A record number of triage level one and two presentations - people with the most pressing clinical needs - were logged in the state's hospitals in the final quarter of 2023, according to the Bureau of Health Information.
Almost 60 per cent of patients spent less than four hours in emergency departments, a slight improvement on the preceding quarter and the same period in 2022.
But one in 10 patients spent longer than 10 hours and 30 minutes in emergency, well above pre-pandemic levels.
Australian Medical Association NSW president Michael Bonning said the figures should be a wake-up call for the state government.
He called for the next NSW budget to include a substantial increase in funding for the health system.
"Our drastically overburdened health workforce cannot continue to perform under the current conditions," he said on Wednesday.
"Without an urgent injection of health dollars, it is patients who will suffer as they wait longer in the emergency department and are forced to endure longer stays in hospital."
Health Minister Ryan Park acknowledged the system was under pressure and said spending on frontline services was a priority for the government.
"We can't afford to have a system where people use our emergency departments as GP clinics, that's not what they're there for," he told ABC Radio.
"The reality is we can't deliver health care under one level of government, it's a cooperative system and we need both the state and Commonwealth to work together."
Of the 195,269 people treated and admitted in the period, 25.4 per cent spent less than four hours in an emergency department.
There was also a continued improvement in the time patients waited to start treatment, despite the record-high presentations.
Two in three patients started their treatment on time and almost 80 per cent of patients who arrived by ambulance had their care transferred to emergency department staff within 30 minutes.
The record triage one and two presentations - those with conditions classified as immediately life-threatening and that of an emergency - coincided with a moderate decline in triage four cases, with triage five remaining stable.
The decrease in non-urgent presentations was reflective of more patients seeking care options outside hospital and relieving pressure on emergency departments, a government spokesperson said.
An emergency department task force has been set up to cut wait times and improve care, while more than 1000 temporary nursing roles have been made permanent.
An extra 1200 nurses and midwives are also being recruited to lift staffing levels in the state's hospitals.
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