INTRODUCTION: The primary aim of this study was to determine which objectively-measured patient demographics, emergency department (ED) operational characteristics, and healthcare utilization frequencies (care factors) were associated with patient satisfaction ratings obtained from phone surveys conducted by a third-party vendor for patients discharged from our ED. METHODS: This is a retrospective, observational analysis of data obtained between September 2011 and August 2012 from all English- and Spanish-speaking patients discharged from our ED who were contacted by a third-party patient satisfaction vendor to complete a standardized nine-item telephone survey by a trained phone surveyor. We linked data from completed surveys to the patient's electronic medical record to abstract additional demographic, ED operational, and healthcare utilization data. We used univariate ordinal logistic regression, followed by two multivariate models, to identify significant predictors of patient satisfaction. RESULTS: We included 20,940 patients for analysis. The overall patient satisfaction ratings were as follows: 1=471 (2%); 2=558 (3%); 3=2,014 (10%), 4=5,347 (26%); 5=12,550 (60%). Factors associated with higher satisfaction included race/ethnicity (Non-Hispanic Black; Hispanic patients), age (patients >/=65), insurance (Medicare), mode of arrival (arrived by bus or on foot), and having a medication ordered in the ED. Patients who felt their medical condition did not improve, those treated in our ED behavioral health area, and those experiencing longer wait times had reduced satisfaction. CONCLUSION: These findings provide a basis for development and evaluation of targeted interventions that could be used to improve patient satisfaction in our ED.