in the surgery , and 99 ( 8 % ) saw the doctor and the nurse in the surgery . The response rate to the postal question naire was 192/271 ( 71 % ) ; 154 ( 88 % ) were satisfied with nurse telephone advice . CONCLUSIONS Telephone triage , by a practice nurse , of patients who wish to see the doctor on the same day , reduced doctor workload . This was a service that patients liked Abstract Objective : To undertake an economic evaluation of  nurse telephone consultation using decision support software in comparison with usual general practice care provided by a general practice cooperative . Design : Cost analysis from an NHS perspective using stochastic data from a r and omised controlled trial . Setting : General practice cooperative with 55 general practitioners serving 97 000 registered patients in Wiltshire , Engl and . Subjects : All patients contacting the service , or about whom the service was contacted during the trial year ( January 1997 to January 1998 ) . Main outcome measures : Costs and savings to the NHS during the trial year . Results : The cost of providing nurse telephone consultation  was £ 81 237 per annum . This , however , determined a £ 94 422 reduction of other costs for the NHS arising from reduced emergency admissions to hospital . Using point estimates for savings , the cost analysis , combined with the analysis of outcomes , showed a dominance situation for the intervention over general practice cooperative care alone . If a larger improvement in outcomes is assumed ( upper 95 % confidence limit ) NHS savings increase to £ 123 824 per annum . Savings of only £ 3728 would , however , arise in a scenario where lower 95 % confidence limits for outcome differences were observed . To break even , the intervention would have needed to save 138 emergency hospital admissions per year , around 90 % of the effect achieved in the trial . Additional savings of £ 16 928 for general practice arose from reduced travel to visit patients at home and fewer surgery appointments within three days of a call . Conclusions : Nurse telephone consultation in out of hours primary care may reduce NHS costs in the long term by reducing dem and for emergency admission to hospital . General practitioners currently bear most of the cost of nurse telephone consultation and benefit least from the savings associated with it . This indicates that the service produces benefits in terms of service quality , which are beyond the reach of this cost analysis BACKGROUND General practitioners ( GPs ) in the United Kingdom have recently begun to adopt the use of telephone consultation during daytime surgery as a means of managing dem and , particularly requests for same-day appointments . However , it is not known whether the strategy actually reduces GP workload . AIM To investigate how the use of telephone consultations impacts on the management of requests for same-day appointments , on re source use , indicators of clinical care , and patient perceptions of consultations . DESIGN OF STUDY R and omised controlled trial . SETTING All patients ( n = 388 ) seeking same-day appointments in each surgery in two urban practice s ( total population = 10,420 ) over a four-week period . METHOD The primary outcome measure was use of doctor time for the index telephone or face-to-face consultation .  Secondary outcomes were subsequent use of investigations and of services in the two-week period following consultation , frequency of blood pressure measurement and antibiotic prescriptions , and number of problems considered at consultation . Patient perceptions were measured by the Patient Enablement Instrument ( PEI ) and reported willingness to use telephone consultations in the future . RESULTS Telephone consultations took less time ( 8.2 minutes versus 6.7 minutes ; diff = 1.5 , 95 % confidence interval [ CI ] = 0.6 to 2.4 , P = 0.002 ) . Patients consulting by  telephone reconsulted the GP more frequently in the two weeks that followed ( 0.6 consultations versus 0.4 consultations ; diff = 0.2 , 95 % CI = 0.0 to 0.3 , P = 0.01 ) . Blood pressure was measured more often in the group of patients managed face-to-face ( 25/188 [ 13.3 % ] versus 12/181 [ 6.6 % ] ; diff = 6.7 % , 95 % CI = 0.6 % to 12.7 % ) . There was no significant difference in patient perceptions or other secondary outcomes . CONCLUSION Use of telephone consultations for same-day appointments was associated with time saving , and did not result in lower PEI scores . Possibly , however , this short-term saving was offset by higher re-consultation and less use of opportunistic health promotion BACKGROUND Advice nurse call centers are used to ensure access to medical advice , thereby potentially reducing the costs of health services . OBJECTIVE To determine if medical advice from advice nurses and on-call physicians delays significant medical treatment in a general pediatrics population . DESIGN R and omized controlled trial . SETTING A university general pediatrics faculty practice . PARTICIPANTS Parents or guardians calling for after-hours advice regarding their children . Intervention After-hours medical advice calls were r and omized at the time of the call to an advice nurse or an on-call pediatrician . MAIN OUTCOME MEASURES The proportion of callers who sought medical care not advised by the advice nurse or on-call pediatrician and the proportion who received unadvised significant care . RESULTS There were 1182 advice calls : 566 in the pediatrician group and 616 in the advice nurse group . There were no significant differences in the types of telephone triage advice in the physician and advice nurse groups . There was no significant difference in the proportion of callers who sought unadvised care ( 108 [ 19.9 % ] in the physician group vs 110 [ 19.0 % ] in the advice nurse group ) or in the proportion of callers who received unadvised significant care ( 23 [ 4.2 % ] in the physician group vs 25 [ 4.3 % ] in the advice nurse group ) . CONCLUSIONS The proportions of callers who sought unadvised medical care and who received unadvised significant care were not significantly different in the advice nurse and pediatrician groups . This suggests that advice nurses do not delay significant medical treatment when compared with pediatricians Objective . Telephone triage programs are becoming very common at children 's hospitals across the nation . One of the proposed benefits of these programs is the more efficient use of health care re sources by triaging patients to the appropriate level of health care . The purpose of this study is to examine the appropriateness of referrals to a pediatric emergency department ( ED ) by the Pediatric Health Information Line ( PHIL )  , a hospital-based telephone triage program  , versus all other sources of referrals . Methods . A blinded Delphi rating system was used to review the physician 's sheets of 133 consecutive ED referrals by PHIL for medical appropriateness . A total of 260 r and omly selected control patients seen in the ED during the same period were similarly review ed . If 2 of 3 pediatric emergency medicine physicians agreed that an ED visit was appropriate , then it was considered appropriate . A comparison of the 2 groups ' ED appropriateness was made using a contingency table χ2 test . An odds ratio with confidence limits was also calculated . Demographic data were collected for both groups including age , race , gender , and insurance status . Results . The PHIL group had an appropriateness rate of 80.2 % , compared with 60.5 % for the control group ( χ2 = 14.6369 ; odds ratio = 2.65 ; 95 % confidence interval [ 1.5759,4.5008 ] ) . Conclusions . This demonstrated that for the period studied , PHIL referrals to the ED had a 33 % higher rate of appropriateness than controls . This evidence supports telephone triage as an efficient gatekeeper for health care re sources Abstract Objective : To compare the outcome of out of hours care given by general practitioners from patients ' own practice s and by commercial deputising services . Design : R and omised controlled trial . Setting : Four urban areas in Manchester , Salford , Stockport , and Leicester . Subjects : 2152 patients who requested out of hours care , and 49 practice doctors and 183 deputising doctors ( 61 % local principals in general practice ) who responded to the requests . Main outcome measures : Health status outcome , patient satisfaction , and subsequent health service use . Results : Patients seen by deputising doctors were less satisfied with the care they received . The mean overall satisfaction score for practice doctors was 70.7 ( 95 % confidence interval 68.1 to 73.2 ) and for deputising doctors 61.8 ( 59.9 to 63.7 ) . The greatest difference in satisfaction was with the delay in visiting . There were no differences in the change in health or overall health status measured 24 to 120 hours after the out of hours call or subsequent use of the health service in the two groups . Conclusions : Patients are more satisfied with the out of hours care provided by practice doctors than that provided by deputising doctors . Organisation of doctors into large groups may produce lower levels of patient satisfaction , especially when associated with increased delays in the time taken to visit . There seem to be no appreciable differences in health outcome between the two types of service . Key messages Between 24 and 120 hours after a request for out of hours care patients cared for by deputising services and practice doctors show no difference in health status There is no difference in health service use between the two groups in the two weeks after a request for out of hours care Patients are more satisfied with out of hours care provided by their own practice doctors Though 
    Output:
    
REVIEW ERS ' CONCLUSIONS Telephone consultation appears to reduce the number of surgery contacts and out-of-hours visits by general practitioners .