Background <p>France is experiencing rapid population aging, increasing demand for healthcare services and pressure on unscheduled care pathways for frail and multimorbid older adults. A significant proportion of transfers to acute care, including emergency departments, are considered potentially avoidable, particularly when timely access to geriatric expertise is lacking. In 2024, a territorial geriatric hotline was implemented at Toulouse University Hospital to provide community-based physicians with rapid access to geriatric advice and optimize patient care pathways. The purpose of this study was to describe the development, implementation, and early activity of a territorial geriatric hotline for community-based physicians and assess its feasibility and role in patient orientation.</p> Methods <p>We conducted a monocentric, observational, descriptive study of the Haute-Garonne territorial geriatric hotline (June 2024–November 2025). The hotline was developed with 15 local professional healthcare networks and provided rapid access to geriatricians for general practitioners. Only calls requesting general geriatric advice or hospitalization were analyzed; calls related to supra-specialty expertise (onco-geriatrics, cardio-geriatrics, dementia care and palliative care) were redirected internally. Among 1,789 calls corresponding to general geriatric advice or hospitalization, multiple calls could relate to a single patient. Each clinical episode (i.e., one patient situation, potentially involving multiple calls) was consolidated into a single record. Only clinical episodes with complete data (<i>n</i> = 393) were included in the detailed analysis. Data collected included patient characteristics, reasons for the call, and patient orientation. Analyses were descriptive.</p> Results <p>During 18 months, 3,627 calls were received, with monthly activity increasing from 100 to 425 calls. Among these, 1,789 calls corresponded to requests for general geriatric advice or hospitalization. These calls corresponded to a lower number of clinical episodes, as several calls could occur for the same patient. Due to the constraints of routine data collection, only clinical episodes with complete documentation were included in the detailed analysis (<i>n</i> = 393). Among these clinical episodes, the mean age was 84.3 ± 7.6 years and 55.5% were women. Calls were placed by 243 general practitioners. Common reasons for calls included impaired general condition (19.3%), falls (12.5%), neurodegenerative diseases (11.2%), hematology/onco-geriatrics (10.4%), nutrition/metabolic disorders (9.4%), and pain (8.1%). Following calls, patient orientation included hospitalization in an acute geriatric unit (35.4%), provision of geriatric advice (27.2%), day hospital admission (16.0%), reorientation to another care pathway (7.6%), and emergency department referral (7.4%).</p> Conclusion <p>A territorial geriatric hotline integrated into local professional healthcare networks is feasible and widely utilized, as reflected by the overall call volume. It facilitates rapid access to geriatric expertise and, based on the analysis of calls with complete data, may contribute to improving patient orientation, and to proposing alternatives to emergency department transfers. However, the study design did not allow for the systematic evaluation of the clinical outcomes associated with these alternatives. The model demonstrates how limited geriatric resources can be leveraged to strengthen interprofessional coordination, optimize care pathways, and enhance equity in access to geriatric care. These results provide a basis for further evaluation of its impact on patient outcomes and healthcare system efficiency.</p>