Introduction <p>As healthcare progressively transitions to shift-work patterns across disciplines and specialist care converges more into tertiary referral units, the burden of providing a 24-hour subspecialist surgery consult service is unquantified. University Hospital Galway is the only tertiary vascular centre receiving referrals from five geographically-diverse hospitals within the Saolta group. We assessed the volume of work generated by external consults to the unit over a twelve-month period.</p> Methods <p>We undertook a retrospective review of consecutive 24-hour call sessions between July 2021 – July 2022. Departmental handovers for each session were analysed, and the demographic characteristics, indication for contact and outcome of each external consult was recorded. The number of interhospital transfers, bed days, outpatient visits and procedures were documented.</p> Results <p>218 individual 24-hour call sessions were analysed. External consults were received on 80% of sessions (<i>n</i> = 174/218). In total, 341 external consults were received over 174 sessions, with an average of two per call. Peripheral arterial disease accounted for 32% of consults, followed by aortic pathology (17%), carotid disease (17%), chronic venous insufficiency (13%) and diabetic foot disease (10%). The referring teams felt 22.3% (<i>n</i> = 76/341) of consults constituted true vascular emergencies, which was downgraded to 15% (<i>n</i> = 51/341) when triaged by the vascular team. Within six months of consult, the external referrals generated 82 interhospital transfers, 89 surgical procedures, 1251 inpatient bed days, 168 outpatient appointments, 178 further imaging requests and 56 vascular lab timeslots.</p> Conclusions <p>Accommodating external consults consumes a significant volume of theatre- and clinic-based resources. The process could be streamlined by creating criteria for appropriate consults for common pathology, such as carotid disease, and a proforma for non-emergent referrals.</p>