During a 34-day study period, general practitioners spoke to the medical registrar in 115 out of 196 acute adult medical referrals made to the A & E department, Wellington Hospital. One hundred and fifty-eight of these cases were admitted along with 131 self-referred acute adult medical patients. Verbal communication was preferred by the majority of general practitioners and medical registrars concerning acute referral and was considered to be useful in assessing the patient. Preliminary telephone referral to the medical registrar by general practitioners made no difference to the time which these patients spent in A & E awaiting admission when compared to self-referred patients.