SEVEN of Australia's 10 worst-performing hospital emergency departments are in NSW, and the state has none of the top performers, the first National Health Performance Authority report into waiting times shows.
Doctors say failure to meet national targets risks lives and hits the sickest patients.
The report shows NSW hospitals have consistently failed to meet national targets (ensuring the majority of emergency patients are moved or discharged in four hours), meaning the state is likely to miss $15.9 million in federal funding.
The president of the NSW Australian Medical Association, Brian Owler, said the failure was not just inconvenient; it was putting patients at risk.
"The number of complications and problems people experience is related to how long they spend in the emergency department," he said. "They need to be moved to an appropriate bed and given appropriate care … no-one can argue that having patients wallowing in emergency is giving them the best care".
Cutting emergency department stays to four hours was linked to a 13 per cent fall in patient deaths in research published in the Medical Journal of Australia this year.
Associate professor Owler said the blockage was not just caused by a lack of resources for emergency departments, but was linked to bed and staff shortages throughout hospitals.
"Maybe the emergency departments are doing things more efficiently, but the rest of the hospital flow, which relies on improving capacity and design, is not," he said.
The new analysis released on Friday shows Westmead, Blacktown, Liverpool, Lismore, Hornsby Ku-ring-gai, Grafton and Mount Druitt hospitals were all listed in the bottom 10 per cent in the country.
At the worst-performing hospital, Liverpool, only 36 per cent of patients left the emergency department within four hours.
And at Blacktown Hospital 10 per cent of patients waited longer than 27 hours, the second-worst result in Australia.
The opposition health spokesman, Andrew McDonald, said the figures were awful.
"To me, the worst thing is each fraction of these figures represents a person who sought care in the NSW health system, who waited longer on average than at any time in the history of NSW, and longer than the rest of Australia," he said. "Sadly, there is no prospect of any change with the $3 billion budget cuts to come."
The president of the Australasian College for Emergency Medicine, Anthony Cross, said the report showed the sickest patients - those who needed to be admitted - were more likely to have inappropriately long stays in emergency, adding that the problem existed nationwide.
The Minister for Health, Jillian Skinner, said more recent data from October showed a dramatic improvement in some hospitals, including Liverpool.
Improvements to patient flow systems, new medical assessment units and home hospital services were being implemented at present.
"And the NSW government is investing heavily in infrastructure, to manage ever-increasing and future demand on the health system," she said. "At Blacktown Hospital, for instance, which is one of the worst-performing for time patients spend in emergency departments, we are investing $324 million.''