Introduction Many centres run “first fit” outpatients’ clinics. NICE guidance is that these patients should be seen in 2 weeks, but this is hard to achieve through an outpatient referral pathway. For 3 years we have had an ambulatory care pathway for patients who attend the Emergency Department (ER) following a suspected first seizure. The aim was to provide a specialist opinion within 24 h of an event to ambulatory patients.

Methods Patient notes with ER discharge diagnostic codes likely to include first seizure were reviewed over 1 year (Oct 2007–Oct 2008).

Results 144 patients presented to ER with a “first seizure”. The majority, 78, were admitted. 36 were referred to within the first seizure pathway, 34 attended, were seen within 24 h, in eight patients the event was not diagnosed as epilepsy by the reviewing specialist, five were admitted and eight commenced on anticonvulsants. From the 30 patients with a different outcome five were seen in to the next day Emergency registrar clinic, 14 booked to OP and 11 discharged.

Conclusions The first seizure pathway offers ambulant patients access to a specialist neurological opinion within 24 h of their attack. This exceeds NICE guidance on speed of access for this group of patients. The specialist opinion differed from the opinion given in ER in a significant minority of patients; in some the diagnosis was not of epilepsy. An early specialist opinion added value to the patient's contact with the hospital.