1. Patience will get you nowhere.

Emergency rooms are no fun. Babies are crying. Children are coughing and wheezing. People are uncomfortable. And that doesn’t even include the people facing life or death situations who are rushed straight to a doctor. As nurses and doctors struggle to look after everyone, sometimes “somebody who doesn’t know they’re having a heart attack, who thinks they’re just having shoulder pain, might not get noticed,” says Dr. William Mileski, director of the emergency department at the University of Texas Medical Branch in Galveston.

In fact, sitting quietly and respectfully could kill you, doctors say. In 2007, 200 emergency physicians nationwide said they knew of patients who died while waiting in the ER for hospital beds, according to the latest figures from the American College of Emergency Physicians. The moral: Speak up if you think the nurse or doctor has misunderstood your symptoms and don’t be afraid to ask them to repeat what you said back to you to make sure your message is clear, says Dr. Mileski.

2. There’s a cheaper option down the street.

After Michelle Morton’s 10-year-old son hit his face with a ceiling fan last year, she skipped the ER in favor of an urgent care center associated with her doctor’s office. They were in and out within an hour — her son had a concussion — and her copayment was 5 less than she would have paid for a visit to the emergency room.

An emergency department will never turn you away, but the hospital staff also won’t necessarily fill you in on your cheaper options. There could be a clinic or urgent care center down the street that is better equipped to treat your condition, meaning shorter wait times and a smaller bill.

Of course, if the situation is critical, call an ambulance or head straight for the ER. But if you have the time and you’re able, find out if there is an urgent care center associated with your hospital or doctor’s office. You might avoid a trip altogether by calling a 24-hour medical help line for advice on ways to alleviate certain symptoms until you can see your doctor.

3. Bring a book.

Most patients don’t realize that getting admitted to a hospital does not guarantee they will actually get a hospital bed. With some cash-strapped hospitals shutting down, there are fewer beds available for emergency room patients, who are sometimes required to wait for hours – or even days – on gurneys, in hallways, until a hospital bed opens up, according to a survey of physicians by the American College of Emergency Physicians.

Even if you get a bed, don’t expect treatment to be swift. The average amount of time spent in the ER has edged up slightly over the past few years to four hours and seven minutes in 2009, up four minutes from 2008, according to the most recent research from Press Ganey Associates, a health-care consulting firm. Nearly 400,000 people waited at least 24 hours. And it’s only getting worse, experts say, as the number of ER visits keeps rising. Annually, ER visits jumped 36% from 1990 to 2008, to 123 million, according to Press Ganey. And all that waiting doesn’t end in the waiting room.