Study objective: To determine the effects of actual waiting time, perception of waiting time, information delivery, and expressive quality on patient satisfaction. Methods: During a 12-month study period, a questionnaire was administered by telephone to a random sample of patients who had presented to a suburban community hospital emergency department during the preceding 2 to 4 weeks. Respondents were asked several questions concerning waiting times (ie, time from triage until examination by the emergency physician and time from triage until discharge from the ED), information delivery (eg, explanations of procedures and delays), expressive quality (eg, courteousness, friendliness), and overall patient satisfaction. Results: There were 1,631 respondents. The perception that waiting times were less than expected was associated with a positive overall satisfaction rating for the ED encounter ( P<.001). Satisfaction with information delivery and with ED staff expressive quality were also positively associated with overall satisfaction during the ED encounter ( P<.001). Actual waiting times were not predictive of overall patient satisfaction ( P=NS). Conclusion: Perceptions regarding waiting time, information delivery, and expressive quality predict overall patient satisfaction, but actual waiting times do not. Providing information, projecting expressive quality, and managing waiting time perceptions and expectations may be a more effective strategy to achieve improved patient satisfaction in the ED than decreasing actual waiting time. [Thompson DA, Yarnold PR, Williams DR, Adams SL: Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med December 1996;28:657-665.]