Timeliness of care is a critical element in the emergency room (ER) care process. The purpose of this study is to evaluate the timeliness of the emergency room cycle time which is measured from patient registration till patient disposition in a tertiary hospital in Egypt. Method: The ER cycle time was tracked by direct observation and by using a data collection sheet. Results: The results showed that the longest phase was the initial physician assessment with a median of 16 minutes and interquartile range of 47 minutes. While the shortest phase was the registration phase with a median of 2 minutes and interquartile range of 2 minutes. The total ER cycle time had a median of 37 minutes and interquartile range of 60 minutes. The time to physician assessment in different categories of patient severity by Canadian Triage and Acuity Scale (CTAS) was noted to meet target duration for each category of the CTAS. Also 30.6% of patients experienced nursing assessment in less than 2 minutes, 28.6% of patients experienced physician assessment in less than 4 minutes, 35.5% of patient experienced their disposition in less than 2 minutes and 26.8% of patients experienced their total ER cycle time between 38-80 minutes.