311 Hot Biliary Clinic: Success or Failure?

Abstract Aim Symptomatic gallstones account for a considerable proportion of emergency general surgical referrals. Limited access to urgent surgery often leads to conservative acute management and interval elective surgery weeks to months later. Acute take and ward round pressures frequently limit time for adequate option and risk discussions, resulting in same-day consent, outside of elective RCS guidance. To address this, a Hot Biliary Clinic (HBC) was established at a tertiary hospital. Senior HPB trainees review patients managed ambulatorily or post-discharge, ensuring comprehensive counselling and receiving informed consent. Initially, HBC planned for 6–8 patients per week, triaged by the on-call HPB team, with expected waits of 2–3 weeks. Longer waits and out-of-scope referrals were subsequently noted, prompting a service evaluation of referral patterns and clinic efficiency. Method Consecutive HBC referrals were retrospectively reviewed for an 8-week period (10/3/25-4/5/25). Data collected included referral source and date, vetting date and outcome, and HBC appointment date. Results 100 referrals were received —median 12.5/week (IQR 10–14.5). Median vetting time 8.5 days (IQR 6–13). 80% were accepted, adding a median 10 patients/week to the wait list. Median time to appointment: 10.6 weeks (IQR 8.9-12.6). Referral sources: 32% post-HPB discharge, 55% ambulatory, 13% other. 15/19 (79%) rejections were due to redirection to Consultant Clinic for complexity; 5 had surgery prior to an appointment. Conclusions HBC succeeded in providing pre-operative counselling however failed to meet target timeframes; referral volume exceeded capacity. Proposed improvements include expanding clinic provision, reducing vetting time, and refining acceptance criteria.