Background Emergency surgical ambulatory care provides safe and effective assessment of acute surgical referrals, in addition to reducing the pressures on hospital beds. Our aim was to look at the effect of opening a surgical ambulatory care unit (SACU) and a dedicated surgeon for the unit on length of stay and same day discharge for emergency referrals. Methods Data was collected prospectively and updated daily to include all referrals to SACU. Historical data was retrieved to compare the effect of introduction of SACU and dedicated surgeon on same day discharge and length of stay. Results Three groups of patients were identified: pre-SACU, SACU and SACU with dedicated surgeon. There was 104.5% percentage increase in same day discharge rate for emergency GP referrals (22% pre-SACU to 45% in the dedicated surgeon group). Similarly, same day discharge for all emergency referrals increased from 17% pre-SACU to 29% in the dedicated surgeon group. There was 25.88 h reduction in the mean length of stay for emergency GP admissions (92.95 h pre-SACU to 67.07 h in the dedicated surgeon group). In pre-SACU group mean length of stay for all emergency admissions was 125 h, this dropped to 107.09 h in the dedicated surgeon group. This resulted in 102 hospital bed stays saved every month since the opening of SACU. Conclusions Establishing an emergency surgical ambulatory service has reduced length of stay and saved significant hospital bed stays. This effect was enhanced by having a dedicated senior surgeon providing early input and decision making.