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Introduction In 2022, an audit of gastroenterology referrals recognised a significant proportion of patients attending acute medical SDEC (Same Day Emergency Care) required specialist gastroenterology input. In response, a senior registrar-led Gastroenterology Hot Clinic (GHC) was established to streamline care through early specialty review, in line with NHS GIRFT (getting it right first time) national programme. We aimed to evaluate the service: the referral process, impact on the patient journey following GHC, and whether it reduced the burden on medical SDEC.Methods Referrals between January 2022 – March 2025 were reviewed, with duplicates excluded. We reviewed whether referrals were accepted or rejected and reasons for those decisions. The range of pathology referred was analysed. Attendances to medical SDEC prior to GHC review and outcomes were assessed: GHC follow up, discharge or transfer to gastroenterology/hepatology outpatient clinic.Results A total of 678 referrals were included. Of these, 398 (59%) were accepted, although only 279 (41% of total referrals) were ultimately seen in GHC. A total of 280/678 (41%) referrals were rejected. The most common reasons for rejection were; outpatient follow up already booked or was more appropriate. Most accepted referrals were discussed with either a gastroenterology or medical SPR/consultant 291/398 (73%). However, it was noted a high proportion of rejected referrals 172/280 (61%) had been discussed.Referrals spanned subspecialties: hepatology/hepatobiliary (401/681; 59%), luminal gastroenterology (263/681; 39%), and cross-subspecialty (16/681; 2%). A total of 97 diagnoses were made. Cirrhosis was the most common 102/681 (14.9%) followed by Inflammatory bowel disease (IBD) 88/681 (12.9%). Most cases of cirrhosis 74/102 (73%) and IBD 63/88 (72%) were new diagnoses.Most referrals were seen once, 258/279 (92%). With 18 being seen twice (6%) and 3 three times (1%). Only 11 (4%) were discharged for more monitoring via medical SDEC. The number of attendances to medical SDEC prior to GHC ranged from 1-7, (average 1.8 times). Most patients were discharged to outpatient follow up 164/279 (59%) or discharged completely 59/279 (21%).Conclusions The significant number of referrals to the GHC highlights the need for continued specialty input within medical SDEC settings, aligning with GIRFT. The GHC reviewed a wide range of pathology, facilitating many new diagnoses and further management. Despite senior discussion, some referrals were inappropriate. Therefore, we suggest an update to the referral form and consideration of education for the medical team. We also recommend continued autonomy and ability to review and reject inappropriate referrals. Most GHC patients were discharged after one review; with a minority discharged to medical SDEC, indicating an effective and decisive service.