The accident and emergency department at Our Lady of Lourdes Hospital in Drogheda is "entirely unfit for current and future purposes", according to an unpublished consultants' report commissioned by the Health Service Executive (HSE).
The report says the emergency department is far too small for the volume of activity and the type of services being provided, and that to exacerbate this problem it is completely ill-equipped to provide appropriate care facilities for patients waiting to be treated.
The report says there are only two sinks for the entire department and that hygiene and infection issues are "a matter of concern". It says that ideally a new emergency facility should be provided as part of the development of the whole hospital site.
The review of emergency services at the hospital was one of 10 such exercises carried out nationally by consultants Tribal Secta for the HSE. The reports have never been published, although the findings on three hospitals were revealed by The Irish Times.
The report says that much of the infrastructure at Our Lady of Lourdes is old and has been developed incrementally, "providing new services for increasing numbers of patients without the level of requisite planning for capacity and sustainability".
It says the emergency unit is cramped and not equipped to deal with over 37,000 attendances per year. The report says that while the hospital had recently obtained resources from the HSE as part of A&E initiatives, "this support will not enable the range of changes which are required to enable the department to level up to the conditions for delivery of 21st-century emergency care".
It says that staff have done as much as they can to improve the layout and flow of the department within the existing physical constraints but that a radical overhaul was needed. "Obviously, the optimum solution for this will be the development of a new facility as part of the development of the whole hospital site."
It says the lack of space militated against an efficient system of streaming categories of patients according to their level of illness.
The report maintains that the inability to zone patients according to illness categories presents significant privacy and dignity issues for patients who may have to be treated in overcrowded conditions.
It says that this is also an issue for infection control. The report also highlights pressures caused by lack of facilities and work practices.
It points out there are no observation beds or acute medical units in the hospital. It says the emergency department has no dedicated X-ray facility and that the triage service (a system for managing patients)does not operate on a 24-hour basis.
It also criticises inconsistency in the timing of consultants' ward rounds to discharge patients.
