Background: Patient satisfaction is a key indicator of service quality in hospital emergency departments (EDs), where care is delivered under time pressure across multiple service touchpoints. This study assessed satisfaction with ED services at a tertiary care hospital and identified specific dimensions requiring administrative attention. Methods: A cross-sectional, descriptive study was conducted in the ED of a tertiary care hospital in Faridabad, India, over a 25-day period. A structured, interviewer-administered 15-item questionnaire covering registration, waiting time, doctor and nursing care, facilities, billing, and overall experience was used. Convenience sampling was employed; critically ill or unconscious patients were excluded, with an accompanying relative or attendant responding as proxy. A total of 400 valid responses were analysed using descriptive statistics, and the association between Left Against Medical Advice (LAMA) discharge status and recommendation intent was tested using Fisher's exact test. Results: Overall, 91.25% of respondents would recommend the ED. Satisfaction was highest for cleanliness (99.8% strongly agree), privacy and dignity (99.8%), and treatment explanation (100% agreement). The weakest item was waiting time for investigation results, with 43.2% dissatisfaction, followed by billing clarity (19.5%). All 35 non-recommenders corresponded exactly to LAMA discharges (Fisher's exact p < .001). Conclusion: ED service quality was strong overall, particularly in interpersonal and facility domains. Diagnostic turnaround time was the primary improvement area, and dissatisfaction was concentrated among LAMA cases, indicating a targeted rather than broad-based improvement strategy.