Emergency patients frequently complain about the amount of time they wait in an emergency department. Everyone who comes to an emergency department will be seen, regardless of ability to pay or insurance status.

Studies show the reasons patients wait include:

• A triage process, which means critically ill patients are seen first and less critically ill patients must wait. In most cases, a triage nurse will assess the severity of a patient’s condition upon arrival, based on symptoms; personal and medical history information; and vital signs, such as body temperature, heart rate, and blood pressure.
• Boarding of patients. Hundreds of emergency departments have closed in the United States. At the same time, the number of emergency department visits increased to 119.2 million in 2006 (up from 110.2 million in 2004).  There were on average, about 227 visits to U.S. Emergency Departments every minute during 2006. Many of the remaining hospitals lack capacity, which means critically ill or injured patients may have extended stays in the emergency department until hospital beds become available. This practice is known as “boarding,” and it is a major factor in overcrowding Boarding also contributes to ambulance diversion and limits a hospital’s ability to meet periodic surges in demand, such as those from disasters.
  
• As the number of visits to the emergency department has increased, the number of hospital EDs has decreased from 4,019 to 3,833.  This increases the annual number of visits per ED.
• On-call physician shortage. Emergency physicians are available 24 hours a day, 7 days a week, but other medical specialists, such as neurosurgeons, cardiologists, and orthopedic surgeons, provide “on-call” backup services as needed. An increasing number of these specialists are not available because of skyrocketing medical liability insurance premiums, inability to obtain liability insurance, and inadequate reimbursement.
  
• Local epidemics and disasters. In an emergency department, many patients may arrive at once, needing immediate medical care. This can happen when multiple motor vehicle crashes occur and during natural disasters or local epidemics, such as the flu.