Objective To determine the emergency department (ED) environmental factors associated with patient satisfaction.

Methods A prospective, observational study in a university-affiliated tertiary-referral ED and associated observation unit (OU). The ED environment was evaluated with a structured questionnaire, scored using a 100-mm visual analogue scale. Patients who stayed in the ED over 8 h (long-stay ED; LSED) were compared with those who stayed less than 4 h (short-stay ED; SSED) and with a control group admitted to the OU.

Results A total of 233 patients was enrolled, overall satisfaction in SSED was 81% (95% CI 70.1 to 88.7), 69% in LSED (95% CI 57.4 to 78.7) and 84% in OU (95% CI 73.6 to 91.0). The most important environmental factors were cleanliness (median importance 95, interquartile range (IQR) 81–98) and communication with medical staff (94, IQR 80–98) and family (92, IQR 74–98). The least important factors were access to nature (38, IQR 19–65), a natural light source (50, IQR 24–74) and ability to sit out of bed (52, IQR 26–75). Factors rated high for importance but low for satisfaction were ED noise levels (median difference 40, IQR 3–70), ED trolley comfort (19, IQR 6–50) and food quality (12, IQR −4–29).

Conclusion Patients who spend over 8 h in the ED are less satisfied with their environment than either those who spend less than 4 h or patients in an OU. Importantly, distinct, amenable factors can be identified. These should be addressed to improve patients’ overall ED management and satisfaction.