Background and aimsAcute neurological symptoms are responsible for 5-15% of referral to the Emergency Department (ED). Since the COVID-19 outbreak, our stroke network shifted toward a mothership model with direct transport of stroke patients to the Comprehensive Stroke Center ("M. Bufalini" hospital, Cesena, Italy). To handle the increase in referrals due to mothership and guarantee a neurological fasttrack in the ED, the Neurology service opened a four-bed Short-Stay Neurological Observation Unit (SSNO or "OBI Neuro"). We retrospectively analyzed the performances of SSNO after one year of activity. MethodsWe evaluated one-year (1st April 2020-31st March 2021) SSNO patients' admissions, discharge destinations, diagnosis and mean length of stay. ResultsWe managed 556 patients in the SSNO. Of these, 280 (50.4%) were discharged at home, 248 (44.6%) were admitted as in-patients, 20 (3.6%) were transferred to other hospitals, 8 (1.4%) selfdischarged. Among patients admitted as in-patients, 91 (36.7%) were admitted in the Neurology ward, 135 (54.4%) were admitted in the Stroke Unit, the remaining (8.9%) in other wards of the hospital. The most common diagnoses were stroke (32.3%), seizure (20.4%), TIA (13%) and headache (7.4%); all other diagnoses individually represented less than 5% of the total. The mean stay of length was 11.5 h (14.4 h for discharged patients and 7.3 h for admitted as inpatients). ConclusionsThe SSNO was feasible and strategic in managing stroke referrals in a mothership model and lifting the burden of neurological patients from the ED during the COVID-19 pandemic.