See how every public hospital in the state performed in the September quarter when it comes to emergency patients seen on time.
Only around half of patients presenting to NSW hospital emergency departments with a condition requiring emergency and urgent treatment were treated on time in the September quarter, a new report reveals.
Just 49.2% of triage 2 presentations (emergency) were treated on time, and 55.9% of triage 3 presentations (urgent) met national benchmarks, according to the Bureau of Health Information’s latest Healthcare Quarterly report.
NSW health minister Ryan Park weighed into the results, saying challenges in accessing primary care were continuing to put pressure on busy EDs.
The report, which includes a patient survey, found more than one in four patients (28% presenting to ED said they wouldn’t be there if they could access a GP to treat their condition.
“I know the Commonwealth government has made significant efforts to address its GP shortage crisis,” said Mr Park.
“The impact of the federal Liberals’ and Nationals’ freeze on the Medicare rebate will be felt for some time to come and won’t be undone overnight. The reality is however, the Commonwealth’s GP shortage crisis is placing severe pressure on our hospitals as people have little choice but to present to our EDs for non-emergency conditions.”
The report, released today, shows activity and performance for public health services in NSW during July to September 2024, and wasn’t big on good news.
It showed that 61.3% of all patients who attended the ED started their treatment on time – the lowest of any quarter since the BHI started reporting in 2010.
There were 787,590 ED attendances across the state’s public hospitals – up 2.1% (15,949) compared with the same quarter a year earlier. Triage 2 and 3 presentations were both the highest of any quarter since BHI started reporting in 2010, while triage 4 and 5 presentations have been trending down since early 2024.
And 195,703 patients arrived at the ED by ambulance – also the highest since 2010.
Of those, 77.5% of patients who arrived by ambulance had their care transferred to ED staff within 30 minutes. One in 10 patients waited longer than 62 minutes for their care to be transferred – down from the record 76 minutes in the preceding quarter.
The Australasian College for Emergency Medicine (ACEM) recommended maximum waiting times for ED treatment to start are:
• Triage 1: Immediately life-threatening condition – 100% immediately
• Triage 2: Emergency – 80% within 10 minutes
• Triage 3: Urgent – 75% within 30 minutes
• Triage 4: Semi-urgent – 70% within 60 minutes
• Triage 5: Non-urgent – 70% within 120 minutes.
The Australasian Triage Scale is only used to describe clinical urgency. Separate measures are required to describe severity, complexity, quality of care, workload and staffing.
Not everyone who presented to an ED in the September quarter opted to wait for treatment. The report showed that of the 67,737 patients who left without or before completing treatment, 32.7% were triage 3, 45.8% were triage 4 and 13.1% were triage 5.
Of the more than 787,000 attendances to NSW EDs, 281,912 were presentations by patients in the semi-urgent category (triage category 4), and 58,023 in the non-urgent category (triage category 5) – a combined decrease of 2451 presentations in these categories compared with the same quarter in 2023.
These conditions can include minor aches and pains, sprained ankles, migraines, earaches, rashes, coughs and colds.
According to the report, some 102,000 people were diverted away from EDs during this period thanks to Healthdirect – a phoneline which directs people to a registered nurse who can guide them to a pathway to care outside of the hospital, including through urgent care or virtual care services.
This compares to 72,000 people diverted away from EDs during the same quarter last year.
The Royal Australian College of General Practitioners (RACGP) said the report highlighted the urgent need for government to do more to ensure everyone can access affordable GP care.
“Today’s report highlights the pressure on New South Wales’ public hospitals and ambulance services – the system is broken and pouring billions more taxpayers’ dollars into hospitals and non-doctor services won’t fix it,” said RACGP NSW chair Dr Rebekah Hoffman.
“GPs are the best medicine for New South Wales’ struggling health system. Studies show patients who see the same GP are healthier and reduce pressure on hospitals and ambulances. There’s simply no substitute for the quality care you get from a GP who knows you, and your history.
“New South Wales needs specialist GPs more than ever. Our population is ageing, and more people are living with chronic illness, which requires specialist GP care – three-in-four people in NSW had at least one long term condition in 2022, that’s over six million people.
“It’s deeply frustrating to see governments continuing to pour billions into hospitals when we know the best investment is funding preventive care and management of chronic conditions by GPs in the community.”
Dr Hoffman said the state’s chief health officer had told the Special Commission of Inquiry into Healthcare Funding in NSW that more funding should go to preventing and managing chronic conditions in the community, “which is what GPs do – going by Ryan Park’s statement today, I don’t think he’s got the message”.
“Over seven million people in New South Wales choose to see a GP for essential care each year. General practice is essential for the health and wellbeing of everyone in New South Wales,” she said.
“I strongly encourage Ryan Park to get in touch with the RACGP to discuss real solutions that will ensure people across News South Wales can access the essential healthcare they need today, and into the future.”
The NSW Nurses and Midwives Association also weighed into the report, with general secretary, Shaye Candish saying it was clear emergency departments were buckling under the immense pressure, and it was nurses who were at the forefront of this crisis.
“It’s no surprise the latest quarterly BHI data confirms what our members know – that they are getting busier and busier. They’re treating more seriously ill patients than ever before, with unparalleled numbers of emergency and urgent presentations this quarter,” said Ms Candish.
“It’s disappointing only 61% of patients who attended EDs started their treatment on time, which is the lowest on record, while only just over half of all patients spent less than four hours in the ED.
“However, it is evident from this data that the severe pressures on our EDs cannot be primarily attributed to the GP shortage, as semi-urgent and non-urgent cases have both fallen, while patients presenting with complex and acute conditions have risen.”
Ms Candish said nurses and midwives were dealing with “extremely testing conditions”, often working chronically understaffed while striving to provide quality clinical care to all patients.
“Workloads have increased tremendously, yet nurses and midwives’ pay has stagnated, resulting in them being some of the lowest paid in the country while living in the most expensive state,” she said.
“We are calling on the government to invest in its largest female-dominated workforce by delivering competitive rates of pay that keep up with the cost-of-living, instead of silencing and punishing nurses and midwives by choosing to pay them low wages.”
NSWNMA Assistant General Secretary, Michael Whaites, said the government would continue to struggle with inadequate staffing levels unless nurses and midwives’ pay and conditions improved.
“These latest hospital figures show a public health system under ever increasing pressure. We have shortages across the state which are being driven by uncompetitive wages. If the government doesn’t act on this, patient care will continue to be compromised,” said Mr Whaites.
“We know the issue of bed block is being exacerbated because of the growing number of ED presentations throughout NSW hospitals.
“Our members’ wages are stuck in 2008 and certainly haven’t kept pace with the increased activity as they struggle to deal with the current demands.”
Most of the state’s EDs saw an increase in emergency presentations in the July-September quarter this year. See the list below, including each hospital’s stats for the percentage of patients whose treatment started on time:
- Campbelltown Hospital: 22,529, up 2.7%; 24% started treatment on time
- Liverpool Hospital: 22,812, up 4.6%; 53.6% started treatment on time
- Nepean Hospital: 21,731, up 7.6%; 58.7% started treatment on time
- Royal North Shore Hospital: 21,675, up 1.8%; 66.4% started treatment on time
- John Hunter Hospital: 20,969, up 1.5%; 46.5% started treatment on time
- Royal Prince Alfred Hospital: 20,807, up 1.3%; 62.2% started treatment on time
- St George Hospital: 20,134, up 0.2%; 49% started treatment on time
- Westmead Hospital: 19,632, up 3.8%; 38.7% started treatment on time
- Gosford Hospital: 19,282, up 0.9%; 51.2% started treatment on time
- Wyong Hospital: 18,346, down 2.4%; 44.4% started treatment on time
- Wollongong Hospital: 17,885, down 1.1%; 50.7% started treatment on time
- Blacktown Hospital: 16,814, up 7.5%; 30.3% started treatment on time
- The Children’s Hospital at Westmead: 16,364, up 0.9%; 61.7% started treatment on time
- Sutherland Hospital: 15,851, down 2%; 49.5% started treatment on time
- Northern Beaches Hospital: 15,789, up 3.6%; 73.9% started treatment on time
- Prince of Wales Hospital: 15,398, up 3.7%; 43.7% started treatment on time
- Bankstown-Lidcome Hospital: 14,569, up 3.1%; 51% started treatment on time
- Tweed Valley Hospital: 13,938, up 2.8%; 79.1% started treatment on time
- Maitland Hospital: 13,677, up 4.8%; 42.7% started treatment on time
- St Vincent’s Hospital Sydney: 13,381, up 4.7%; 64.9% started treatment on time
- Canterbury Hospital: 12,473, up 4%; 66.3% started treatment on time
- Hornsby Ku-ring-gai Hospital: 12,275, up 2%; 68.8% started treatment on time
- Port Macquarie Base Hospital: 12,263, up 4.4%; 61.3% started treatment on time
- Wagga Wagga Base Hospital: 11,616, down 1.5%; 61% started treatment on time
- Coffs Harbour Health Campus: 11,060, up 1.3%; 48.6% started treatment on time
- Concord Repatriation General Hospital: 10,819, up 1%; 81% started treatment on time
- Tamworth Hospital: 10,643, down 2.8%; 47.7% started treatment on time
- Shoalhaven District Memorial Hospital: 10,447, up 4.7%; 51.9% started treatment on time
- Mount Druitt Hospital: 10,445, up 3.8%; 49.6% started treatment on time
- Dubbo Hospital: 9909, down 3.1%; 74.7% started treatment on time
- Calvary Mater Newcastle; 9871, up 1.2%; 82.1% started treatment on time
- Fairfield Hospital: 9620, down 1.7%; 51.7% started treatment on time
- Sydney Children’s Hospital, Randwick: 9412, down 2.9%; 64.4% started treatment on time
- Lismore Base Hospital: 9348, up 1.7%; 51.3% started treatment on time
- Manning Hospital: 9288, up 3.3%; 49% started treatment on time
- Shellharbour Hospital: 9230, down 0.8%; 68.9% started treatment on time
- Auburn Hospital: 8526, up 3%; 69.9% started treatment on time
- Orange Health Services: 7785, down 1.7%; 65.6% started treatment on time
- Hawkesbury District Hospital: 7693, up 8.8%; 53.3% started treatment on time
- Sydney Hospital and Sydney Eye Hospital: 7619, up 3.3%; 75.3% started treatment on time
- Belmont Hospital: 7192, up 1.5%; 71.5% started treatment on time
- Ryde Hospital: 7022, up 0.4%; 67.5% started treatment on time
- Queanbeyan Hospital and Health Service: 6715, up 3.8%; 81.2% started treatment on time
- Grafton Base Hospital: 6633, up 5.8%; 56.3% started treatment on time
- Kempsey District Hospital: 6545, up 1.2%; 72.7% started treatment on time
- Bathurst Health Service: 6148, down 4.4%; 73.8% started treatment on time
- Bowral and District Hospital: 5908, up 1.5%; 87.3% started treatment on time
- South East Regional Hospital: 5660, up 7.6%; 68.9% started treatment on time
- Goulburn Base Hospital: 5752, up 3.2%; 65.7% started treatment on time
- Griffith Base Hospital: 5392, down 5.1%: 63.4% started treatment on time
- Armidale Hospital: 5381, up 9.5%; 52.2% started treatment on time
- Broken Hill Health Service: 5355, up 5.3%; 70.5% started treatment on time
- Byron Central Hospital: 5180, up 2.1%; 85% started treatment on time
- Blue Mountains District Anzac Memorial Hospital: 4852, up 1.5%; 72% started treatment on time
- Murwillumbah District Hospital: 4768, up 5.6%; 80.7% started treatment on time
- Ballina District Hospital: 4469, up 8.5%; 62.1% started treatment on time
- Mudgee Health Service: 4418, up 8%: 73.8% started treatment on time
- Singleton Hospital: 4342, up 4.6%; 71.3% started treatment on time
- Cessnock Hospital: 3936, up 0.9%; 76% started treatment on time
- Milton Ulladulla Hospital: 3899, up 6.7%; 65.3% started treatment on time
- Maclean District Hospital: 3793, up 5.9%; 75.5% started treatment on time
- Casino and District Memorial Hospital: 3444, up 7.3%; 59.8% started treatment on time
- Macksville District Hospital: 3303, up 5%; 80.2% started treatment on time
- Lithgow Hospital: 3160, up 2.3%; 80.1% started treatment on time
- Cooma Hospital and Health Service: 3124, down 8.7%; 90.5% started treatment on time
- Moruya Hospital: 2849, down 7.6%; 77.2% started treatment on time
- Bateman’s Bay District Hospital: 2839, down 15.8%; 84.4% started treatment on time
- Muswellbrook Hospital: 2556, up 1.3%; 72.3% started treatment on time
- Inverell Hospital: 2546, up 5.46%; 79.6% started treatment on time
- Deniliquin Health Service: 2467, up 11.1%; 96.3% started treatment on time
- Moree Hospital: 2411, down 8.2%; 82.4% started treatment on time
- Young Health Service: 2397, up 3.9%; 76.3% started treatment on time
- Cowra Health Service: 2200, up 6%; 88.6% started treatment on time
- Lachlan Health Service – Forbes: 2028, down 3.9%; 88.8% started treatment on time
- Gunnedah Hospital: 1929, up 14.1%; 79.8% started treatment on time
- Narrabri Hospital: 1766, up 9.8%; 88.7% started treatment on time
- Kurri Kurri Hospital: 643, down 16.2%; 96.9% started treatment on time
The release of the BHI’s quarterly report coincided with its release of the latest Emergency Department Patient Survey results, reflecting the experiences of more than 21,000 people who attended one of 77 large NSW EDs from July 2023 to June 2024.
BHI chief executive Dr Diane Watson said the majority of patients were positive about their ED care in 2023–24, with almost nine in 10 (88%) reporting that overall, their care was ‘very good’ (62%) or ‘good’ (26%).
“Despite very busy EDs in 2023–24, patients’ ratings for most survey questions improved or remained stable from the previous year,” Dr Watson said.
For this report, BHI’s analyses found that patients whose treatment started on time, spent fewer hours in the ED or required more urgent care, were more likely to rate their overall care in the ED as ‘very good’.
It also found that, regardless of the timeliness or urgency of their care, patients were 11 times more likely to rate their overall care as ‘very good’ if they said the ED health professionals ‘definitely’ did everything they could to help manage their pain.
They were eight times more likely to report a ‘very good’ overall experience if they said the way ED health professionals worked well together was ‘very good’.
Being treated with kindness and care and being ‘very well organised’ were also strong drivers of ‘very good’ overall experiences.
“These findings show health services the key areas where improvements can make the biggest difference for patients’ overall ratings of care,” Dr Watson said.
The report also includes special insights into patients’ reasons for visiting the ED. More than one-quarter of patients who visited EDs in May and June 2024 thought their condition could have been treated by a GP or other health professional either ‘definitely’ (12%) or ‘to some extent’ (16%).
Of those patients, 38% said they went to the ED because the GP/health professional service was closed and 23% said they couldn’t get an appointment within a reasonable time.
Read the survey report in full here.