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Introduction Acute gastrointestinal and hepatology presentations commonly arise from emergency departments and primary care, generating high demand for timely specialist gastroenterology input. Acute gastroenterology in-reach services aim to support early specialist review, optimise investigations and management, and facilitate appropriate follow-up in virtual or outpatient pathways. This service evaluation describes referral patterns, review modalities, and clinical outcomes associated with such a service.Methods We conducted a retrospective service evaluation of acute gastroenterology referrals over a four-month period (1 May–31 August 2025) at Croydon University Hospital. Patients referred to medical Same-Day Emergency Care unit (SDEC) were identified using the electronic patient records. Data collected included patient age, referral source and indication, investigations requested and clinical outcome (discharge, admission or onward gastroenterology follow-up). Descriptive analysis was performed to assess service activity and patient pathways. Gastroenterology reviews were conducted twice a week.Results A total of 239 patients were included (mean age 48±18 years; 51% female). Most referrals originated from the emergency department (55%), gastroenterology discharges (22%) and 7% from primary care. Of the referrals, 66% were deemed routine. Charleson co-morbidity index was 0 (41%), 1-2 (25%), 3-4 (20%) and over 5 (12%). The referrals included deranged liver function tests (46%), abdominal pain (17%), diarrhoea (8%), reflux (5%) and procedures (3%). Patients with acute on-chronic presentations such as inflammatory bowel disease (IBD) flares (13%) and decompensated liver disease (6.3%). Gastroenterology reviews included virtual in 58%, face to face 15%, and no review in 26% (medical team manged patient). Investigations included mainly blood tests (96%) and imaging (44%). Admission rates were low (6%) with most patients discharged with same-day emergency care follow-up (37%) or outpatient gastroenterology follow-up (27%). Procedures included ascitic drain/tap. Main diagnosis included gallstones (9.6%), viral hepatitis (8.4%), autoimmune hepatitis (5.9%), malignancy (4.2%), drug induced hepatitis (2.9%), upper gastrointestinal bleed (1.3%), pancreatitis (1.3%), diagnosis indeterminate (10%) and no abnormality (2.1%).Conclusion An acute gastroenterology in-reach service supports safe patient management with low admission rates and effective use of ambulatory and outpatient pathways. Liver disease represents a key driver of acute referrals. The study highlights opportunities for targeted triage pathways and standardised investigation protocols to ensure inappropriate referrals are avoided. Data will also support in setting up gastroenterology hot clinics to off load patients from a busy SDEC.