BACKGROUND: To investigate clinical effectiveness of a physiotherapy-led, hospital-based vestibular service by assessing initial and longer-term clinical outcomes, and to compare outcomes for immediate and delayed intervention pathways. METHODS: Pragmatic, prospective, observational study reporting baseline, discharge and follow-up outcomes. Set in hospital-based vestibular rehabilitation service including emergency/acute settings and those referred to out-patients. Participants included adults (N.=193) presenting to hospital with non-emergent dizziness (mean age: 64.21±15.28 years; female 60%). Physiotherapy vestibular diagnostic tests categorized people as vestibular/non-vestibular. Vestibular rehabilitation commenced immediately (<48 hours of hospital presentation) or was delayed (referred and wait-listed for outpatient services, average 22 days). Vestibular rehabilitation, a program of exercises, consisting of eye/head movements integrated with balance and mobility exercises designed to promote adaptive vestibular system changes. Dizziness impairment, functional vestibular ocular reflex, static balance, gait velocity and functional gait were measured at initial presentation, discharge, and 3 months post-discharge. RESULTS: Participants had significantly reduced dizziness and significantly improved functional gait at discharge, which was maintained 3 months post-discharge (P≤0.001). Both immediate and delayed intervention groups reported significantly reduced dizziness impairment (P≤0.001) but only the immediate group significantly improved in all mobility measures (P≤0.005). Resultant symptoms and functional impact of a vestibular disorder did not significantly subside to normal without vestibular rehabilitation, even 3 weeks after presenting to hospital. CONCLUSIONS: Physiotherapy-led vestibular service was clinically effective in managing people presenting to hospital with suspected vestibular dysfunction with outcomes maintained in the longer term. Immediate intervention allows for quicker improvements in symptoms, and patients’ symptoms do not spontaneously resolve whilst waiting for intervention.