Background/Objectives: Emergency department short-stay units (ED SSUs) manage patients requiring short-term observation and treatment. For a small number of patients, a longer hospital admission is required. Care for these patients is provided by an inpatient team and the responsibility for managing acute clinical deterioration falls to a rapid response team, activated by an emergency call. While emergency calls have primarily been a feature of the inpatient setting, admitted patients are increasingly boarding within ED SSUs and the occurrence and impact of emergency calls in this setting remains largely unreported. This study aimed to determine the incidence and characteristics of emergency calls within an ED SSU, describing patient demographics, clinical triggers, and outcomes. Methods: This retrospective cohort study utilised the Tasmanian Emergency Care Outcomes Registry (TECOR) to analyse emergency calls in the ED SSU of a tertiary emergency department between 1 February 2024 and 28 February 2025. Inclusion criteria were defined as adult patients (≥14 years) admitted to an inpatient service who had emergency calls whilst in the ED SSU. Descriptive statistics were used to characterise this cohort. Results: Of 83,238 ED presentations, 11,775 adult patients were transferred to the ED SSU. 1464 (12.4%) of these patients were subsequently admitted under an inpatient service but remained boarding in the ED SSU, with 54 emergency calls occurring in 38 unique patients (2.6%). The median age was 81.5 years (IQR 65–86), older than both the main ED cohort with a median age of 71 years, and median ages of 65 to 69.5 years reported in ward-based cohorts. Most calls were medical emergency team (MET) activations (52, 96.30%) with only 2 (3.7%) code blues. The most common triggers were hypotension (20, 37.04%), reduced level of consciousness (7, 12.96%) and serious concern (7, 12.96%). Delays occurred in 18.52% of calls (mean 82 min). The median ED SSU length of stay for patients having an emergency call was 40.15 h, substantially exceeding the intended ED SSU admission criteria threshold of 24 h. Goals of care remained incomplete in 33.33% of calls, even after emergency team review. Conclusions: ED SSU emergency calls are infrequent but clinically significant, involving an elderly, vulnerable population with late sign triggers and prolonged boarding. These findings highlight fundamental mismatches between patient acuity and ED SSU environment capabilities, emphasising the need for improved monitoring, more selective admission criteria, and enhanced systems for recognising deterioration for patients boarding in ED SSUs.
Barrington et al. (Tue,) studied this question.