Introduction
An emergency room (also called an emergency department) is designed to assess and treat serious illness or injury quickly, including conditions that could become life-threatening or lead to disability. A practical way to think about an “excellent” ER is: it reliably prioritizes the sickest patients first, evaluates patients in an organized clinical flow, and supports safe follow-through when patients leave.
Key takeaways
- Patients are assessed before treatment to determine urgency and order of care.
- This means someone who arrives later may be seen sooner if their condition is more urgent.
- A discharge plan can help people get the right care after leaving and help prevent a return trip to the hospital.
- Use emergency services if the situation could be life-threatening or lead to permanent disability, or if you cannot wait for care.
What “excellent” means in practice
1) Rapid assessment and prioritization
High-quality emergency care includes triage, an initial assessment by a clinician that helps decide what order patients should be seen in, so the most seriously unwell patients are treated first. This means someone who arrives later may be seen sooner if their condition is more urgent.
Important details supported by evidence:
- Patients are assessed before treatment to determine urgency and order of care.
- Arrival by ambulance does not always mean someone will be seen sooner than someone who walked in.
What to expect during an ER visit
While details vary by facility, a typical ER visit may include:
Arrival and registration
If you arrive on your own, you may start in a waiting area where staff begin check-in and collect basic information and medical history.
Triage (assessment)
A clinician may check vital signs and assess symptoms and history to determine how serious the condition is and prioritize care.
Examination, testing, and treatment
After triage, you may be placed in an examination area where an emergency clinician evaluates you. Testing may include imaging or other diagnostics. Nurses and other staff may monitor vital signs and provide treatment.
Next steps: discharge, transfer, or admission
What happens next depends on the results of assessment and testing:
- Some patients may go home with instructions and prescriptions.
- Some may be referred onward (for example, to another service) or admitted if very ill and needing further care.
Safety and communication you can reasonably expect
Hand hygiene and infection prevention
People receiving healthcare can be at risk of infection while being treated for other conditions, and cleaning hands helps prevent the spread of germs. Patients and loved ones can play a role by asking or reminding healthcare personnel to clean their hands.
Speaking up during care
Patient-safety guidance for the public encourages speaking up if:
- You do not understand something or something does not seem right.
- You think you may be confused with another patient.
- You do not recognize a medicine or think you are about to get the wrong medicine.
It also encourages checking staff ID badges and reminding clinicians to clean their hands.
There is no high-quality evidence supporting this as a universal guarantee.
Discharge quality and follow-through
Leaving a hospital or emergency setting often involves instructions meant to help recovery and reduce avoidable return visits.
Evidence-supported components of discharge follow-through include:
- A discharge plan can help people get the right care after leaving and help prevent a return trip to the hospital.
- Patients may receive written instructions about medications, specialists to visit, restrictions, and symptoms that should trigger a return visit.
- Discharge instructions may include what to do next, who to call with questions or in an emergency, and follow-up appointment details.
- Transitions of care are a known point of vulnerability for errors, and effective discharge planning can help reduce medical errors during transitions.
- There is no high-quality evidence supporting this as a standard expectation.
ER vs. urgent care: what’s the difference?
Evidence-supported distinctions:
- Emergency care is appropriate when someone could die or be permanently disabled without immediate care; calling the local emergency number is recommended when the situation cannot wait.
- Urgent care may be appropriate when a problem is not life-threatening or risking disability, but you are concerned and cannot see your regular provider soon enough.
Recognition and quality signals
Some emergency departments participate in recognition programs. For example, a national emergency nursing organization describes an award recognizing emergency departments for exceptional and innovative performance across areas such as leadership, practice, education, advocacy, and research—and frames it as a visible symbol of commitment to quality, safety, and a healthy work environment.
When to See a Doctor
Seek emergency care immediately
Use emergency services if the situation could be life-threatening or lead to permanent disability, or if you cannot wait for care.
Consider urgent care
If the issue is not life-threatening or risking disability, but you are concerned and cannot see your regular provider soon enough, an urgent care clinic may be appropriate.
Frequently Answer Questions
What is triage?
Triage is an assessment performed by a doctor or nurse before treatment that helps decide what order patients should be seen in, so the most seriously unwell people are treated first.
Why do people who arrive later sometimes get seen sooner?
Because triage prioritizes urgency. Arrival time is not the only factor; the sickest patients are prioritized first.
What should I bring to the ER?
Evidence supports bringing any medicines you take and being ready to share your medical history and medication list.
What discharge information should I expect?
Evidence supports receiving instructions and follow-up information, including medication guidance and what symptoms should prompt a return visit, plus who to call with questions or in an emergency.
What is a “good” ER?
A “good” ER can be described (based on evidence) as one that uses triage to prioritize the sickest patients, performs clinician evaluation with appropriate monitoring/testing, and provides discharge instructions and follow-up guidance.
Is the ER “safe,” and what does “safe” mean in practice?
Evidence supports that hand hygiene helps prevent spread of germs and that public patient-safety guidance encourages speaking up about concerns like possible patient mix-ups, medication questions, and hand hygiene reminders. Beyond these points, there is no high-quality evidence supporting a single universal definition of “safe” that applies to every ER.
What are five characteristics of an effective hospital emergency room?
Based only on high-quality evidence, five evidence-supported characteristics are:
Uses triage to prioritize the most seriously unwell patients first
Has a defined clinical flow from arrival/registration to assessment and treatment
Can monitor vital signs and evaluate patients clinically, with testing when needed
Provides written discharge instructions, including when to return for care
Supports patient safety practices such as hand hygiene and encourages patients to speak up about concerns
How do I find the best emergency room near me?
There is no high-quality evidence supporting this.
Which emergency room is better?
There is no high-quality evidence supporting this.
What qualities make a good ER nurse (from a patient perspective)?
There is no high-quality evidence supporting this.
Are there hospitals with a reputation for outstanding emergency care services?
There is no high-quality evidence supporting this.
APAReference List
American College of Emergency Physicians. (n.d.). What can I expect when I go to the emergency department? https://www.emergencyphysicians.org/article/er101/what-can-i-expect-when-i-go-to-the-emergency-department
American College of Emergency Physicians. (2023, January 8). Emergency care vs. urgent care: What’s the difference? https://www.emergencyphysicians.org/article/in-the-news/1-8-23-emergency-care-vs.-urgent-care-whats-the-difference
Bajorek, S. A., & McElroy, V. (2024, June 15). Discharge planning and transitions of care. PSNet (Agency for Healthcare Research and Quality). https://psnet.ahrq.gov/primer/discharge-planning-and-transitions-care
Centers for Disease Control and Prevention. (2024, February 27). About hand hygiene for patients in healthcare settings. https://www.cdc.gov/clean-hands/about/hand-hygiene-for-healthcare.html
Emergency Nurses Association. (n.d.). Lantern Award. https://www.ena.org/about-us/awards-recognition/lantern-award
Hesselink, G., Sir, Ö., Koster, N., Tolsma, C., Munsterman, M., Olde Rikkert, M., & Schoon, Y. (2021). Teach-back of discharge instructions in the emergency department: A pre–post pilot evaluation. Emergency Medicine Journal, 39(2), 139–146. https://doi.org/10.1136/emermed-2020-210168
Joint Commission. (2019). Speak Up™ about your care [Infographic]. https://www.cc.nih.gov/sites/default/files/assets/patient/pdf/speak-up.pdf
National Health Service. (2023, February 3). When to go to A&E. https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-go-to-ae/
National Library of Medicine. (2024, July 15). Discharge plan. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/patientinstructions/000867.htm
National Library of Medicine. (2024, September 4). When to use the emergency room – adult. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/patientinstructions/000593.htm
NHS England. (2022, August 12). Guidance for emergency departments: Initial assessment. https://www.england.nhs.uk/guidance-for-emergency-departments-initial-assessment/
Reynolds, T. A., Sawe, H., Rubiano, A. M., Shin, S. D., Wallis, L., & Mock, C. N. (2017). Strengthening health systems to provide emergency care. In D. T. Jamison et al. (Eds.), Disease control priorities: Improving health and reducing poverty (3rd ed., Chapter 13). The World Bank. https://doi.org/10.1596/978-1-4648-0527-1_ch13