Safety-net hospitals provide medical services to underserved patients. Given limited resources, such systems are susceptible to prolonged wait times for necessary endoscopic procedures. Direct access endoscopy (DAE) aims to limit these delays and avert consultative costs by allowing medical providers to refer patients for procedures without first seeing a gastrointestinal provider. Critics of DAE would argue that open access results in unnecessary endoscopic procedures. The primary aim of our study was to identify the prevalence of inappropriate referrals for upper endoscopy in our safety-net system based on the American Society of Gastrointestinal Endoscopy (ASGE) guidelines.