A closed loop audit of the ear nose and throat(ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed,referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The reaudit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of ￡32490 in a period of 3 mo(￡590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are nonlabour intensive can have a significant impact on service provision and cost. A closed loop audit of the ear nose and throat (ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed, referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P <0.05. We rep orted a total financial saving of £ 32490 in a period of 3 mo (£ 590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are non-labor intensive can have a significant impact on service provision and cost.