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A retrospective cohort study was conducted to evaluate the effect of the built environment of an emergency department (ED) on the timeliness of physician assessment of chest pain patients. The main outcome variable was time to initial physician assessment. Potential predictor variables included presence of a solid door, distance of treatment room from work area, staffing team, day of week, and the patient's age, sex, and triage level. After multi-variate adjustment, the only predictors of time to initial assessment greater than 10 minutes were being placed in a room with a door (adjusted odds ratio [OR] 1.58; 95% confidence interval [CI] 1.01-2.48) and being placed in a room 25 feet or more from the main physician work area (adjusted OR 1.38; 95% CI 1.13-1.67). These findings suggest that the ED built environment can be a barrier for providing timely care for this group of patients and may have implications for future ED architectural designs.