From October to December last year, only 52.8 per cent of patients in the emergency department were treated within target times - the third worst rate of any health service in Victoria.

And while all urgent category one patients were seen immediately, only half of category two patients - those with conditions that could be life threatening and require prompt attention such as chest pain or possible stroke - were seen inside the target 10 minutes.

Ballarat Health Services chief executive Dale Fraser said COVID-induced changes to the emergency department had exacerbated delays, with the number of people presenting to the ED almost back to pre-COVID levels.

According to the Victorian Health Services Performance report, the median waiting time for patients to be seen in the ED during the October to December 2020 quarter was 30 minutes - up from 27 minutes for the same quarter in 2019.

And in December alone, 5031 patients visited the BHS emergency department - equivalent to just over 160 a day or one every 10 minutes.

Mr Fraser said works were underway to help improve the flow of patients through the ED, but admitted the next six or seven years before a new emergency department is built as part of the hospital redevelopment, would be challenging.

Pressure on the hospital emergency department will only increase as Ballarat's population continues to boom.

The city's population is forecast to increase 10 per cent from a current estimate of around 113,725 to 125,772 in 2027 when the hospital redevelopment is scheduled to be completed. The number of older people, typically with more health concerns, will also rise.

Last month it was revealed that the completion date for the Ballarat Base Hospital redevelopment would be delayed from 2026 to 2027.

"The next six to seven years are going to be challenging," Mr Fraser said. "I do speak to council representatives frequently about population change, and the water board about the number of permits being issued.

"There's population change occurring, a tree change, and COVID has escalated that so we have to push to be as responsive as we can within limited values."

The works, which are due to start this year and take place in three stages, include a multi-level tower with a new emergency department, as well as a women and children's hub, a new theatre suite and 100 more inpatient and short-stay beds. The project will also expand critical care facilities, procedure rooms, endoscopy suites and consulting rooms, and now includes an extra $80 million for a central energy plant.

Last week, former Australasian College of Emergency Medicine president Dr Simon Judkins said the state of Australia's emergency medicine sector was "the worst I have seen in my 30 years".

"The acute parts of the health care system (EDs and ambulance services) are spending part of most days in "Code Yellow" - a perpetual state of crisis escalation," Dr Judkins wrote.

"Whether it be mental health care, drug and alcohol care, homelessness, underfunded or inefficient outpatient clinics, lack of hospital capacity, all roads will eventually lead to the ED."

Erin Nielsen has seen the wait times in Ballarat Base Hospital's emergency department blow out over recent years, having waited as long as nine hours for treatment.

With several disabilities including epilepsy, a blood clotting disorder and an indwelling catheter, she is unfortunately a frequent visitor to the emergency department.

"I can't urinate myself so I've got a bag, which unfortunately I have had issues with lately ... so I go in to urinary retention which can lead to kidney issues and further damage the bladder," she said.

"I've been left there for hours because it isn't an 'emergency emergency' or immediately life threatening ... but I'm in agony at the time.

"Even after a major trauma like a head strike (from a seizure) they've had no bed, nowhere to put me and ambulances backed up out the door."

Comments about the frequency of her visits from nursing staff have also raised her ire and at times she has put in complaints, which have resulted in two written apologies.

"Ballarat is definitely growing and the emergency department is just not catering for the expansion right now," she said.

Ms Nielsen said she had seen aggression in the waiting room among patients frustrated at others being seen before them.

"I have seen people get aggressive, not toward staff but toward the situation and out of frustration. Yes every case is different but for someone sitting there for six hours in pain, it's like 'why are you going straight through'?"

She recognised that staff were overworked because of the number of patients coming through the emergency department, and sometimes that could impact their attitude toward patients.

"It's not our fault they are overworked but if someone like myself that has a lot of disabilities and has to come in quite often, they do have to drop the attitude.

Ballarat Health Services has a team of people working on different projects to help reduce patient numbers and waiting times in the hospital's emergency department.

"We've had 12 months of a slow down in the growth of numbers but we are rapidly getting back to pre-COVID levels," said BHS chief executive Dale Fraser.

While the hospital's emergency department is still physically split in two for respiratory/potential COVID cases and non-respiratory cases, which is hampering efficient bed use and exacerbating delays, Mr Fraser is hopeful that might change in the coming months.

But with population growth driving up patient numbers, and a delay in building the hospital's new ED, there are projects afoot to manage demand now and in the coming years.

One team is looking at ways to use spaces near the emergency department to stream patients with varying levels of need, creating extra capacity for those needing urgent care.

"Not everyone going through ED has the same level of acuity so you might go to different locations for different things," Mr Fraser said.

BHS is one of six Victorian hospitals working with the world-leading Institute of Health Care Improvement in Boston on improving emergency department flow.

Last month about 20 senior BHS clinicians and staff did a "virtual week" with the Boston experts to pull apart patient flow and look at how it could be put back differently to improve wait times and outcomes.

Mr Fraser said the hospital was also working closely with local GPs to make sure there was adequate patient capacity, because ED presentations could be dealt with by local doctors.

Before COVID, BHS was looking to ramp up their BHS@Home program which could also help keep people, particularly those with chronic illness, out of the ED.

"There's a small number of people who make a lot of attendances so we are trying to put more interventions in and work with them in a more case-managed arrangement," Mr Fraser said.

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"We know a lot of people who come in to hospital would rather have care delivered at home and we think there's great potential to expand and substantially add additional resources ... so we intervene early instead of them coming to the ED all the time which helps us out and helps them create a better quality of life.

Extra resources are also being put in to timely care partnerships, supporting surrounding regional health services to keep patients close to home.

Mr Fraser said about 300 patients a year came from Maryborough, Daylesford, Stawell, Nhill and Horsham. Keeping them local would free up beds in Ballarat, reducing the time taken to transfer ED patients into wards and freeing up beds.

"Through timely care partnerships we are working with health services around the region to make better use of their facilities and support them in their own locations ... whether that's through equipment, remote telemedicine or some on-site physical presence," he said.

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