The level of private patients being treated at Tallaght hospital is twice the official norm and it must take steps as a priority to address this situation, the Health Service Executive (HSE) has said.
It forecast that fewer patients would be treated at Tallaght this year compared to a number of other hospitals around the country with smaller budgets.
In a letter sent to hospital management 10 days ago the HSE also said that it did not believe the resources provided to Tallaght were inadequate.
The executive also expressed concern that the level of referrals of patients on waiting lists at Tallaght to the National Treatment Purchase Fund was much lower than in other centres in Dublin.
The fund buys treatment in the private sector or elsewhere for public patients on lengthy queues for treatment.
The HSE said the official norm for the number of private patients treated in public hospitals was 20 per cent. "The average for Tallaght at 40 per cent is significantly above the norm. I suggest that as a priority Tallaght take the necessary steps to address the significant imbalance.
"This is of particular concern in the context of the elective workload and more so when the low use of the National Treatment Purchase Fund by Tallaght is taken into account, for example St James's Hospital have 1,245 referrals in the current year, the Mater have 1,967 while Tallaght has referred 364 patients," the letter stated.
The executive noted that the number of elective (or non-emergency) patients admitted stood at the recommended level of 20 per cent. However, it warned that the number of such admissions had increased considerably in the third quarter of the year.
The HSE acknowledged that there had been "significant improvements" in the performance at Tallaght in relation to A&E services, but it signalled that more needed to be done.
The letter stated the decrease in the numbers of patients waiting more than 24 hours for admission was acknowledged as was the reduction in the number of people whose discharge was delayed. However, it added that the focus of attention must now shift to those waiting between 12 and 24 hours for admission from the A&E department.
The HSE said the average length of stay at the hospital at 8.3 days was at the lower end of the scale when compared to other large hospitals in Dublin.
"However, there is significant scope to reduce the average length of stay further when compared to similar-type hospitals outside the greater Dublin area, including Waterford Regional Hospital and the Mid-Western Regional Hospital in Limerick where the average length of stay is six days.
"There is also scope for more significant reductions among specialties, for example cardiology at 6.9 days compared to 4.7 days at Cork University Hospital, geriatric medicine at 27.1 days compared to 9.8 days in Limerick, vascular surgery at 14.8 days compared to 8.5 days at Beaumont", the letter argued.
The HSE said that bed occupancy at Tallaght was at 89.1 per cent which was at the mid-point of a range of hospitals. However, it said St James's Hospital had a bed occupancy rate of 98 per cent and the Limerick, St Vincent's and Galway all had occupancy levels above 90 per cent.
"This may be a contributory factor to the capacity/emergency department issue", it states.
The executive also said that the efficacy of the system used at Tallaght for discharge planning was acknowledged and could be used as a national template.
A spokeswoman for Tallaght could not be contacted last night for comment on the HSE letter.
