More than 100,000 patients are waiting to undergo procedures in NSW hospitals, approaching levels during the COVID-19 pandemic when elective surgeries were suspended.
The latest quarterly performance report from the state's Bureau of Health Information also showed record demand for ambulances.
Health Minister Ryan Park said NSW has some of the busiest emergency departments in the nation and had improved the transfer of patients from paramedics to hospital staff, at a time of increased demand for both ambulances and on hospitals.
It showed "encouraging progress" in the government's effort to reduce ambulance ramping - where paramedics are forced to wait to offload patients outside overcrowded emergency departments, he said.
"But I don't want us to get ahead of ourselves, because there is still much more to do ... people who present to hospitals with non-life threatening conditions can still expect to wait long periods in the ED," Mr Park said.
There are signs people are starting to get the message, with a four per cent fall in the number of patients presenting to emergency departments being placed in the least-urgent triage category.
The 391,370 ambulance responses recorded between October and December was a 3.1 per cent increase over the same quarter in 2023, and the most since the bureau began reporting in 2010.
More than 800,000 people attended public hospital emergency departments in the final three months of 2024, with almost a quarter of them arriving in an ambulance.
But only 65 per cent of patients started to receive treatment on time, and almost 68,000 people left the emergency department without completing treatment, some of them waiting more than six hours.
Patients waiting longer than clinically recommended for an elective surgery surged more than 220 per cent, with 6842 still waiting at the end of December, up from 2133 in 2023.
Australian Medical Association NSW president Kathryn Austin said the unacceptable results of the performance report are a clear indication the state's health system is not coping with demand.
"This is what happens when a health system does not have enough doctors, nurses and other healthcare workers to care for its community," Dr Austin said.
She called for investment to recruit and retain more workers as well as better funding for services, saying public hospitals should be a key issue in the upcoming federal election.
"Our exhausted health workforce cannot continue to do more with less," Dr Austin said.
