The Royal College of Physicians and Society of Acute Medicine have proposed the introduction of Acute Care Quality Indicators. These include the need for rapid initial patient assessment and instigation of a management plan.1 Reductions in junior doctor working hours may impact on our ability to meet these standards. We present the result of a service review of 297 consecutive admissions to a large acute medical unit. This has identified a marked dichotomy between waiting times during daytime and out-of-hours, despite appropriate response to initial triage. We conclude that further service redevelopment is required to reach the standards proposed in the current Acute Care Quality Indicators.