A past Institute of Medicine report highlighted the unique challenges in providing high-quality and safe patient care in emergency departments (EDs). In addition to overcrowding, fragmentation in care, and shortage of on-call specialists, there are noted barriers to adopting The Joint Commission's National Patient Safety Goals in the ED. This study surveyed ED providers from diverse practice settings to illustrate the disconnect between nationally stated safety goals and locally expressed safety concerns. Investigators discovered that overcrowding, lack of nursing staff, and unavailability of consultants were the most pressing safety problems identified. Rural providers were most concerned about consultant availability and lack of follow-up after ED care, whereas crowding was the greatest concern for suburban and urban providers. The authors advocate for greater measurement and reporting of these ED provider concerns in future safety benchmarking programs.