Noeline Dalzell was murdered by James Fairhall at her home in Melbourne's southeast in February 2020, three months after he was released from custody for breaching a family violence intervention order.
He was not allowed to contact or be near Ms Dalzell and their children, but 13 days after his release, he attended her home while intoxicated and verbally abusive.
Ms Dalzell contacted police but Fairhall had already left by the time they arrived.
Officers issued a warrant for Fairhall's arrest but that warrant was never executed.
Instead, Fairhall ended up moving back in with Ms Dalzell from about Christmas 2019 after claiming he had nowhere else to go.
He killed her on February 4, 2020, by reaching over their children to stab her in the neck.
Fairhall is serving 25 years behind bars for Ms Dalzell's murder.
State Coroner John Cain in April held a five-day inquest into her death to investigate how police and other agencies failed to protect her.
He released his findings on Wednesday, stating the response from family violence unit officers in the lead-up to Ms Dalzell's death "fell short of best practice".
Police had missed opportunities to engage with Ms Dalzell and other agencies to keep her and the children safe, the coroner said.
Judge Cain noted it was possible Ms Dalzell would have declined to engage but officers should have done more than passive monitoring in the three months between Fairhall's release and her murder.
He recommended Victoria Police engage an external independent person to evaluate the effectiveness and skill set of its family violence units.
The coroner also made a recommendation victims be notified within 48 hours of their perpetrator being released from custody.
Ms Dalzell was not contacted when Fairhall was released, despite him being listed as a high-risk family violence offender.
There should also be improved communication between police and government agencies to ensure risk management plans can be put in place and victims are protected, Judge Cain recommended.
At the end of his findings, the coroner commended Ms Dalzell's three children for their resilience and extraordinary bravery in the face of persistent violence.
He conveyed his sincerest sympathies to the children and Ms Dalzell's family.
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