Background Inpatient colonoscopy is frequently requested by general surgical teams for acute gastrointestinal bleeding, colitis, anaemia, and other lower gastrointestinal presentations. Reported wait times for inpatient colonoscopy are significant, with a median admission-to-procedure time of 5 days (IQR 3–7 days) in the literature. However, the clinical utility of inpatient colonoscopy in this setting remains uncertain. This audit aimed to assess the time from referral to attempted inpatient lower gastrointestinal endoscopy at Fiona Stanley Hospital, as well as the clinical utility. Methods A retrospective review was conducted of all patients (n = 125) admitted under the Fiona Stanley Hospital General Surgery service who were referred to Gastroenterology and underwent inpatient lower gastrointestinal endoscopy (colonoscopy or flexible sigmoidoscopy) between January 2024 and June 2025. Results The median time from admission to inpatient endoscopic examination was 2.09 days (IQR 0.89–4.29). The median time from referral to inpatient endoscopic examination was 21.6 hours (IQR 5.82–29.3). Median length of stay was 5.02 days (IQR 3.23–7.38). The most common indications for referral were per rectal bleeding (68.0%, n = 88), further investigation of a mass identified on imaging (16.0%, n = 24), and decompression of sigmoid volvulus (8.0%, n = 10). While the diagnostic yield for these indications was high (80–90%), the overall intervention rate was low (21.3%, n = 26). Discussion General Surgery patients at Fiona Stanley Hospital undergo inpatient lower gastrointestinal endoscopy substantially sooner than reported in the literature. The clinical utility of inpatient colonoscopy may be better evaluated through indication-specific studies, particularly for rectal bleeding, and by comparing outcomes with those in patients managed without inpatient endoscopic investigation.