An investigation has begun at the Mid Western Regional Hospital in Limerick to examine the circumstances which led to 36 patients waiting on trolleys for admission on Tuesday.
The overcrowding was so severe that the emergency department ran out of trolleys and three patients had to be cared for on trolleys from the ambulances that brought them to the hospital. Ambulances were out of commission for about 45 minutes as a result.
As doctors and nurses blamed each other for the situation that arose, the Health Service Executive announced a review of what happened would take place.
"The review will be carried out by a team comprising senior nursing, medical and management personnel under an independent chairperson. The membership of the review team will be announced later," it said in a statement. There were, it added, serious questions to be answered with regard to what happened.
"One of these questions is why, if it was possible to have 34 of the 36 patients who were on trolleys at 8am in beds by 2.45pm, this was not done earlier?" it said.
Dr Colman O'Leary, senior emergency consultant at the hospital, said flexibility was required from all to deal with such situations. He said if two extra patients had been placed in each general ward in the hospital, the problem would not have arisen.
He said the HSE had considered issuing a directive in the past ordering wards to accept extra patients in the event of overcrowding in A&E, but the Irish Nurses' Organisation (INO) had opposed it.
Mary Fogarty, industrial relations officer with the INO, said the critical factor was that consultants at the hospital did not discharge patients at the weekend and "this then led to a back-up in the demands for the service and the situation which arose".
She added it was not HSE policy to place patients on trolleys in already overcrowded wards and no directive has been issued in this regard.
"At no point was it suggested that trolleys should be moved to wards and the problem arose in the discharge of patients by consultants," she added.
"The INO has a clear policy on this matter and we do not support and will not co-operate with any initiative which overcrowds existing overworked wards and has the potential to compromise the patient care of the total patient population in a hospital.
"Placing additional beds on wards was tried in the past and uniformly found not to address or correct overcrowding in A&E departments."