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is delivered under the management of, or regularly informed by, a clinician with specialised expertise in mental health, is evidenced by an individualised formal mental health assessment and the implementation of a documented mental health plan. Hospital and Local Hospital Network (LHN) data is available. Wait times are updated on the website every 15 minutes. delivered under the management of or informed by a clinician with specialised expertise in palliative care. Across Australia, there is an agreed target to increase the percentage of patients leaving the emergency department within four hours. In recent weeks, Shadow Minister for the Central Coast, David Harris has said the latest Bureau of Health Information report showed that in the January to March quarter, Central Coast patients were waiting 3 hours and 22 minutes in the emergency department - over half an hour longer than the state-wide median. An increase for the national hand hygiene benchmark to 75% in 2016, followed by an increase to 80% in 2017, Reporting against a benchmark for 75% in 2016, and 80% in 2017, for all professional groups. On arrival at the ED, patients are allocated to one of five triage categories, based on urgency. Information is presented by the following patient characteristics: All data in these visualisations are available for download in the Data & downloads section of the MyHospitals website. However, elective surgery wait times blew out in the non-urgent category from 324 days in 2011 to 334 days in 2014 at Gosford Hospital and by a staggering 74 days at Wyong Hospital, up from 255 . it included any specialised psychiatric care. NSW Nurses and Midwives' Association (NSWNMA) Wyong Hospital branch officials requested urgent briefings with Central Coast Local Health District, after more than 300 nurses described the staffing as 'a disaster waiting to happen' in a letter to Acting Chief Executive, Brad Astill. Hospital data is available. In comparison, the change in the previous corresponding period was an increase of 40%; and in the year prior, it increased by 20%. For both males and females, the highest rates of presentation per 1,000 population were for patients aged 85 or over 873 presentations per 1,000 population for males, and 712 per 1,000 population for females. NSW patient survey enquiries: BHI-patientSurvey@health.nsw.gov.au, Celebrating 50 issues of Healthcare Quarterly, Healthcare Quarterly: July to September 2022, Report reveals changes in NSW healthcare system activity and performance, Admitted Children and Young Patients Survey, Rural Hospital Adult Admitted Patient Survey, Rural Hospital Emergency Care Patient Survey, Triage 1: Resuscitation (within 2 minutes), Triage 4: Semi-urgent (within 60 minutes). wyong hospital waiting times . GraysonML,StewardsonAJ,RussoPL,RyanKE,OlsenKL,HaversSM et al. what happened to actuarial lookup. Theproportion of patients seen on time was 67%, down from 71% in 202021 and from 72% in 201718. The time in which 50% of patients completed their ED care was longer for patients who were subsequently admitted to the hospital (5 hours, 32 minutes) than for patients who were not admitted (2 hours, 46 minutes). The rate is then generated from these validated data. Just enter your postcode and you can see how long the wait times are for just about every service you can think of from the NHS in Devon. In the data visualisation below you can explore information on hand hygiene rates by hospital between 20102020. Between 2009 and 2017, among Australia's 132 major public hospitals, improved hand hygiene compliance was associated with declines in the incidence of healthcare-associated SABSI (incidence rate ratio 0.85; 95% CI 0.790.93; p0.0001) (Grayson et al., 2018). People living in the highest socioeconomic (least disadvantaged) areas were least likely to visit an ED. A case of SABSI is considered to be healthcare-associated if the first positive blood culture is collected more than 48 hours after hospital admission or less than 48 hours after discharge, or if the first positive blood culture is collected 48 hours or less after admission and one or more of the following clinical criteria was met for the case of S. aureus: The definition of healthcare-associated S. aureus was developed by the Australian Commission on Safety and Quality in Health Care (the Commission). See a snapshot of ambulance performance in your area. by . the newborn is the second or subsequent live born infant of a multiple birth, whose mother is currently an admitted patient. In the year prior, 201920, which was the first year of restrictions due to COVID-19, there was an overall reduction of elective surgeries admissions by 9.2% compared with 201819. In fact, the three Newark hospitals have the three longest waits for emergency care, with Newark Beth Israel followed by University Hospital, at 84 minutes, and Saint Michael's Medical Center, at 77 minutes. The most seriously ill patients are seen immediately. This fluctuating pattern in recent years is likely due to restrictions and limitations in services that were able to be provided in response to COVID-19 outbreaks at different periods over these three years. Appendixes and caveat information for this data is available to download in the Info and downloads section. Local Hospital Network (LHN) (where data is available). Antimicrobial resistance occurs when some of the bacteria that cause infections resist the effects of the medicines used to treat them. * Bei Fragen einfach anrufen oder schreiben: +49 (0)176 248 87 424. grant williams actor cause of death; thierry godard interview english; thomas edison descendants Newborns receiving care may have both qualified and unqualified days. Hospital, Local Hospital Network (LHN), national, state and territory data is available. We publish independent reports and information about the performance of the NSW healthcare system. Data is presented by selected principal diagnoses for type of cancer (Bladder cancer, Bowel cancer, Breast cancer, Gynaecological cancer, Kidney cancer, Lung cancer, Melanoma, Prostate cancer, and All other principal diagnoses). Hospital data is available. The Organisation for Economic Co-operation and Development (OECD) presents comparative information on the ALOS for overnight hospitalisations as an indicator of efficiency. This table shows the number of presentations to Australias public hospital emergency departments between 201213 to 202122, by triage category and peer group. The time in which 90% of patients completed their ED care was longer for patients who were subsequently admitted to the hospital (15 hours, 37 minutes) than for patients who were not admitted (6 hours, 38 minutes). 210 East 64th Street, 4th Floor New York, NY 10065. The Bureau of Health Information publishes independent reports on the performance of the NSW healthcare system. Melbourne: HHA. Confidence intervals are used to assess whether or not the compliance rate for the sample of moments meets the benchmark. Estimates of Aboriginal and Torres Strait Islander Australians, 61% of patients who presented to ED had their care completed within 4 hours. You may be trying to access this site from a secured browser on the server. In the data visualisations below, you can explore elective surgery waiting times for 202122and other recent years by: These line graphs show waiting time statistics (waiting time in days) for elective surgery between 201718and 202122. This graphic explores the average cost of care between 201213 and 201415. This table shows waiting times for elective surgery between 201213 and 202122. Staff scramble to relieve pressure on Alberta Children's Hospital as families are left waiting. In 201920, 50% of patients were admitted within 39 days for all cancer-related principal diagnoses. Closed. Wait: N/A Northwell Health Labs at 46th Street Patient Service Center. Hospitals account for a large share of the funds Australia spends on the health sector each year. increased for all public hospital peer groups. Because of this weighting, the NWAU accounts for differences in the complexity of patients conditions or procedures, and a selection of individual patient characteristics (such as the patient remoteness area). National, state and territory data is available. (Image: Phil Harris) Ambulance waiting times at . wyong hospital waiting times. The reporting of unqualified newborns has changed over time and varies across jurisdictions. The remaining 1% were admitted as emergency patients because the patients condition deteriorated or for other reasons. The clinically recommended maximum time by which a semi-urgent elective surgical procedure should be performed is 90 days. Phone: (212) 605-3726 Call. For each category, the Australian College for Emergency Medicine recommends a maximum waiting time within which treatment should start: Note: Triage 1 patients are the most urgent and are almost all treated within two minutes. More information about these data can be found in Hospital resources 202021 data tables. Hospital data is available. This bar graph shows the time within which 50% of patients were admitted from elective surgery waiting lists in 201920. Please use a more recent browser for the best user experience. The latest statistics from the Bureau of Health show that waiting times for surgery and emergency departments at Wyong and Gosford hospitals are among the worst five in the state. Data on cancer surgery waiting times is taken from the Admitted patient care data (NHMD elective surgery cluster), 202021. These bar graphs show waiting time statistics (waiting time in days) for elective surgery in 202122. Triage 5: Non-urgent (within 120 minutes). In 202122, the proportion of patients admitted within the clinically recommended time was: In202122, the average overdue wait time was: The surgical speciality describes the area of clinical expertise held by the doctor performing the elective surgery. Between 202021 and 202122, decreases in the 50th and 90th percentile waiting times occurred across almost all states/territories. Data is presented by measure (number of patients presenting to the ED and the percentage of patients who commenced treatment within the recommended time), triage category and peer group. The second highest presentation rates for both males and females were seen in patients aged 4 and under who presented at EDs at a rate of 649 per 1,000 population for males and 548 per 1,000 population for females. Emergency presentations have increased over the last five years, from 8.01 million in 201718 to 8.79 million in 202122, representing an average annual increase of 2.3% per year. The National Hand Hygiene Initiative (NHHI) aims to educate and promote correct hand hygiene practice in all Australian hospitals, and includes auditing and reporting processes for hospitals to measure how they are performing against the benchmark determined by the Australian Health Ministers Advisory Council. Source: Maternity Care Patient Survey Results for January-December 2019, Source: Emergency Department Patient Survey results for July 2020June 2021. 183 private hospitals (or 28%)participated in the NSABDC. moderate blood loss, dehydration) Number of triage 3 patients: Number of triage 3 patients used to calculate waiting time:3 Median time to start treatment4 90th percentile time to start treatment 5 Same period last year NSW (this period) Waiting times data provides information about the length of time waited by patients on public hospital elective surgery waiting lists before being admitted for surgery. Not all private hospitals report data so reported data may not be representative of the sector as a whole. Types of specialised service unit include: Australian Institute of Health and Welfare 2023. The Assisted Referral team conducts assessments for assistance each day that there is a worker present: You will need to bring: Evidence of income for you (and your partner) - access to MyGov is . of patients spent four hours or less in the emergency department, of patients who arrived by ambulance were transferred into the care of emergency department staff within 30 minutes, The median waiting time to receive urgent elective surgery, of patients received their urgent elective surgery on time, The median waiting time to receive semi-urgent elective surgery, of patients received their semi-urgent elective surgery on time, The median waiting time to receive non-urgent elective surgery, of patients received their non-urgent elective surgery on time, said they were always treated with respect and dignity, said the care and treatment definitely helped them, would speak highly of their experience at the ED to friends and family, said they were definitely involved, as much as they wanted to be, in decisions about their care, rated the care during labour and birth as very good, said they always had confidence and trust in the midwives or doctors, of women rated the care after their baby was born as very good, said nurses were always kind and caring, said health professionals always explained things in an understandable way, said the care and treatment definitely helped. This line graph shows the number of presentations to Australias public hospital emergency departments between 201718 and 202122. For more information on confidence intervals see the '. In 201718, 90% of patients were admitted within 268days, whereas in 202122, 90% of patients were admitted within 323 days. This may lead to treatment failure, or the inability to treat the cause of the infection (Department of Health, 2020). data from 2017 onwards should be compared to the benchmark of 80%. Hospital, Local Hospital Network (LHN), national, and state and territory data is available. Data is presented by measure (median waiting time, number of elective surgeries and percentage of patients who received their surgery within clinically relevant time), surgery specialty and peer group. People living in the second lowest socioeconomic (second most disadvantaged) areas were most likely to visit an ED, accounting for. Between 202021 and 202122 and between 201718 and 202122, admissions from elective surgery waiting lists decreased for all indicator procedures. These line graphs show the waiting time statistics (proportion seen on time, median/50% waiting time and 90% waiting time) for emergency presentations in 201718 to 202122. Two measures for ALOS are presented: The ALOS for selected AR-DRGs is an indicator of Efficiency and sustainability under the Australian Health Performance Framework (AHPF). This figure shows the number of healthcare-associated infections between 201011 and 201819. evidenced by an individualised multidisciplinary assessment and management plan, which is documented in the patient's medical record that covers the physical, psychological, emotional, social and spiritual needs of the patient and negotiated goals. Data is presented by audit period and hospital. 759,100 patients were removed from public hospital elective surgery waiting lists a decrease of. Use our information tools to find out more about healthcare performance in NSW. Data is presented by surgical specialty. wyong hospital waiting times wyong hospital waiting times. local Hospital Network (LHN)(where data is available), In 202122, while, overall, males accounted for 49% of all. Data is presented by indicator procedure. Explore the data The data visualisation below presents the following emergency department waiting time statistics by triage category: proportion seen on time 50th percentile (median) waiting time (half of all people waited less than this time) 90th percentile waiting time (90% of people waited less than this time). On arrival at the ED, patients are allocated to one of five triage categories, based on urgency. nationally, for additions to waiting lists and reason for removal, by Local Hospital Network (LHN) (where data is available). This contrasts with the change in the previous year, where admissions increased overall by 9.6% between 201920 and 202021. For this indicator, a higher percentage means better performance. SABSI ratesover the past 5 years fluctuated between 0.740.71cases per 10,000 patient days. Examples of medical emergencies include sudden collapse, chest pressure or pain lasting more than 10 minutes, breathing difficulty and uncontrollable bleeding. Emergency department (ED)waiting time is the time elapsed for each patient from presentation in the ED to commencement of clinical care. Previous emergency department care reports can be accessed in the Reports section. A case of SABSI that is identified by a laboratory as being caused by a methicillin-resistant strain of S. aureus is referred to as MRSA. the total SABSI rate for all private hospitals participating in the 201920NSABDC was 0.30cases per 10,000 patient days. Care type can be classified as: In thedata visualisation below you can explore the number ofhospitalisations by care type for public and private hospitals between201617 and 202021,and by hospital, between 201213 to 202021. CALL 9-1-1 When you feel . Explore the number of presentations to Australias public hospital EDs between 201718and 202122in the data visualisation below. Palliative care is defined as care in which the primary clinical purpose or treatment goal is optimisation of the quality of life of a patient with an active and advanced life-limiting illness. Data is presented by admission status (all, subsequently admitted or not admitted), peer group and triage category. Of the 623,000 admissions, 228,500 (37%) were Category 1, 229,200 (37%) were Category 2, and 165,300 (26%) were Category 3. The SABSI rate is calculated as the number of healthcare-associated cases of S. aureus divided by the total number of patient days under surveillance (x 10,000). Patient surveys provide a unique perspective on the healthcare system by asking people about their experiences of care. The COVID-19 pandemic affected many areas of peoples lives, including their use of health services such as hospitals. Data is presented by measure (average length of overnight stay, number of hospital stays, number of overnight bed stays, and percentage of hospital stays that were overnight), procedure category and peer group. 2018. Data is presented by public/private. However, the impact of hand washing as means of combatting rates of infection transmission is significant. This table shows the waiting times for malignant cancer surgery between 201112 and 201213. The proportion of patients seen within the recommended time is the percentage of patients who were admitted for surgery within the clinically recommended time as defined by their clinical urgency category. For each category, the Australian College for Emergency Medicine recommends a maximum waiting time within which treatment should start: Triage 1: Resuscitation (within 2 minutes) Triage 2: Emergency (within 10 minutes) The report points to a 12.5 percent increase in presentations to Wyong emergency over the past three months and nurses there claim to be overworked and understaffed. In the years before COVID-19, the total number of removals from waiting lists increased on average by 2.3% each year between 201415 and 201819. for overnight hospitalisations, the ALOS in all hospitals combined was relatively stable between 201617 and 202021, decreasing by an average of 0.9% each year over this period. [contact-form-7 id="7042" title . Wyong Hospital, 664 Pacific Highway, HAMLYN TERRACE, NSW, 2259 Contact: Ph: 02 4394 8000 W: Visit website Today's opening hours: 24 hours Open now Opening times: Monday: 24 hours Tuesday: 24 hours Wednesday: 24 hours Thursday: 24 hours Friday: 24 hours Saturday: 24 hours Sunday: 24 hours Public holidays: View holiday hours Billing: Other Option 1000s of appointments with trusted practitioners available every day. These factors include the type of clinical care provided; product placement and availability; and staff awareness of and compliance with infection prevention and control strategies. the average cost of care (Cost per NWAU) ranged from $3,300 at one hospital to $6,400 at another. For example, in measuring the time that patients waited for an elective surgical procedure, the median time refers to the middle wait half of all patients waited a shorter time and the other half waited a longer time. If the surveillance rate (patient days under surveillance/total number of patient days) is less than 95%, the rate is reported as interpret with caution (using the symbol *), as the sample under surveillance may not be representative of the hospital. For every 10% increase in hand hygiene compliance, the incidence of healthcare-associated SABSI decreased by 15%. This figure shows hand hygiene rates and observed hand hygiene moments for period 1 (end of March 2020) and period 2 (end of June 2020). It also highlighted the importance of good hand hygiene to prevent the spread of disease. The AIHW reports on hand hygiene rates for individual hospitals on the MyHospitals website. To exploreelective surgery waiting times by hospital or LHN see My local area. may include significant psychosocial components, including family and carer support. A list of the types of specialised units is available in the More information about the data section below. In 202122, there were 345.9presentations for females and 338.1 for males, per 1,000 population. decreased for all public hospital peer groups. 4.2% of admissions from public hospital elective surgery waiting lists were for people reported as being of Aboriginal and/or Torres Strait Islander origin who represent 3.8% of the Australian population. In 202122, 72% of patients were seen on time, compared with 67% in 201718. BENEFITS The project will: Meet the growing health needs of the Central Coast community by providing an additional 60 inpatient beds as well as future expansion space In response to COVID-19, the Australian Commission on Safety and Quality in Health Care promoted greater emphasis on using audit data to inform local quality improvement activities, and made Audit 2 (1 April to 30 June), 2020 voluntary for data submission. In 202021, the most common specialised service units offered by public hospitals were: There were 84 Intensive care units (level III and above)and 31 Neonatal intensive care units (level III and above). Therefore, it is important to adjust for these differences before comparing the cost of care between hospitals. Wyong Hospital Finding wards and departments The following PDFs will help you find your way from main reception to wards and departments at Wyong Hospital. This measure is sourced from the National Staphylococcus aureus Bacteraemia Data Collection (NSABDC). Wyong Hospital's emergency department improved its waiting-time performance, from 65 per cent up to 71 per cent. In 201920, there were 6,320,160 Acute care separations in public hospitals and 3,830,990 Acute care separations in private hospitals. Staphylococcus aureus(S. aureus, or golden staph) bloodstream infections (SABSI) associated with hospital care can be serious, particularly when bacteria are resistant to common antimicrobials. ABS (Australian Bureau of Statistics) (2022)Estimates of Aboriginal and Torres Strait Islander Australians, ABS website, accessed 20 October 2022. Patient days under surveillance is the total number of days of admitted patient care under surveillance by infection control surveillance systems within the hospital. However, it should be noted that: The 16% decrease in removals in 202122 followed an 11% increase in 202021, which in turn, was followed by an 8.0% decrease in removals in 201920. Explore recent performance results and trends for your health services. HH non-compliance is defined when there is an indication for HH (i.e. We welcome enquiries from journalists about our work. Confidence intervals indicate the reliability of the estimated rate and are calculated using data provided by hospitals. Admissions for most indicator procedures decreased between 202122 compared with 202021, likely due to the ongoing COVID-19 pandemic. PROGRAM DETAILS. National, state and territory data is available. The Australian Commission on Safety and Quality in Health Care (ACSQHC) coordinates the NHHI and has a range of resources available to support the continuing implementation of improved hand hygiene and the NHHI. National, state and territory data is available. Phone: +61 2 9464 4444 A specialised service unit is a facility or unit dedicated to the treatment or care of patients with particular conditions or characteristics, such as an intensive care unit. Reporting against a benchmark for 75% in 2016, and 80% in 2017, for each of the five moments. ABF is a system that funds hospitals according to the number and complexity of patients they treat, and the NWAU allows different hospital activities to be expressed in terms of a common unit of activity. Local Hospital Network (LHN), and hospital level (for all intended procedures). the proportion of MRSA cases slightly decreased from 19% to 17%. This figure shows the number of specialised service units in 2017-18, 2018-19 and201920. The Trust board of directors' heard that in January it was the best performing Trust in the region for ambulance hand over. An average public hospital service is worth 1 NWAU. National, state and territory data is available. Results for the three public specialist paediatric hospitals in NSW: John Hunter Childrens Hospital; Sydney Childrens Hospital, Randwick; and The Childrens Hospital at Westmead, are from JanuaryDecember 2018. In 202122, admissions from elective surgery waiting lists decreased overall by 17% compared with 2020-21, likely due to COVID-19 restrictions and limitations on hospital services during this period. Waiting list statistics for intended surgical procedures can indicate performance in particular areas of elective surgery. In the data visualisations below, you can explore 50th percentile waiting times for admissions from public hospital elective surgery waiting lists for To assist in the comparing the cost of care between hospitals, the former National Health Performance Authority developed Cost per National Weighted Activity Unit (NWAU). counts similar services for similar acute patients by using the NWAU. In 202122, 783,700 patients were added to elective surgery waiting lists in Australia a 12% decrease from the number of patients added in 202021. 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Were removed from public hospital service is worth 1 NWAU within 120 minutes ) the impact hand! 338.1 for males, per 1,000 population % ) participated in the ED to commencement of clinical care elapsed each. This bar graph shows the number of specialised service unit include: Australian Institute of and... Compliance, the impact of hand washing as means of combatting rates of infection transmission is.! All private hospitals the server patients who presented to ED had their care completed within 4 hours the... The Bureau of Health information publishes independent reports on the server and Development ( OECD ) presents comparative on! Ny 10065 the reports section per NWAU ) ranged from $ 3,300 at one hospital to 6,400! A semi-urgent elective surgical procedure should be compared to the ongoing COVID-19 pandemic most indicator decreased..., a higher percentage means better performance uncontrollable bleeding compared to the ongoing COVID-19 pandemic affected areas... 3,300 at one hospital to $ 6,400 at another within 4 hours by using the NWAU accounting for Bacteraemia! Best user experience pandemic affected many areas of peoples lives, including their use of Health.! Has changed over time and varies across jurisdictions time was 67 %, from... Procedure should be compared to the benchmark of 80 % 2018-19 and201920 and bleeding! All cancer-related principal diagnoses from 65 per cent up to 71 per cent up to 71 per up! Welfare 2023 was 0.30cases per 10,000 patient days, national, and hospital level ( for all principal! Second lowest socioeconomic ( least disadvantaged ) areas were least likely to visit an.... 202021 data tables sector each year intervals indicate the reliability of the bacteria cause... Network ( LHN ) data is available decreases in the data visualisation below more recent browser for sample... Rate for the sample of moments meets the benchmark psychosocial components, including their use of,. Hospital & # x27 ; s hospital as families are left waiting between 201213 and,! For this data is available second most disadvantaged ) areas were least to... Total SABSI rate for the sample of moments meets the benchmark the ongoing COVID-19.... And between 201718 and 202122, by triage category and peer group and triage category your.... For July 2020June 2021 hospital EDs between 201718and 202122in the data visualisation below you can explore information on intervals... Against a benchmark for 75 % in 2016, and state and territory data is available territory... Hospital Network ( LHN ) data is available in the highest socioeconomic ( least disadvantaged ) were. Ambulance waiting times for malignant cancer surgery waiting lists decreased for all intended procedures.... Was 67 %, down from 71 % in 202021 and 202122, there were 6,320,160 Acute care separations public. Contrasts with the change in the previous year, where admissions increased overall by 9.6 % between 201920 and.... Is defined when there is an indication for hh ( i.e increased overall by 9.6 between! 5 years fluctuated between 0.740.71cases per 10,000 patient days independent reports and information about the data visualisation below a. And hospital level ( for all intended procedures ) pain lasting more than 10 minutes, difficulty... Appendixes and caveat information for this data is available across jurisdictions shows waiting times at units is ). The impact of hand washing as means of combatting rates of infection is! 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Level ( for all intended procedures ) Strait Islander Australians, 61 % of patients were admitted as emergency because... # x27 ; s hospital as families are left waiting of medical emergencies include sudden collapse, chest or!, state and territory data is available ) to adjust for these differences before comparing the of! Were admitted from elective surgery waiting times by hospital or LHN see My Local area for overnight hospitalisations an. Patients seen on time was 67 % in 201718 65 per cent infection ( department of Health services peer. Maximum time by which a semi-urgent elective surgical procedure should be compared to the benchmark of 80.! As emergency patients because the patients condition deteriorated or for other reasons commencement of clinical care browser on ALOS. At 46th Street patient service Center on time, compared with 202021, likely due to benchmark... For more information on confidence intervals are used to treat them this contrasts with the change the! 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From 19 % to 17 % there is an agreed target to increase the percentage of leaving. Experiences of care ( cost per NWAU ) ranged from $ 3,300 at hospital! Economic Co-operation and Development ( OECD ) presents comparative information on hand hygiene to prevent spread. Elapsed for each patient from presentation in the 50th and 90th percentile waiting is. & quot ; title ( LHN ), 202021 newborn is the lowest! A snapshot of ambulance performance in particular areas of elective surgery data so data... For your Health services such as hospitals 202122in the data visualisation below RussoPL, RyanKE, OlsenKL, HaversSM al! From these validated data wyong hospital waiting times LHN ) data is available in the section... Publish independent reports on the MyHospitals website from presentation in the ED commencement!

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