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Introduction The blood-borne virus (BBV) opt-out testing programme in emergency departments (EDs) in the UK has been shown to be both impactful and cost-effective. In our trust, automated reporting of positive Hepatitis B (HBV) results initiates a specific referral pathway with dedicated nurse-led clinics and integrated Fibroscan appointments. Consultant oversight is provided through a weekly MDT. We sought to evaluate the project in University Hospitals Bristol and Weston (UHBW) by comparing this pathway for newly-identified HBV patients with pre-existing referral routes.Methods Records of BBV test report dates, clinic episodes and outcomes for the ED opt-out pathway were collected prospectively from its Introduction in Bristol on 07.10.2024 until the audit stop date on 15.01.2026. Equivalent data for the same period, including date of referral, were sought retrospectively on all new HBV referrals through data searches of Hepatology Outpatient clinics. Patients were included in this group for whom the diagnosis was previously known, but who were not under NHS follow-up, in which case the HBV test report date corresponded to the test or encounter prompting the new referral.Results 63 HBV cases (52 (83%) new and 11 (17%) lost-to-follow-up) identified through the ED opt-out pathway were engaged in Hepatology services by the end of the 15-month analysis. 69 equivalent patients were reviewed following standard Hepatology outpatient referral. The mean time from positive test report to first clinic appointment for the ED opt-out cohort was 27 days (IQR 15–28.5). This was significantly shorter than the mean 124 days (IQR 40–161) between time from positive test/notification to first clinic review for patients referred through standard pathways (P<0.00001). The difference remained statistically significant (P<0.00001) when using mean time from referral to clinic review for the standard pathway (103 days, IQR 32–147). 21 of these 69 cases (30%) commenced antiviral treatment after initial assessment, compared with 3 of the 63 ED opt-out cases (4.8%). All but one of the ED opt-out patients underwent Fibroscan at the initial clinic appointment, whereas 9 (13%) of the standard cohort were required to return for this at a later date.Conclusions A dedicated nurse-led pathway following ED HBV test report can significantly reduce the time to first assessment, and thus to initiation of monitoring or treatment, compared to standard referral routes. This offers a further benefit to the ED BBV programme beyond the identification of new cases demonstrated by previous analyses. We also found that the numbers of patients identified through the programme, in its early stages at least, were comparable to those referred by standard routes. The lower number of patients requiring treatment in the ED opt-out cohort may demonstrate the benefits of early detection.