A series of 465 consecutive psychiatric consultations to medical-surgical services was examined to compare consultations designated as emergencies with those requested on a routine basis. Twenty-three percent of the consultation requests were designated as emergencies, and psychotic thinking and suicidality were noted more frequently in this group. Emergencies, however, were invoked less frequently in patients 60 years of age or older. The consultant's approach to emergency consultations demonstrates a more active role, with more recommendations for initiation of psychotropic drugs, more follow-up visits, greater numbers of recommendations for disposition, and greater numbers of contacts with outside sources of information effected. Notably, concordance with diagnostic and psychotropic drug recommendations and representation of psychiatric diagnosis in discharge summaries did not differ significantly between the two groups. The results underscore the usefulness of closely monitoring consultation outcomes and the need to explore and implement interventions that will enhance consultee responses in situations requiring acute psychiatric interventions.