The Most & Least Stressful States to Visit the ER

A trip to the emergency room is rarely a pleasant experience, but in some states, it can be significantly more stressful than in others. Overcrowding, long wait times, and high medical costs can add to an already tense situation—leaving patients frustrated as they seek urgent care.

To determine where ER visits are the most and least stressful, we analyzed healthcare data across all 50 states, ranking them based on five key factors:

• ER Visits per 1,000 People – Higher visit rates may indicate busier emergency rooms, leading to wait times and overcrowding longer.
• Hospital Beds per 1,000 People – A lower number of hospital beds suggests limited resources, which can contribute to ER congestion.
• Hospital Admissions per 1,000 People – A high admission rate may signal frequent severe cases, delaying care for less critical patients.
• Hospital Inpatient Days per 1,000 People – This represents the total number of days patients collectively spend in a hospital per 1,000 residents over a year. Longer hospital stays indicate hospitals operating at or near capacity, which can slow down ER efficiency.
• Average Cost of an ER Visit – High medical costs add financial stress to an already difficult situation.

At Policy Guide, we understand that access to timely and efficient healthcare is crucial to overall well-being. By identifying the states where ER visits are the most and least stressful, we aim to highlight regions where medical infrastructure is under strain—and where patients may have an easier time receiving the urgent care they need.

Key Findings

• Florida ranks as the most stressful state for ER visits due to having the highest ER costs in the country and a high rate of hospital admissions.
• North Dakota has the most ER visits per capita, contributing to its place among the most stressful states for emergency care.
• Washington D.C. ranks #1 for both hospital admissions and inpatient days, indicating a high strain on hospital resources.
• Maryland has the least expensive ER costs in the U.S. by a wide margin, making it one of the least stressful states for emergency care.
• Over the past decade, Idaho has seen the largest increase in ER visits (+43.24%), while Washington D.C. has seen the biggest decline (-31.73%).

The Most Stressful States for an ER Visit

Based on our ranking criteria, these are the 10 most stressful places for an emergency room visit. Each state’s score reflects factors such as ER visit rates, hospital bed availability, admission rates, inpatient stays, and costs.

Where are ER Visits Most Stressful?

1 – Florida – Score: 72.1

• ER Costs: Ranks #1 (Most Expensive)
• Hospital Admissions: Ranks #7

2 – Washington D.C. – Score: 67.9

• Hospital Inpatient Days: Ranks #1
• Hospital Admissions: Ranks #1
• ER Visits: Ranks #4

3 – West Virginia – Score: 62.6

• ER Visits: Ranks #3
• Hospital Admissions: Ranks #2
• Hospital Inpatient Days: Ranks #4

4 – North Dakota – Score: 62.5

• Hospital Inpatient Days: Ranks #3
• ER Visits: Ranks #1 (Most ER Visits Per Capita)
• Hospital Admissions: Ranks #8

5 – Kentucky – Score: 62.2

• ER Visits: Ranks #6
• Hospital Admissions: Ranks #10

6 – Missouri – Score: 61.5

• Hospital Admissions: Ranks #5
• Hospital Inpatient Days: Ranks #9

7 – Tennessee – Score: 60.4

• Hospital Admissions: Ranks #13
• ER Costs: Ranks #12

8 – New Jersey – Score: 59.4

• ER Costs: Ranks #2

9 – Pennsylvania – Score: 59.3

• Hospital Inpatient Days: Ranks #13
• Hospital Admissions: Ranks #12

10 – Alabama – Score: 59.2

• Hospital Admissions: Ranks #3
• Hospital Inpatient Days: Ranks #6

While some states struggle with overcrowded emergency rooms and high medical costs, others offer a smoother ER experience. These states have lower visit rates, better hospital infrastructure, and more manageable costs, making them the least stressful places for emergency care.

Least Stressful States for ER Visits

1 – Wyoming – Score: 27.9

• ER Visits: Ranks #43 (Fewer ER Visits Per Capita)
• Hospital Beds: Ranks #7 (Higher Availability)
• Hospital Admissions: Ranks #51 (Lowest in the U.S.)

2 – Utah – Score: 30.7

• Hospital Inpatient Days: Ranks #50
• Hospital Admissions: Ranks #48
• ER Visits: Ranks #50

3 – Maryland – Score: 31.7

• ER Visits: Ranks #48
• ER Costs: Ranks #51 (Lowest in the U.S.)

4 – Montana – Score: 38.2

• ER Costs: Ranks #47
• Hospital Beds: Ranks #8 (Higher Availability)

5 – Minnesota – Score: 38.7

• ER Visits: Ranks #45
• Hospital Admissions: Ranks #39

6 – Iowa – Score: 38.8

• ER Costs: Ranks #40

7 – Oregon – Score: 39.8

• Hospital Inpatient Days: Ranks #49
• Hospital Admissions: Ranks #43

8 – Alaska – Score: 41.8

• Hospital Admissions: Ranks #47
• ER Visits: Ranks #46

9 – Hawaii – Score: 41.9

• ER Visits: Ranks #47
• Hospital Admissions: Ranks #45

10 – Washington – Score: 42.0

• Hospital Admissions: Ranks #49
• Hospital Inpatient Days: Ranks #48

Emergency Room Trends: How States Compare Across Key Factors

Emergency room conditions vary widely across the U.S., with some states facing overcrowding and long wait times while others maintain a more efficient patient flow. Below, we break down key factors influencing ER stress levels, including visit frequency, hospital bed availability, and costs.

Which States Have the Most ER Visits?

A high number of ER visits per capita often signals overcrowded hospitals, longer wait times, and strained emergency medical resources. States with frequent ER visits may have limited access to primary care, forcing residents to rely on emergency departments for non-urgent medical needs.

Most ER Visits per 1k residents:

• North Dakota – 588 visits
• Louisiana – 574 visits
• West Virginia – 550 visits

Least ER Visits per 1k residents:

• Nevada – 251 visits
• Utah – 280 visits
• Arizona – 293 visits

States like North Dakota and Louisiana see high ER usage, potentially due to rural healthcare limitations and higher rates of chronic illness. On the other hand, Nevada and Utah have some of the lowest ER visit rates, possibly due to better access to urgent care facilities and preventive healthcare services.

Which States Have the Least Available Hospital Beds?

The number of hospital beds per capita is a critical factor in determining a state’s ability to handle medical emergencies and inpatient care efficiently. States with fewer hospital beds may struggle with ER overcrowding, leading to longer wait times and delayed admissions.

Least Hospital Beds per 1k residents:

• Washington – 1.60 beds
• Oregon – 1.66 beds
• Utah – 1.70 beds

Most Hospital Beds per 1k residents:

• Washington D.C. – 5.01 beds
• South Dakota – 4.61 beds
• North Dakota – 4.26 beds

Washington, Oregon, and Utah have the fewest hospital beds per capita, which may contribute to extended ER wait times and difficulty in admitting patients for further treatment.

In contrast, Washington D.C., South Dakota, and North Dakota maintain higher bed availability, potentially allowing for more efficient patient flow and shorter hospital stays.

Which States Have the Highest ER Costs?

The cost of an emergency room visit can add significant financial stress, especially for those without adequate insurance coverage. ER expenses vary widely across states, influenced by factors such as hospital pricing structures, insurance regulations, and regional healthcare costs.

Highest ER Costs:

• Florida – $3,394
• New Jersey – $3,377
• California – $3,238

Lowest ER Costs:

• Maryland – $682
• Maine – $1,041
• Rhode Island – $1,195

Florida, New Jersey, and California rank as the most expensive states for emergency care, with high hospital service fees and out-of-pocket costs contributing to financial strain for patients.

Meanwhile, Maryland, Maine, and Rhode Island offer the lowest ER costs, likely due to state regulations and hospital pricing controls that help keep expenses in check.

Which States Have the Most Hospital Admissions?

Hospital admissions per capita indicate how often ER visits result in inpatient care. A high admission rate may suggest a greater prevalence of severe medical conditions or strained hospital resources, leading to longer wait times for patients needing urgent treatment.

Most Admissions per 1k residents:

• Washington D.C. – 161 admissions
• West Virginia – 125 admissions
• Alabama – 119 admissions

Least Admissions per 1k residents:

• Wyoming – 65 admissions
• Idaho – 66 admissions
• Washington – 67 admissions

Washington D.C., West Virginia, and Alabama have the highest hospital admission rates, likely due to older populations, higher rates of chronic illness, or limited outpatient care alternatives.

Conversely, Wyoming, Idaho, and Washington experience the lowest hospital admission rates, which may indicate better preventive care options or stricter inpatient admission criteria.

Which States Have the Most Hospital Inpatient Days?

The number of hospital inpatient days per capita measures how long patients typically remain hospitalized. More inpatient days may indicate overburdened healthcare facilities, longer recovery times, or hospitals operating at or near capacity, which can delay new admissions from the ER.

Most Hospital Inpatient Days per 1k residents:

• Washington D.C. – 1,303 inpatient days
• South Dakota – 1,073 inpatient days
• North Dakota – 916 inpatient days

Least Hospital Inpatient Days per 1k residents:

• Idaho – 335 inpatient days
• Utah – 355 inpatient days
• Oregon – 414 inpatient days

Washington D.C., South Dakota, and North Dakota rank highest in hospital inpatient days, suggesting hospitals in these areas see longer patient stays, which may limit bed availability for incoming ER patients.

Meanwhile, Idaho, Utah, and Oregon have the lowest inpatient days, potentially reflecting more efficient hospital discharge processes or stronger outpatient care options.

How ER Visits and Hospital Beds Have Changed in the Last Decade

Emergency room trends have shifted over the past decade, influenced by healthcare policies, population growth, and major public health events. The COVID-19 pandemic, in particular, caused a dramatic dip in ER visits nationwide in 2020, as many patients avoided hospitals due to infection risks and restrictions on non-urgent care.

However, in some states, ER visits have rebounded sharply, while others continue to see declines.

ER Visits Overtime

Emergency room visit trends vary widely across the U.S. Some states have seen a significant rise in ER visits, potentially due to population growth, reduced access to primary care, or increased healthcare demand. Others have experienced a decline, which may be attributed to improved outpatient services, telemedicine expansion, or policy changes aimed at reducing unnecessary ER usage.

Where Have ER Visits Increased the Most? (2012–2022)

(National average change: -3.07%)

1 – Idaho +43.24%

2 – South Carolina +41.45%

3 – Nebraska +32.87%

4 – New Mexico +17.32%

5 – Colorado +15.43%

Where Have ER Visits Decreased the Most? (2012–2022)

(National average change: -3.07%)

1 – Washington D.C. -31.73%

2 – Maryland -28.11%

3 – Nevada -20.06%

4 – Rhode Island -19.96%

5 – Alaska -18.59%

States like Idaho, South Carolina, and Nebraska have seen the biggest increase in ER visits, possibly due to growing populations and healthcare provider shortages, which force more people to rely on emergency care.

On the other hand, Washington D.C., Maryland, and Nevada have experienced the sharpest declines, likely benefiting from expanded urgent care centers, telehealth adoption, and policy-driven efforts to reduce ER dependency.

👉 Explore how ER visits have changed in every state using the interactive graphic below. Use the dropdown menu to select your state.

Availability of Hospital Beds Overtime

Over the past decade, the number of hospital beds per capita has declined in most states, reflecting shifts in healthcare delivery, hospital closures, and a greater emphasis on outpatient care.

While some states have expanded their hospital capacity, many have seen reductions, which can contribute to longer ER wait times and increased patient overflow.

States Where Hospital Beds Have Increased Over the Past Decade (2012–2022)

(National average change: -9.62%)

1 – Alaska +6.19%

2 – Delaware +4.55%

3 – Hawaii +2.50%

4 – Nevada +2.00%

5 – Vermont +1.50%

States Where Hospital Beds Have Decreased the Most (2012–2022)

(National average change: -9.62%)

1 – South Carolina -17.41%

2 – Rhode Island -15.65%

3 – Wisconsin -15.22%

4 – Iowa -15.00%

5 – Minnesota -14.64%

While states like South Carolina, Rhode Island, and Wisconsin have seen steep declines in hospital bed availability, states such as Alaska and Delaware have bucked the trend by expanding capacity.

This difference highlights the growing challenge of medical resource shortages, particularly in states that have lost hospital infrastructure.

👉 Explore how the number of hospital beds has changed in every state using the interactive graphic below

Closing Thoughts

Emergency room experiences vary significantly across the U.S., with some states facing overcrowding, high costs, and limited hospital resources, while others provide a more efficient and accessible healthcare environment.

Our analysis highlights the states where ER visits could be more or less stressful, helping consumers better understand the challenges of emergency medical care based on location.

Managing ER costs and healthcare coverage can be overwhelming, but having the right insurance plan can make all the difference.

At Policy Guide, we recognize the importance of navigating healthcare options effectively, whether it’s finding the right Medicare plan, exploring supplemental coverage, or understanding healthcare accessibility in your state.

With the right coverage, you can minimize financial stress and ensure you have access to the care you need—when you need it most.

🔍 Looking for the best healthcare plan? Explore your options with Policy Guide and find a plan that fits your needs.

Data and Methodology: How We Scored the States

To determine the most and least stressful states to visit the ER, we ranked states based on five key factors that contribute to ER stress levels.

These factors include ER visits per 1,000 population, hospital beds per 1,000 population, hospital admissions per 1,000 population, hospital inpatient days per 1,000 population, and average cost of an ER visit.

For this analysis, we used the most recently available hospital data from KFF’s State Health Facts, and ER visit cost data from 2024 provided by Mira Health. Each factor was assigned a score out of 5, and the combined total created an overall stress score out of 100, where higher scores indicate more stressful ER conditions.

Additionally, we analyzed long-term trends (2012–2022) in ER visit rates and hospital bed availability to assess how these conditions have changed over time.