The hospitals where you’ll wait more than four hours in emergency

Emergency departments at four Sydney hospitals have recorded significant blow-outs in the proportion of patients waiting too long to be treated.

More than 60 per cent of patients who presented at Westmead Hospital’s emergency department were not treated within the clinically recommended timeframe in April to June this year, found the Bureau of Health Information’s latest quarterly report.

The results meant the majority of people who came through the hospital’s ED did not have their treatment start on time compared to just under 46 per cent over the same period in 2016.

NSW hospital emergency departments are recording rising numbers of presentations. Photo: Damian Shaw

The 14 percentage point drop in on-time treatment – the biggest decrease of any NSW hospital – was almost matched by Blacktown Hospital, where 53.8 per cent of ED patients did not start their treatment on time, down 13.6 percentage points on the same quarter last year.

The timeframes in which patients should start treatment depend on the seriousness of their condition and are recommended by the Australasian College of Emergency Medicine. As an example, 80 per cent of triage 1 emergency patients should start treatment within 10 minutes.

Roughly 47 per cent of patients at both Westmead and Blacktown hospitals had not left the EDs four hours after they had arrived, the report released on Tuesday found.

At Fairfield Hospital, just over 30 per cent of patients did not start treatment on time, a 13 per cent jump on the same quarter last year, and at Auburn Hospital’s emergency department roughly 30 per cent of patients waited longer than clinically recommended for their treatment to start, a 10.4 per cent rise on last year’s results.

Overall, almost one in four of NSW emergency department patients did not have their treatment start on time (24.4 per cent). Just over one in four spent more than four hours in an emergency department (26.9 per cent). The report confirmed the state’s hospitals were facing rising numbers of patients increasingly presenting with more serious and complex conditions.

NSW emergency departments recorded 641,423 presentations over the April to June quarter, up 4.6 per cent on the same quarter last year.

The number of patients triaged to the “emergency” and “urgent” categories had risen by 7.5 per cent and 5.2 per cent respectively (triage 1 patients requiring resuscitation dropped by 0.7 per cent), and just over 29 per cent of ED patients were admitted to hospital (up by 4.5 per cent).

Time from presentation to starting treatment targets

Triage 1: (Resuscitation) within two minutes

Triage 2: (Emergency) 80 per cent of patients within 10 minutes

Triage 3: (Urgent) 75 per cent of patients within 30 minutes

Triage 4: (Semi-urgent) 70 per cent of patients within 60 minutes

Triage 5: (Non-urgent) 70 per cent of patients within 120 minutes

But the influx in presentations alone did not explain the increases in wait times, BHI acting chief executive Dr Kim Sutherland said.

Westmead Hospital – which recorded the biggest decrease in the proportion of patients treated on time (14 percentage points) – recorded an increase in presentations of just 3.7 per cent, below the state average.

Emergency departments in other parts of the state who recorded staggering rises in presentations in the order of 15 per cent were still managing to maintain their treatment times.

“It’s up to the local hospitals to look into [and] work out what is going on and what is underpinning the timeliness of their responses,” Dr Sutherland said.

Nepean Hospital recorded significant improvements in wait times, despite a 3.7 percent increase in presentations.

The western Sydney hospital, which recently recorded some of the worst wait times in the state achieved a 4.1 percentage point rise in the proportion of patients treated on time (63.8 per cent) and a 4.1 percentage point jump for patients leaving the ED within the four-hour window, though still below half at 48.2 per cent.

Western Sydney Local Health District chief executive Danny O’Connor said Westmead, Blacktown and Auburn hospitals have experienced a steep rise in emergency department presentations in the past 12 months, with many patients presenting have also had more complex conditions needing more extensive treatment.

“Our hospitals have worked hard to manage the increasing influx of patients, focusing on handling waiting times without compromising patient care,” Mr O’Connor said in a statement.

Westmead Hospital had reallocated staff and resources and introduced a traffic “light system” in the ED that had lifted treatment times by 30 per cent since they were introduced in April 2017, the statement read.

Blacktown Hospital has changed the layout of its ED to maximise space, redesigned rosters for more efficient transport and bed-cleaning processes, expanded the ED’s short-stay admission zone, and have moved patients into the discharge lounge in the mornings to free up beds earlier in the day, he said.

“Western Sydney is the fastest growing region in and we are spending nearly a billion dollars in expanding Westmead, Blacktown and Mount Druitt hospitals to cater to demand,” Mr O’Connor said.

Fairfield Hospital general manager Arnold Tammekand said the $7 million redevelopment of Fairfield’s ED will start this month, “which will improve patient flow and treatment areas”.

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