Patients seeking care at the County General emergency room wait, on average, $17$ minutes before seeing the triage nurse who spends, on average, $4$ minutes assessing the severity of their problem. The most serious cases are seen first and the less serious often have to wait. On average, the wait time before being taken to the examination room is $23$ minutes. In the examination room, a nurse spends about $7$ minutes taking vitals and making notes on the patient's condition. The patient then waits for the doctor. This wait averages $13$ minutes. Treatment times by the doctor average $21$ minutes. Following treatment, patients wait $10$ minutes for the nurse to come to discuss the post treatment instructions. It takes about $5$ minutes to review with the patient these instructions before they leave. Considering any time spent interacting with a nurse or doctor as value$-$added time.

What is the precent value$-$added time in a trip to the emergency room?