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The St George’s Hospital Hyperacute Neurology Service is a comprehensive consultant-delivered service in a regional neuroscience centre setting that builds on existing recommendations, incorporating hyperacute stroke assessments and the delirium multidisciplinary team. There is proactive daily inreach into acute medicine and the emergency department with Rapid Access Neurology ‘Hot’ clinics providing a means of avoiding admission referrals from primary care and supporting rapid discharge of ambulatory patients from ED. We present data from the first year of this service.Results1299 patients were reviewed (stroke:603; acute neurology:452; Hot clinics:244).30% of all referrals were discharged directly from the ED and, with ‘hot’ clinics, contributed to 361 admissions avoided.Stroke mimic utilisation of acute beds (11% reduction) and median thrombolysis times also improved (38 v30 mins). For admitted acute neurology patients, median(IQR) LoS=2.0 (0.0–7.0), representing a 50% improvement on previous performance (p<0.001). For hot clinics, the median wait for an appointment=4.0 days(IQR:2.0–6.0). No diagnostics were required in 25% of cases.ConclusionThis new service complements existing hyperacute stroke pathways, improving outcomes for all neurology patients presenting to primary care, emergency and acute medical services. In particular, rapid access clinics appear to be an efficient means of providing unscheduled OP care.