John Hunter and Cessnock hospitals recorded their worst quarterly result for the median time that patients spend in the emergency department since modern records began in 2010.
Only 34.6 per cent of John Hunter emergency patients were treated and discharged within four hours - also the worst result on record.
The latest Bureau of Health Information [BHI] data also showed that 69.5 per cent of emergency patients left John Hunter without or before completing treatment within four hours.
However, the region's emergency departments did show improvements in the percentage of patients starting treatment on time.
Matthew Rispen, the John Hunter branch secretary of the NSW Nurses and Midwives' Association, said the data showed the hospital needed nurse-to-patient ratios promised by the Minns government.
The government announced last month that the ratios would begin at emergency departments at Liverpool and Royal North Shore.
"We need the ratio rollout fast-tracked to John Hunter," Mr Rispen said.
The district's chief executive Tracey McCosker said "our dedicated emergency department staff do a fantastic job".
"I want to express my gratitude to our teams providing care to our most sick and vulnerable patients," Ms McCosker said.
"The district has been very successful in its recent recruitment efforts."
Nonetheless, she acknowledged the "strains on our staff".
"I want to reassure the community we are working very hard to bring more people to our regions with generous incentive offers and relocation payments."
Hunter New England Health highlighted a rise of 8.9 per cent in planned surgeries performed during the October to December quarter.
This amounted to 7210 surgeries in total.
Completed non-urgent surgeries rose by 13.8 per cent to 2758.
The district also said it made "significant improvements" in reducing overdue surgeries.
There were now 383 patients waiting for surgery longer than recommended, a fall of 781 patients from the same quarter in 2022.
Semi-urgent patients waiting for surgery fell by 14.4 per cent to 1802.
Ms McCosker said it was "a testament to the dedication of our staff" that 86 per cent of patients received their surgery on time
The data showed 10,849 patients were on waiting lists for surgery in Hunter New England, a fall of 0.9 per cent on the same quarter in 2022.
Emergency departments in Hunter New England had 114,767 attendances overall, a fall of 0.1 per cent on the same quarter in 2022.
The median times from arrival to departure at emergency departments were: John Hunter (5 hours and 16 minutes), Maitland (5 hours and 33 minutes), Calvary Mater (4 hours and 15 minutes), Belmont (4 hours and 11 minutes), Cessnock (2 hours and 38 minutes), Kurri (1 hour 11 minutes).
The NSW median was 3 hours and 29 minutes.
John Hunter's result was the second worst in its peer group of 13 principal referral hospitals.
Mr Rispen said the data reflected the ageing population and shortage of GPs in Newcastle and Lake Macquarie.
"There's increasing demand. The upgrades to the John Hunter are urgently needed," he said.
Mr Rispen added that John Hunter was "the only trauma centre in NSW that isn't in Sydney".
"That does affect the presentations that come to the hospital," he said.
The percentage of patients leaving ED within four hours were: John Hunter Hospital (35 per cent), Maitland Hospital (34.5 per cent) and Calvary Mater (47.3 per cent), Belmont Hospital (47.6 per cent), Cessnock Hospital (69 per cent) and Kurri Hospital (89.8 per cent).
The NSW rate was 58.1 per cent and John Hunter's peer group rate was 44.8 per cent.
The percentage of patients starting treatment on time in Hunter emergency departments were: John Hunter (61 per cent), Maitland (59.3 per cent), Belmont (73.5 per cent), Cessnock (76.7 per cent) and Calvary Mater (80.6 per cent) and Kurri (92.9 per cent).
The NSW result was 68.3 per cent.
