INTRODUCTION: The provision of occupational therapy services in providing a minimum essential service in public health institutions in South Africa are currently guided by a quality control measure by the National Department of Health. AIM: To review the occupational therapy services in an acute, public tertiary hospital from 2015-2019 and to compare this with the expectations of these services in a tertiary hospital to identify potential gaps in service delivery. METHOD: A single site, retrospective quantitative audit from 2015-2019 was completed at one tertiary hospital. Patient-related and occupational therapy service data were included. 18579 patient entries were captured. The analysis included descriptive and inferential statistics of mean, standard deviations, frequency tables, percentages, and ANOVA. RESULTS: Findings indicated a consistent decline in the mean values of, the number of therapists attending to patients, number of patients, assistive devices issued, total time of patient units and consultations, total time spent on ward rounds, clinics, and meeting attendance. The number of student therapists attending to patients, splints, pressure garments and issued wheelchairs showed an increase in trend across the reviewed years. CONCLUSION: Inadequate human resources and budget systems are potential gaps in occupational therapy service delivery in an acute public tertiary hospital.