Iowans may want to think twice before complaining about long waits in the emergency room.

According to a national study, Iowa is the quickest place in the country to get emergency medical attention — the average visit lasting two hours, 18 minutes.

The national average is three hours, 42 minutes, according to a study from Press Ganey Associates Inc., a South Bend, Ind.-based company that measures patient satisfaction.

The study, which was published this month, rated hospitals' performances last year. Nebraska rated second fastest in the nation at two hours, 26 minutes, followed by South Dakota (2:28), Vermont (2:32) and Wisconsin (2:34).

The longest average visits were in Arizona (4:57), Maryland (4:07), Utah (4:04), New York (3:58) and Florida (3:57).

Scott McIntyre, spokesman for the Iowa Hospital Association, said Iowa's rural landscape could be one reason why ER visits are shorter here.

"We have a lot of small hospitals that don't have a lot of emergency room traffic," he said. "The pressure on the ERs here is not comparable to ERs in, say, Los Angeles."

In addition, McIntyre said more Iowans have primary physicians, regular health care and insurance than people in other states, which leads to less time in the emergency room.

"People get care when they need it," he said, "and they get good primary care that keeps them from getting too sick or not having the job done."

Dr. Melvin Hall, president and CEO of Press Ganey, said hospitals in states with longer average visits should let patients know how long they'll be in the emergency room and why. He said the strategy helps patients better cope with the situation.

Dr. Andrew Nugent, clinical director of University Hospitals' Emergency Treatment Center in Iowa City, said his staff meets each week with Press Ganey to measure patient satisfaction in the emergency room.

He said analyzing hours and minutes is not the only way to gauge success in an emergency room.

"That's kind of misleading, because some visits take 15 minutes and some are more complicated and take a few hours," he said. "I think most patients think the ideal visit would be in five minutes and out in five minutes."