"I couldn't be prouder of our expert clinicians and hospital staff": Jillian Skinner. Credit:Janie Barrett "NSW cares for the largest caseload of patients in the country ... I couldn't be prouder of our expert clinicians and hospital staff and I thank them for the wonderful work they do to achieve these results," Ms Skinner said. But Australian Medical Association NSW president Brad Frankum warned the rising tide of presentations and surgery waiting lists was further straining an already stretched health system. "The tsunami of patients presenting at emergency departments and being admitted to hospital is one way the federal government's failures to invest properly in general practice manifests," Dr Frankum said. "The staff across the system are doing a wonderful job looking after people, but this squeezing of efficiency can't go on forever," he said.

Emergency departments 'bursting at the seams' Emergency departments had a huge increase in presentations, having over 7,000 more visits than the same period last year. Almost one in four patients (23.7 per cent) who presented to EDs weren't treated within the clinically appropriate timeframe and there were marked increases in the most serious triage cases. The number of patients who needed treatment within 10 minutes (triage 2) rose by 3000, a 4.2 per cent increase on the same period last year. People needing treatment within 30 minutes (triage 3) rose by 7800 (3.8 per cent), while the number of less serious presentations dropped by more than two per cent.

"Frankly, it worries me that we are seeing this marked increase in very sick people," Dr Frankum said. "The pressure to deal with sicker, more complex cases is a recipe for mistakes and problems," he said. Nepean Hospital, one of the busiest EDs in the state, fared considerably worse over the last quarter than any other hospital and had more than half of patients (51.8 per cent) waiting longer than four hours. "We are on track to improve our performance with 55 per cent of patients spending less than four hours in the ED during July 2016," a spokesperson for the Nepean Blue Mountains Local Health District said. Labor health spokesman Walt Secord said it was more evidence that Nepean Hospital was "bursting at the seams".

"Nepean Hospital is at breaking point and, with the expected increase in population, this means waits will get longer and longer in Sydney's west," Mr Secord said. Biggest ever rise in admissions The rise in the number of admissions from EDs was another telling sign that hospitals were treating sicker, more resource-intensive patients. About 8500 more patients were admitted compared with the same quarter in 2015, a 4.8 per cent jump. "It's the biggest increase the BHI has ever seen," said the chief executive of the Bureau of Health Information, Dr Jean-Frederic Levesque, whose organisation has been compiling the data for the past six years. "The reasons could be the ageing population, an increase in the prevalence of people with chronic diseases, but also potentially factors related to their access to primary care," Dr Levesque said.

The federal government's continued attack on primary care, including the GP rebate freeze and failure to appropriately fund the sector could be driving people to EDs in worse health, Dr Frankum said. "We know that better primary care will take more pressure off the hospital system," he said. Non-urgent surgeries take a back seat About 4000 more elective surgeries were performed over the 90-day period compared with the same 2015 quarter, as the sector tried to whittle down the state's waiting lists, the longest in the country. The number of people waiting longer than 365 days for surgery dropped from 596 in last year's equivalent quarter to just 158.

But as surgeons worked to treat the more serious cases on time, fewer non-urgent cases made it to the operating table. An additional 400 non-urgent patients waited more than a year for surgery compared with the same quarter last year. Nepean Hospital also recorded the worst elective surgery treatment times. Despite increasing the number of surgeries at the hospital by 14 per cent, fewer than 81 per cent were performed on time, leaving one in five patients waiting longer than clinically recommended for their operations. Just 71 per cent of non-urgent surgeries were performed on time. The spokesperson for NBMLHD said it had taken action to help meet the growing demand for services in the area. "These strategies have helped us to provide elective surgery for 6154 patients in 2015/2016. At the end of June 2016, Nepean Hospital had only one overdue patient."

The report found marked improvements in the times it took for paramedics to hand over patients to ED staff: a 6.1 per cent increase in the proportion of patients transferred within 30 minutes, taking the state average to 91.6 per cent. The Royal Prince Alfred Hospital was a star achiever, lifting its game by 25 percentage points to 94.5 per cent for transfers within 30 minutes.