Long waits in the emergency room are one of the most common complaints about hospital care. Understanding why waits happen, how patients are prioritized and where to find wait time data will not make the wait shorter, but it can help you make sense of what you see and know when to speak up.
If your condition is getting worse while you wait, tell the triage nurse or front desk immediately. If you think you are having a medical emergency and are not yet at a hospital, call 911. This guide is general information, not medical advice.
The emergency room is not first come, first served
Emergency departments use triage to decide who is seen first. A triage nurse quickly checks your symptoms, vital signs and history, and assigns an urgency level. Patients with the most serious conditions are seen first, even if they arrived later.
Many US emergency departments use the Emergency Severity Index (ESI), a five-level system:
| ESI level | Meaning | Examples |
|---|---|---|
| 1 | Needs immediate life-saving intervention | Cardiac arrest, severe breathing failure, major trauma |
| 2 | High risk, should not wait | Chest pain suggesting a heart attack, stroke symptoms, severe pain, confusion |
| 3 | Stable but needs several resources | Abdominal pain needing labs and imaging |
| 4 | Needs one resource | Simple laceration needing stitches, a possible simple fracture |
| 5 | Needs no resources beyond an exam | Mild rash, prescription refill |
Levels 1 and 2 are seen quickly. Patients at levels 4 and 5 can wait the longest when the department is busy, because their conditions are least urgent. A long wait usually means the staff believe your condition is stable.
Why emergency rooms get crowded
- Boarding: when patients who need admission cannot get an inpatient bed, they stay in the emergency department, sometimes for many hours. This uses beds and staff that would otherwise see new patients. Boarding is a major cause of crowding nationwide, and it is especially common for patients waiting for psychiatric beds.
- Staffing: shortages of nurses and other staff can limit how many beds are open.
- Arrival surges: visits rise at certain times of day, during flu and respiratory virus season, and after nearby hospitals close or divert ambulances.
- Testing and results: lab tests, CT scans and specialist consultations take time even after you are seen.
- Ambulance arrivals: patients arriving by ambulance are triaged the same way, so they are not automatically seen first, but many are seriously ill.
The stages of an emergency room visit
- Arrival and registration: basic information is collected. Under the Emergency Medical Treatment and Labor Act (EMTALA), a hospital may not delay your medical screening to ask about insurance or payment.
- Triage: a nurse assesses urgency.
- Waiting room: depending on your triage level and how busy the department is.
- Evaluation: a physician, physician assistant or nurse practitioner examines you. Some hospitals start tests during triage to save time.
- Testing and treatment: labs, imaging, medications.
- Decision: discharge home, observation, admission or transfer.
Several of these steps involve waiting. The total time from arrival to leaving is often several hours, even for patients who go home.
Where to find emergency room timing data
Medicare.gov Care Compare reports emergency department measures for many hospitals, including the average (median) time patients spent in the emergency department before leaving, and the percentage of patients who left before being seen. These numbers are averages over past periods, not live wait times.
Some hospitals post estimated current wait times on their websites or apps. These usually reflect the time until you are first seen by a clinician and can change quickly.
You can browse hospital emergency rooms in our directory, where available timing data from CMS appears on hospital pages.
Should you go somewhere else to avoid a wait?
For a true emergency, go to the nearest emergency department or call 911. Driving farther to save time is risky.
For minor problems, an urgent care center or telehealth visit may be faster and less expensive. See ER vs Urgent Care for guidance on which setting fits.
If you decide to leave
Leaving before being seen can be dangerous if your condition is serious. If you are thinking about leaving, tell the triage nurse first. They may reassess you, and if you do leave, you can get advice about where else to go and what symptoms should bring you back. If you leave after being seen but before the team recommends it, you may be asked to sign a form saying you are leaving against medical advice. That does not, by itself, stop insurance from paying, despite a common belief.
Tips for a smoother visit
- Bring a list of your medications and allergies.
- Bring a phone charger and something to do.
- Tell staff right away if symptoms change, such as new chest pain, worsening pain, fainting or trouble breathing.
- Ask before eating or drinking, since you may need tests or a procedure.
- If you have a support person with you, let them help keep track of what you are told.
See What to Bring to the Hospital for a fuller list.