MONitoring Knockbacks in EmergencY (MONKEY) - An Audit of Outcomes in Emergency Patients with Rejected Admission Requests

Background Emergency department (ED) clinicians commonly experience difficulties in referring patients to inpatient teams for hospital admission. There is limited literature reporting on patient outcomes following these complicated referrals, where ED requests for inpatient admission are rejected – termed a ‘knockback’. Study Objective: To identify disposition outcomes in ED patients whose admission referral was initially rejected, i.e., encountered a ‘knockback.’ Secondary objectives were to identify additional factors associated with knockbacks. Methods A prospective audit of patients identified as having knockbacks over two time periods (Jan-Feb 2020 and Aug 2020 to Jan 2021) at a tertiary Australian ED. Data was analysed with a mixed-methods approach and subsequent descriptive and thematic analyses were performed. Results A total of 109 patients were identified as knockbacks. Despite the knockback, 89.0% of cases (n = 97) ultimately required a hospital admission. Moreover, in 60.6% (n = 66) of the admissions, patients were admitted under the inpatient team initially referred to by the ED. There was a statistically significant link between the number of in-hospital units involved in the admission process and the ED length of stay (Pearson correlation 0.404, p