I have both ED and Stepdown/PCU experience, and I have sent pt's to SD/PCU with this BP, and I have received pt's from the ED with a similar clinical picture. A lot depends on other factors...what does their BP usually run, what is their normal mental status, what have they looked like on previous admissions? I think it it right to question this admit--go to the charge, and if you don't get a satisfactory answer, then go to the nursing supervisor. If they come to floor and look inappropriate for your unit (every PCU has slightly different rules for acuity) then call at RRT.
Also, I need to address report, throughput times, etc. It more than the ED wanting to get pts. out. It is not about the ED nurse trying to dump the pt on floor nurse. It is more than Medicare rules. Recently a local TV station in my area compared ED times of various EDs. The thing was, their report was based on the random charts that were "pulled" by Medicare. So this news report basically ranked (and, and in some cases, slammed) EDs based on very limited data and random reports. In a competitive market, with local news pretending that their report provides an accurate picture of the "best" EDs, there has to be a focus on throughput times, even if it comes in the way of patient care.