Victoria's major hospitals have been given a mixed emergency department report card in the National Health Performance Authority's latest report.
The report rates hospitals across the nation between January and March this year.
In Victoria, three major hospitals recorded declines in the percentage of patients leaving their emergency departments within four hours.
In the State's north-east, the Wangaratta hospital recorded a drop of nine percentage points to 67 per cent of patients and the Albury Wodonga hospital declined from 83 to 78 per cent.
Numbers at the Casey Hospital in Melbourne's fast-growing outer south-east also fell from 75 to 70 per cent.
The Western Hospital was the biggest improver, up 11 percentage points to 53 per cent.
Only six out of 28 major hospitals, including the Alfred, met the 2013 benchmark of 75 per cent.