Objectives: Increasing numbers of emergency department (ED) visits and higher leaving-without-beingseen rates resulted in an evaluation of the contribution of the internal medicine service to the admission process. Methods: Standardized ED encounter sheets were completed by the medicine physician on duty (MOD) assessing various admission and consultative parameters. Results: 304 patient encounters revealed a 44-minute mean time from MOD consultation to order submission; 49% in under 30 minutes and 76% in under an hour. There was no difference in time among MOD shifts, staff and residents, or admission diagnoses. Reasons for delays were receiving multiple consults at a time (36%) and needing further specialty consultation or additional workup (30%). Conclusions: Most medicine admissions took less than an hour from time of MOD consultation to time orders were written. Areas of improvement include expediting discussion with specialists and timely but appropriate ED workup before consultation.