The purpose of this research was to develop a consensus description of occupational therapy practice in acute care orthopaedics and neurology by Australian therapists. The Delphi technique was used to develop consensus concerning therapists' aims for their patients, the interventions they used, and the factors affecting their practice in acute care. Therapists' primary aim was to conduct a thorough assessment for referral and further treatment purposes. Therapists in acute hospital neurology focus on developing maximal independence in self-care activities and preventing deformities, followed by preparations for discharge or transfer to rehabilitation. Therapists with an orthopaedic caseload state independence in self-care as their second most important aim, but the ranking of intervention methods indicates preparation for discharge in various ways takes precedence over direct self-care retraining. This difference may indicate a disparity between practice ideals and the realities of the acute care setting. The most important factor affecting practice in acute care is early referral for occupational therapy services. Recommendations are made for managers and educators to ensure the most effective practice in acute care are made.