INTRODUCTION: Smoking is the most important risk factor for morbidity and mortality in hospital patients. Patient contact with the healthcare system should include smoking cessation counselling. Emergency admissions are seldom given this opportunity. Objective: The aim of the study was to illustrate the implementation of motivational counselling in a department of acute surgery. METHODS: Between May 2003 and January 2004, 200 emergency patients were offered motivational counselling and a 6-week smoking cessation programme. RESULTS: We measured the number of patients who accepted motivational counselling. Of the initial 200 patients, 121 (61%) accepted motivational counselling. The only factor related to the level of motivation was age. The most motivated group had an average age of 45 years, whereas the average age of the least motivated group was 64. There was no correlation between the Fagerstrom score, pack-years, gender, illness, employment, or alcohol consumption and the outcome. Fifty-seven patients agreed to us following them up, of which 10% quit smoking for 6 months; 44% either quit or reduced their smoking for a shorter period of time, and 17% of the continuing smokers requested admission to the smoking cessation programme. CONCLUSION: The majority of smokers acutely admitted to an acute orthopaedic department accepted motivational counselling against smoking, the youngest being the most motivated. It appears possible to implement motivational counselling for smoking cessation in an acute orthopaedic department. It is relevant to consider how, and for which groups, a smoking intervention programme can be offered to acutely admitted patients.