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No primary evidence has hitherto existed of predisposing, enabling, need, and social reinforcing factors influencing Emergency Department (ED) visits in an acute setting in Saudi Arabia. The aim of this study was to examine the association between emergency department visits and predisposing, enabling, need, and reinforcing social factors in an acute care. A cross-sectional study that randomly selected representative patients visiting ED services at King Abdulaziz Medical City in Riyadh from December 2016 to January 2017. Patient and facility validated questionnaires were used. Descriptive analysis and multivariate analysis were carried using STATA version 12. Average ED visit was 3.8 in 12 months with a range of 50 visits. Visits were concentrated on a few small discrete and non-negative integer values, but without an explicit upper limit. Perceived "good" health (P=0.026; 95% CI, 0.1334, 2.0547), "very good" health (P=0.006; 95% CI, 0.4288, 2.5432), and "excellent" health status (P=0.007; 95% CI, 0.5532, 3.5230) were associated with ED visits increasing by 9.4%, 48.6%, and 103%, respectively. Prior hospitalization was associated with 2.7 times higher ED visits. Household income more than $800 was associated with ED visits decreasing by between 49% to 70%. Getting useful advice on social matters was associated with 27% increase in ED visits, getting help when sick was associated with 9.4% decrease in ED visits. The findings suggest majority of the respondents were Saudis, with history of hospitalization, low income, less educated, perceived their health status as good, and considered their medical condition at the time of ED visit as not urgent. Future studies are needed to establish causality of ED visits the covariates to inform the balance between frequencies of visits versus medical need.