Purpose: Right iliac fossa (RIF) pain accounts for a substantial proportion of emergency general surgical admissions. There is evidence to suggest that systemically well patients with RIF pain can be safely assessed using an ambulatory care pathway (ACP), thus reducing length of stay (LOS) and hospital bed pressures. This is a prospective cohort study that assesses the effectiveness and safety of the ACP implemented for patients presenting out of hours with acute RIF pain. Methodology: Patients with RIF pain who were assessed as suitable for the ACP between 20th June 2021 and 19th June 2022 were compared against a matched historical group of patients admitted with RIF pain out of hours between 1st July 2019 and 30th June 2020. Data was extracted regarding LOS, progression to theatre and theatre access delays, as well as post-operative complications including return to theatre and readmission within 30 days. Comparative analysis was performed. Results: Inpatient bed days were significantly shorter for patients in the ACP group with a median LOS of 1.0 (IQR 0.0 – 1.1) days compared to a median of 1.5 (IQR 1.2 – 1.8) days for the historical group (p < 0.001). There was no significant difference between the cohorts regarding progression to theatre, theatre access delays, or post-operative complications including return to theatre and readmission within 30 days. Conclusion: The RIF pain ACP safely reduced LOS and avoided unnecessary hospital admission for systemically well patients with acute RIF pain presenting out of hours.