Tasmania's health system is failing to meet the growing demand for emergency department care and is severely compromising patient safety, according to a scathing report handed down by the state's auditor-general.

Key points: The auditor-general's report found ambulance ramping had increased by 149 per cent in six years

The auditor-general's report found ambulance ramping had increased by 149 per cent in six years The Royal Hobart Hospital was bed blocked 93 per cent of the time

The Royal Hobart Hospital was bed blocked 93 per cent of the time The Launceston General Hospital was in an almost constant state of gridlock

The damning report looked into the effectiveness of the state's four biggest hospitals — the Royal Hobart Hospital, the Launceston General Hospital, the Mersey Hospital, and the North-West Regional Hospital — in delivery of emergency department (ED) services.

It also made 10 recommendations to improve emergency care.

Auditor-General Rod Whitehead's findings included:

Ambulance ramping across the four hospitals between 2012-13 and 2018-19 had increased by 149 per cent, despite only a 20-per-cent growth in ambulance presentations to EDs over the same period.

Ambulance ramping across the four hospitals between 2012-13 and 2018-19 had increased by 149 per cent, despite only a 20-per-cent growth in ambulance presentations to EDs over the same period. The duration of ambulance ramping increased with the offload delay exceeding the 15-minute target growing by 197 per cent, and exceeding 30 minutes by 239 per cent.

The duration of ambulance ramping increased with the offload delay exceeding the 15-minute target growing by 197 per cent, and exceeding 30 minutes by 239 per cent. The Royal Hobart Hospital was bed blocked for 93 per cent of the time between June 2018 and January 2019, with patient safety severely and routinely compromised almost once every four days on average.

The Royal Hobart Hospital was bed blocked for 93 per cent of the time between June 2018 and January 2019, with patient safety severely and routinely compromised almost once every four days on average. The Launceston General Hospital spent more than 70 per cent of the time over the same period at the highest possible level of escalation "and in a state of almost constant 'gridlock'".

The report also found patients were increasingly waiting longer in EDs for treatment, adding the Tasmanian Health Services performance targets had deteriorated over the last five years.

The rate of ED adverse events grew by 60 per cent between 2015 and 2018 with most incidents occurring at the RHH and LGH.

"These challenges increase the risks for patients and staff and are preventing the EDs of Tasmania's four major hospitals from operating efficiently and effectively," Mr Whitehead said.

Do you know more about this story? Contact tasindepth@abc.net.au

He said successive reviews over the last decade had highlighted dysfunctional silos, behaviours process barriers and resistance to change from some clinicians and administrators as major drivers of inefficiencies.

"The patient journey through Tasmania's four major EDs as a result has become more challenging over the last decade for both patients and ED staff," he said.

The report also found presentations to EDs was increasing faster than population growth, and attributed the trend to the state's older and sicker population as well as the low rate of bulk-billing doctors in the state.

Mr Whitehead said although the State Government had made some reforms to the health system in 2018, the changes were in the early stages of implementation and could not be reliably assessed.

Health system needs 'urgent' action

He called for urgent action to strengthen "whole-of-hospital and system-wide leadership, coordination and accountability for addressing the long-standing barriers to improve patient flow".

The auditor-general made 10 recommendations for the THS and Department of Health to improve emergency care, including an urgent review of the root causes of the growth in ED adverse events, implementing a culture improvement program and strengthening performance monitoring and reporting processes.

Health Minister Michael Ferguson said he would take time to consider the auditor-general's recommendations.

"I think the key point is that everybody in the Tasmanian community deserve and expect we will work together, and that is absolutely what we will continue to do by receiving expert advice," he said.

Mr Ferguson said next month's meeting between health officials, the state government and emergency doctors would identify measures to improve emergency care.

"It is not acceptable when patients are waiting too long for care, so we are budgeting for a bigger emergency department," he said.

Nurses claim four suicide attempts in emergency

The Australian Nursing and Midwifery Federation claimed there had been four attempted suicides at the RHH's emergency department in three months, the most recent being on Friday.

Union spokesman Andrew Brakey said delays in accessing emergency care and admission to wards outlined in the report were of particular risk for mental health patients.

"There are not enough resources in those departments to make sure those patients are well supported in that environment where they should not be anyway," he said.

In a statement, a spokesman for the Tasmanian Health Service said the assertions were incorrect.

"Any serious incident, such as a suicide attempt, is thoroughly investigated and any appropriate changes are implemented, as well as an immediate response put in place, such as additional staffing, to ensure patient safety."

In the state's north, Dr Scott Parkes from the Launceston Hospital Staff Association said the report confirmed what medical professionals in there had been saying for months.

"We need another ward with another 30 to 50 beds to cope," he said.