What it said on three hospitals - Cork University Hospital, University College Hospital Galway and Wexford General Hospital.
Cork University Hospital
Some 2,286 bed days were lost due to the delayed discharge of patients from Cork University Hospital (CUH) in the first six months of 2005, a new report has found. The report from Tribal Secta consultants says the hospital has been experiencing increasing difficulty in discharging elderly, frail patients into the community or to alternative care settings.
"Much delay is attributable to the significant amount of bureaucracy associated with subvention application and response," it says.
"There are also challenges that families and carers might not accept first places available and refuse to condone a move from hospital," it adds.
There were problems with discharging younger patients requiring long-term rehabilitation and support.
CUH reported six- to eight-month waits for rehabilitation beds for young people.
"This causes problems for the patient accessing timely rehabilitation and also for their families who often have to travel long distances to visit."
The consultants also found elective surgery frequently has to be cancelled at the hospital because medical patients were occupying beds on the day ward in order to prevent trolley waits in A&E.
Furthermore, they note there are three A&E departments in Cork city - at CUH, the Mercy Hospital and South Infirmary Victoria University Hospital.
"There are no city-wide arrangements for pooling the resources of three major emergency departments ... All operate every day of the week throughout the year."
The consultants say these A&Es are not "configured in the most effective way to use emergency resources" and it recommended the HSE, as a priority, review A&E provision across the city to develop "a more cost/ resource-effective model of emergency care".
After looking at 10 patients with chronic obstructive pulmonary disease, Tribal Secta found that while five saw a consultant either on the same day or the day following their admission, one patient waited two days, one three days, two four days and one six days before a consultant review.
The hospital, which has 618 beds, needs to try to balance elective work throughout the week, the report says.
University College Hospital Galway
There are often patients waiting on trolleys in A&E at Galway's University College Hospital (UCHG) while beds lie empty at another large public hospital a few miles away. That's according to the Tribal Secta consultants, who conclude the practice of one A&E serving the two "on-take" hospitals in Galway city is "unsustainable" and is contributing to duplication and delays.
UCHG has about 600 beds and Merlin Park Hospital, six miles across the city, has approximately 250 acute beds and 100 long-stay beds.
"The bed pool across the two hospitals is not managed as a joint resource. Therefore, on occasions when UCHG is on take and is struggling to find beds for emergency admissions, patients will not be transferred to Merlin Park even though they may have appropriate empty beds.
This contributes to overcrowding in the A&E department, long trolley waits and overall high occupancy at the UCHG site," the consultants' report says.
It adds that a GP out-of- hours-service in Galway had not reduced attendances at A&E.
"The GP out-of-hours service [ WestDoc], located in the city centre, has been in place for approximately two years. This has not, however, resulted in any noticeable reduction in attendances to the A&E department."
The report also says: "The organisation reported many GP referrals to A&E, specifically for diagnostics, tests and where outpatient appointments are not being provided in a timely manner, or because of elective cancellations."
The consultants note that elective surgery frequently has to be cancelled as patients are occupying beds to prevent A&E trolley waits.
They found that the A&E at UCHG does not have 24- hour access to its own X-ray department, which is only staffed from 9am to 5pm, Monday to Friday. "The hospital is considering purchasing a second CT scanner, but the current scanner is lying idle from 5pm onwards," the report says.
They note patients with similar problems are often scattered across the hospital. This results in consultants and their teams having to undertake "safari" ward rounds across many wards, which takes more time from already-busy medical staff.
Wexford General Hospital
The A&E department at Wexford General Hospital is far too small to cater for the numbers attending it every year, the consultants found.
The department, which regularly has patients on trolleys, is "not fit to provide modern-day emergency healthcare".
The report of its inspection of the unit states the A&E unit at the hospital was meant to be a pharmacy and "has few of the design features expected of an A&E in the 21st century". It is "extremely small and cramped and affords little patient privacy, dignity and comfort, and children and adults are treated side-by-side".
Nurses have to use the store cupboard as a rest area, it adds.
The report also says many tourists use the A&E unit as their first port of call for health issues.
The hospital has 211 beds but "far fewer beds and staff per capita of population than other acute general hospitals". Extra beds have been promised for some time.
"The hospital considers that there is a real bed- capacity issue," the report adds, but it points out it was not in its remit to assess or advise on capacity. The HSE is undertaking its own review of bed capacity.
The report notes that medical patients can be located in different parts of the hospital, resulting in consultants having extensive ward rounds. This results in patients getting "missed", resulting in discharges being delayed.
Tribal Secta also finds that some patients did not see a specialist consultant for between one and seven days after transfer to a specialist ward. The hospital said the visits may just not have been recorded in the notes.
In addition, the report points to the hospital having "a very poor IT infrastructure" and no MRI scanner. It says its CT scanner is only staffed until 5pm, from Monday to Friday, which is a problem.
It also says elective surgery frequently has to be cancelled due to no beds being available which adds to the tendency for patients to present in A&E.
Inpatients may wait three to four days for cardiology tests, it adds.
The hospital opened a medical admissions unit 18 months ago but lack of beds further upstream makes it difficult for the unit to move patients into wards, the report says.