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To determine factors predictive for patients requiring ongoing hospital admission from the emergency department observation unit (EDOU).Prospective observational study on all patients admitted to the EDOU over 3 months. The primary outcome measure was patients requiring subsequent admission to hospital from the EDOU.Of 860 EDOU admissions occurring from 8337 ED presentations, 145 (16.9%) were subsequently admitted as inpatients. Of all analysed variables, four (inability to independently mobilize in the ED, requiring ongoing active treatment while in the EDOU, requiring referral to another subspecialty prior to transfer to the EDOU and requiring multidisciplinary allied health assessment while in the EDOU) were significantly associated with admission to hospital.Variables exist that predict a ‘failed’ short stay admission. These might be used to identify patients less suitable for admission to the EDOU and better suited to admission directly under a hospital team.