At some hospitals in the San Joaquin Valley, a visit to the emergency room can last an average of four to five hours.
A visit to a hospital emergency room is typically no walk in the park. Along with the stress of a potential medical crisis, patients know they’re likely to be there for hours to be poked, prodded, tested, perhaps taken for X-rays – and a lot of hurry-up-and-wait.
Data from the U.S. Center for Medicare & Medicaid Services shows that nationwide, the median duration of a visit to a hospital emergency department in 2024 – the most recent information available – was 2 hours 41 minutes. In California, the median ER visit duration was 2 hours 58 minutes.
The median duration is the time at which half of all visits took longer – sometimes much longer – and half were shorter from arrival to either discharge from the ER, admission as an inpatient or transfer to another facility.
Among more than 30 hospitals in the San Joaquin Valley, the median times of emergency room visits in 2024 ranged from a low of just over two hours at Oak Valley District Hospital in Stanislaus County to almost five hours at Adventist Health Bakersfield in Kern County.
There are several reasons why there are wide variations between hospitals in the Valley. Chief among them are the volume of patients and ambulance arrivals, and the number of treatment stations inside the departments, which vary from one hospital to another. But wait times can also depend on the number of residents who lack health insurance coverage in a given region.
“There are health care access barriers, especially in Fresno County, said Dr. Danielle Campagne, medical director of the emergency department at Community Regional Medical Center in downtown Fresno. “There are a lot of impoverished people who have a lack of access to care, and the emergency room is a safety net.”
Community Regional Medical Center and Clovis Community Medical Center are both part of Fresno-based Community Health Systems. Clovis Community had the third-highest duration of ER visits among Valley hospitals, at 4 hours 32 minutes in 2024.
At Community Regional, which is the only Level 1 trauma center in the region and one of the busiest hospitals and emergency rooms in the Valley, the median duration of an emergency room visit was 4 hours 1 minute.
Ambulance arrivals are one component
The flow of patients through emergency rooms is affected by the volume of ambulance arrivals, as well as the incoming transfers of patients who need more advanced care than what other hospitals can provide.
In March 2025 alone, more than 33,000 “ambulance patient offloads” were reported at Valley hospitals by the California Emergency Medical Services Authority. Valley hospitals that received 1,000 or more patients by ambulance in that single month were:
- Community Regional Medical Center, Fresno: 4,102 patients.
- Saint Agnes Medical Center, Fresno: 2,685 patients.
- Clovis Community Medical Center, 2,224 patients.
- St. Joseph’s Medical Center, Stockton: 2,205 patients.
- Kaweah Health Medical Center, Visalia: 2,110 patients.
- Memorial Medical Center, Modesto: 1,819 patients.
- Bakersfield Memorial Hospital, Bakersfield: 1,602 patients.
- Doctors Medical Center, Modesto: 1,593 patients.
- Adventist Health, Bakersfield: 1,593 patients.
- Mercy Medical Center, Merced: 1,463 patients.
- Kern Medical Center, Bakersfield: 1,304 patients.
- San Joaquin General Hospital, French Camp: 1.078 patients.
- Adventist Health, Hanford: 1,059 patients.
Community Regional in Fresno “is one of the busiest emergency departments in the state and saw 131,600 patients in the ED, with 52,552 of those patients arriving by ambulance in 2025,” said Michelle Von Tersch, senior vice president for Community Health System. “More patients arrived to Community Regional [by ambulance] than any other facility in California.”
As the volume of patients who arrive at emergency rooms by ambulance increases, it adds to the strain that those facilities face. Emergency departments are frequently pushed to their limits by the number of patients seeking treatment.
At several points since 2020, during and even since the COVID-19 pandemic – when emergency rooms were stretched beyond their normal capacities by coronavirus cases as well as more typical crises like heart attacks, strokes, injuries from accidents and assaults – the Central California Emergency Medical Services Agency encompassing Fresno, Kings, Tulare and Merced counties put in place an “assess and refer” policy requiring ambulance paramedics to deny transport to hospital emergency rooms unless patients had a true emergency condition.
Those restrictions sometimes lasted for days or even weeks at a stretch. During those periods, non-emergency patients who called for an ambulance were referred to either their primary-care doctor, an urgent-care clinic, or telehealth services.
Not just emergencies
Emergency room visits can be costly for both hospitals and for patients because of the intensity of care needed to quickly assess, diagnose and treat patients. But not everyone who comes to an emergency room has a truly urgent or life-threatening condition.
The National Committee for Quality Assurance recently reported that nationwide, 24% of adults from ages 18 to 64 who visited hospital emergency departments came in for non-urgent reasons, with conditions that could have been handled by either primary-care doctors or in urgent-care clinics.
“A high rate of ED utilization may indicate poor care management, inadequate access to care or lack of patient education surrounding care alternatives, resulting in ED visits that could have been prevented,” the NCQA report stated.
But in the Valley, a region with a shortage of doctors and nurses, such alternatives are not always available to people, including those without health insurance, and emergency rooms are sometimes a last resort or only option.
“If you look at how many urgent care clinics are open on weekends, it’s surprisingly small,” Campagne said.
It’s worth noting that while the duration of emergency room visits may be hours, that should not be confused with how long someone has to wait to have an initial assessment or their condition triaged to determine their priority relative to other patients
“The word is out; if you go to the ER, you will see a trained physician,” said Marilyn Greene, emergency department director at Clovis Community Medical Center. “Within 15 to 20 minutes, you’ll be in the presence of a [nurse or doctor] who can help you.”
That goes for people who may come in for symptoms that may not seem urgent on the surface but could signal a more serious condition.
“Our baseline health in the Valley is not very strong,” Community Medical’s Campagne said. “We don’t always know who needs emergency intervention until we do the tests. We can’t just say, ‘If you have a runny nose, don’t come to the ER.’”
The broader shortage of medical providers may create delays for some patients because even if they have a primary-care doctor, they may not be able to book an immediate appointment or have to wait to schedule lab tests, scans or specialist visits.
In some instances, Greene said primary-care doctors may advise their patients to go directly to the emergency room rather than wait for an office appointment.
“If you go to your doctor, it might take six weeks to do all that. … It’s not uncommon to see a patient who says, ‘I’m scheduled for an MRI (magnetic resonance imaging), but I can’t wait,’” Greene said. “Depending on the situation, an emergency department can do all that in one visit.”
But getting results back from tests in the emergency department takes time, and because more serious cases take precedence, those with less serious conditions will face longer wait times once their situation is assessed. “It’s not a first-come, first-served environment,” Von Tersch said.
Not enough hospital beds
One additional factor that contributes to lengthy ER visits is a lack of beds in the hospital when a patient needs to be admitted for inpatient care. “Boarding” is the term for when a patient has to remain in the ER until a bed opens up for them. And it’s a growing problem, not only in the Valley, but nationwide as well.
“Patients who are sick enough to require inpatient care can wait in the ED for hours, days or even weeks after a physician has decided to admit them while waiting for an inpatient bed to become available,” according to a 2025 report on emergency department boarding by the federal Agency for Healthcare Research and Quality.
“The U.S. healthcare system has spent many years emphasizing outpatient care, resulting in fewer inpatient beds nationwide,” the report stated. “Concurrently, we have seen a growing number of ED visits that lead to hospital admission. Taken together, this has created a mismatch between supply and demand, with less inpatient capacity for admitting patients from the ED” and an increase in boarding.
A 2024 study by doctors Reham Mostafa and Khaled El-Atawi “revealed that longer patient stays in the ED, often a result of high occupancy rates, are linked to a range of negative outcomes. These include extended waiting times, compromised patient care, and overall decreased efficiency of ED operations.”
And the concern isn’t only for patients who need to be admitted to the hospital for inpatient care. For patients who are ready to leave the hospital but cannot be discharged directly home, there’s a matter of finding skilled-nursing or rehabilitation beds to which they can be transferred.
Von Tersch said that on average, “Community has about 65 patients in hospital beds awaiting to be discharged … due to a lack of available ‘post-acute’ beds in skilled nursing or rehabilitation centers.”
The result can resemble a traffic jam.
“These patients no longer need hospital-level care, but need additional care before they can recover at home,” she added. “This causes patients to remain in the ED until a hospital bed becomes available.”
Speeding things along
Adventist Health Bakersfield had the highest median ER visit duration among Valley hospitals in 2024 at 4 hours 51 minutes. But by the fourth quarter of 2025, that had dropped to 4 hours 16 minutes.
“This 35-minute improvement reflects targeted investments and significant operational enhancements,” according to a prepared statement provided by Adventist Health.
Among those measures were increasing inpatient capacity by adding 22 medical-surgical beds to help reduce ER boarding times; expanding a partnership with an emergency physicians group to increase the number of available ER providers to see patients; and adding radiological capacity to speed interpretation of diagnostic imaging such as X-rays, CT scans and MRIs.
Clovis Community reduced its median ER visit time from 4 hours 32 minutes in 2024 to 230 minutes in 2025. The hospital has found open spaces “to move patients out of the emergency department into patient care areas that were not necessarily indicated for inpatient care,” Greene said. “We’re opening up as much space as we can put people safely.”
In Fresno, Community Regional has its lab and other ancillary services “working at max capacity … 24 hours a day, seven days a week,” Campagne said. “The idea is we expect high volumes [in the emergency room], so the faster we can get results back, the sooner we can discharge or admit a patient.”
For patients who are transferred to Community Regional from other hospitals because they need a higher level of care, officials at Community are working to free up inpatient beds by sending those patients back to the originating facility once their need for more extensive care has been met, Von Tersch said.
Community Regional is also awaiting licensing approval from the Centers for Medicare
& Medicaid Services to open a newly renovated, 154-bed extended-care center on its downtown campus. “This facility will provide much-needed post-acute beds for our region, free up additional inpatient beds and improve ED patient throughput,” Von Tersch added.
Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at [email protected].
