PATIENTS in the emergency department of one of the country's busiest hospitals were put at significant risk because their exact whereabouts were only known and monitored by one nurse.
A confidential inspection of the emergency department at Beaumont Hospital in Dublin said these patients had to be placed on a corridor or annexe because of overcrowding.
They could find themselves on a trolley or chair for up to two days, revealed the audit by the special delivery unit of the Department of Health.
In addition, the trolleys might be packed close together, without room to adequately assess patients. "The exact whereabouts of these patients is only known and monitored by one nurse and can constantly change, which means that no one clearly knows where individual patients are.
"We feel this constitutes a significant risk to patients and has to be addressed as a matter of urgency," the audit warned.
The report noted that this had since been addressed by adding numbered areas for trolleys and chairs and ending the use of the annexe.
The audit was carried out in July last, but the hospital is still under pressure with 24 patients on trolleys, second only to Cork University Hospital with 32.
On the day of the audit, 60 patients were in the emergency department, 40 of them were a waiting admission and 20 were waiting to be seen by an emergency doctor or speciality team.
"There was no clear system of monitoring the waiting times for patients and they were all registered and entered into the Beaumont IT system .
"But they were not in time order and were placed on the system according to the area where they were waiting in rather than in chronological arrival time."
There was no easy way to determine who had been waiting for more than six hours, where they were waiting, or what point in their visit they had reached.
The report, first published in fortnightly newspaper the 'Medical Independent', also found that elderly people were spending considerable time on trolleys, with not enough of them being admitted to a specialised 'care of the elderly' bed, and their length of stay in hospital was too long.
Many of them were there for more than 50 days, often waiting for services such as a nursing home place, the report added. A spokesman for the hospital said progress has been made since in addressing the issues.
"Looking at the report as a whole, a lot of the recommendations outlined have been delivered and most of the remainder are in progress," he said.
These include the appointment of a fourth consultant and a 'plan per patient', charting their journey through the unit.
"In the period since also, the hospital has hit its performance targets in terms of waiting lists for appointments and elective surgery and its obligations in respect of the national cancer, neurosurgery and renal programmes."