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The aim of the study was to identify and quantify patient, physician, hospital, and system factors that are associated with a longer ED length of stay.Data were from the 2001–2003 National Hospital Ambulatory Medical Care Survey. The primary outcome was length of stay in minutes. Predictor variables were patient level (eg, age, triage score), physician level (eg, level of training), and hospital/system level (eg, geographic location, ownership).Admitted patients' median length of stay was 255 minutes (interquartile range, 160–400); discharged patients stayed a median of 120 minutes (interquartile range, 70–199). Factors independently associated with longer ED stays for admitted patients were Hispanic ethnicity (+20 minutes), computed tomography scan or magnetic resonance imaging (+36 minutes), and hospital location in a metropolitan area (+32 minutes). Intensive care unit admissions had a shorter length of stay (−30 minutes).Several factors are associated with significant increases in ED length of stay and may be important factors in strategies to reduce length of stay.