Tasmania's health system is severely compromising patient safety, the state's auditor-general says.

Auditor-General Rode Whitehead' has issued a damning report after a review of the effectiveness of the state's four biggest hospitals - the Royal Hobart Hospital, the Launceston General Hospital, the Mersey Hospital, and the North-West Regional Hospital - in delivery of emergency department (ED) services.

The findings include:

Ambulance ramping across the four hospitals between 2012-13 and 2018-19 increased by 149 per cent, despite ambulance presentations to EDs growing by just 20 per cent over the same period

The Royal Hobart Hospital was ‘bed blocked’ for 93 per cent of the period between January 2018 and January 2019

Patient safety was severely and routinely compromised at Royal Hobart almost once every four days on average

The Launceston General Hospital spent over 70 per cent of the time in the same period at the highest possible level of escalation “and in a state of almost constant ‘gridlock’”.

The review reveals that patients have been increasingly waiting longer in EDs for treatment, with Tasmanian Health Services performance targets having deteriorated over the last five years.

The rate of ED adverse events grew by 60 per cent between 2015 and 2018.

“These challenges increase the risks for patients and staff and are preventing the EDs of Tasmania's four major hospitals from operating efficiently and effectively,” Mr Whitehead said.

A series of reviews have now highlighted dysfunctional silos, behaviours process barriers and resistance to change from clinicians and administrators, he said.

“The patient journey through Tasmania's four major EDs as a result has become more challenging over the last decade for both patients and ED staff,” he said.

The auditor-general found that the State Government had made some reforms to the health system in 2018, but those changes have occurred too recently to be reliably assessed.

He called for urgent measures to improve “whole-of-hospital and system-wide leadership, coordination and accountability for addressing the long-standing barriers to improve patient flow”.

The auditor-general’s 10 recommendations for the THS and Department of Health include an urgent review of the root causes of the growth in ED adverse events, as well as measures to create a culture improvement program and strengthen performance monitoring and reporting processes.

The review is accessible in PDF form, here.