I was a hospital administrator in the Air Force and the VA runs like most hospitals do. Not to be critical, but if you were able to wait for 18 hours and then leave the ER at the VA, then you in the wrong department. ER’s are not meant as places to go in lieu of regular appointments. If you are really sick but its not life and death but you can’t get a regular primary care appointment soon enough, you need to go directly to Urgent Care. They will triage you after you check in. Depending on how urgent you complaint is, you will be seen as soon as possible or you may have to wait if there are sicker people ahead of you.
I’ve been to my VA Urgent Care twice. Once I had bronchial pneumonia and waited for most of the day to get treated and meds to treat the problem. I was pleased that someone was able to see me the same day I went in. I was uncomfortable and coughing but not dying, so I had to wait while sicker patients were dealt with. The second time, I had acute pancreatitis and they admitted me to the hospital within an hour because I was in severe pain, vomiting and becoming dehydrated. I needed immediate help. I spent 4 days in the hospital that time.
Both times my problems were acute but not emergencies. Urgent Care is for patients who present with acute problems and can’t get a primary care appointment soon enough. The Emergency Room is for emergencies, as in life or death cases.