Record numbers of patients are presenting to NSW emergency departments, the latest data reveals, as doctors and nurses scramble to treat the highest volumes of sicker patients the state's hospitals have seen.
A herculean effort by hospital staff has seen the state's overall performance measures remain stable in the face of ballooning patient numbers, at the expense of stressed and overworked healthcare practitioners, especially in Sydney's west, the NSW Australian Medical Association says.
NSW hospitals smashed through their previous records for the number of emergency department (ED) attendances, admissions to hospital and elective surgery procedures, the Bureau of Health Information reported on Wednesday.
Five years ago EDs were recording roughly 450,000 presentations every quarter. The total is now edging towards 700,000, with the latest report recording 684,740 patients presenting to an ED between October and December 2016, almost 20,000 more than the same quarter in 2015.
It is not just an increase in the sheer volume of patients coming through ED doors. ED staff are treating sicker patients, with an increase in the numbers of patients classified as "emergency" and "urgent" cases.
Hospitals recorded a 6.5 per cent increase in patients in the most critical triage category (patients with immediately life-threatening conditions including cardiac or respiratory arrest), a 4.4 per cent increase in "emergency" category patients and a rise above 6 per cent in "urgent" patients compared with the same quarter last year, BHI chief executive Jean-Frederic Levesque said.
More ED patients were being admitted to hospital, up 7.3 per cent on the same 2015 quarter, and the state recorded a 2.6 per cent rise in patients brought by ambulance.
"This tells us we are seeing sicker, more acute patients coming into EDs," Dr Levesque said.
The rise in more serious cases took its toll, with fewer "emergency" and "urgent" patients starting treatment on time.
One-third of triage 2 patients (considered to have imminently life-threatening conditions) waited longer than the recommended 10 minutes for their treatment to start, and roughly 30 per cent of triage 3 patients with potentially life-threatening conditions did not have their treatment start on time (within 30 minutes).
Putting the results into perspective, Dr Levesque referred to the Australian College of Emergency Medicine, which acknowledged that not all patients could be seen within the recommended time frame. For instance, the college recommended a target of 80 per cent of triage 2 patients should be seen within 10 minutes.
The system was carving out improvements in the midst of the barrage. Overall, 92 per cent of patients who arrived by ambulance were transferred to hospital staff within 30 minutes - the highest result since the BHI started releasing its report - and more than 74 per cent of patients were able to leave the ED within four hours, though this was still below the over 80 per cent target.
Liverpool Hospital was among the most improved, with a 12.5 percentage point jump for patients treated on time, lifting the western Sydney hospital above the state average. Concord Hospital recorded an almost 10 percentage point improvement.
But the onslaught of patient numbers battered several western Sydney EDs, with Blacktown, Westmead and Bankstown hospitals all recording poorer performances in ED treatment times compared with their results previous year.
Blacktown Hospital was deluged over the quarter, with 7.3 per cent more patients, and it admitted 25 per cent more ED patients compared with the same period in 2015. The rising patient load affected performance, with 44 per cent of patients not starting treatment on time, an almost 10 per cent drop compared with the 2015 quarter.
Westmead Hospital ED - which recorded a 4 per cent increase in presentations - had the worst result in terms of time to treat, with 58 per cent starting treatment outside the recommended time frames, a 12.2 percentage point rise.
Only one-third of category 2 "emergency" patients started treatment within the recommended 10-minute time frame.
Bankstown Hospital, which had previously sailed above the state average, recorded a 9.7 per cent drop in the proportion of ED patients starting treatment on time, falling to 71 per cent.
Western Sydney surgeon and chairman of the hospital practice committee for AMA NSW Fred Betros said staff were being "pushed to the absolute limit".
He said overcrowded EDs meant patients with serious abdominal pain were left in chairs for up to 24 hours after they were admitted as they waited for surgery.
"At the coalface there is no doubt the system is literally holding back the tidal wave of patients flowing in. If we don't change something dramatically we will be sacrificing quality," he said.
Health minister Brad Hazzard said it was clearly "boom time for hospitals".
"To have almost 75 per cent of patients being in EDs four hours or less is a reflection of the incredible efforts of staff throughout the hospital system," Mr Hazzard said.
"We have front-line staff who are working under big time pressure and yet they keep effectively reinventing how they look after patients in a timely and professional manner."
AMA NSW president Brad Frankum warned the situation was "a pressure cooker set to blow", and the record breaking exposed a failure to address the state's healthcare needs.
"The system is at breaking point and patients, doctors, nurses and healthcare workers are suffering," Professor Frankum said.
He called on all levels of government to address chronic underfunding and invest in general practice to keep patients out of the state's hospitals.
Labor health spokesman Walt Secord said the state hospital system lurched from crisis to crisis under the Liberals and Nationals.
"Sadly, patients wait at every stage in NSW. They wait for an ambulance; they wait outside the emergency department and they wait inside the emergency department. They wait for a bed and then they are discharged early to make room for other patients," Mr Secord said.
The state hit a new record for the number of elective surgeries performed, up almost 1500 on the same 2015 quarter.
"Overall, 97.6 per cent of patients who received elective surgery this quarter did so on time, which is the highest result reported in an October to December quarter for the past five years," Dr Levesque said.
The greatest improvement was among non-urgent surgeries, with 96.3 per cent performed on time, up 1.5 per cent on the same quarter the previous year.