A report from the Health Information and Quality Authority has said there are serious patient safety risks at University Hospital Limerick and has concluded that its Emergency Department is "not fit for purpose".
The review found serious delays and risks for patients and staff due to persistent overcrowding in the Emergency Department.
There were also delays in transferring patients from the Emergency Department to the Intensive Care Unit and the High Dependency Unit, partly due to the absence of a single clinical governance structure.
HIQA said the conditions experienced by patients attending the Emergency Department were unacceptable.
It found the department overcrowded and not fit for purpose.
The report also said that emergency response ambulances were being significantly delayed when waiting to transfer patients from the ambulance trolley to an ED trolley at the hospital.
This meant that pre-hospital emergency care services were potentially unable to respond to critical calls within a safe timeframe.
During the announced assessment of the ED, there were 37 patients on trolleys at the peak.
There was just one toilet in the Emergency Department for all patients, adults and children, and there were no single rooms to isolate patients with communicable diseases.
A critically ill non-ventilated patient, who required a high-dependency care bed, remained in the ED until their condition improved to the extent that they no longer required a high dependency bed.
HIQA said this practice was unacceptable.
Local communities were not using the minor injuries units in Ennis and Nenagh hospitals.
The report noted that a new Emergency Department is under construction and should be completed by 2016.
The hospital said it had put in place several measures to alleviate pressure on the current Emergency Department.
It said a €20m capital development is under way to build the new department.
The hospital said to alleviate overcrowding problems it opened a 17-bed short-stay ward.
Since the HIQA review, it said a separate paediatric emergency area is now fully open and is used for children up to the age of 14.
A €35m Critical Care Unit was also opened at the hospital recently.
HIQA Director of Regulation Phelim Quinn said the conditions increased the risk of healthcare infections, impeded access to patients for care and observation, and severely reduced patients' privacy and dignity.
The review also found delays in the admission of children to wards while being accommodated in adult surroundings.
This was despite the fact that a new children's area had been developed, but it remained unopened.
At the same time, staff in the region's local injuries unit reported under-use of their services.
The governance review found no evidence that patients' complaints were being reviewed at board level, executive management team level; at meetings between the CEO and the directorates; or in minutes or action points that were submitted for review.
The review found there had been progress in the way in which services within the University of Limerick Hospitals group are being governed and organised.
HIQA said the findings must be reviewed by the University of Limerick Hospitals group and the HSE nationally, given the reorganisation of acute hospital services across the country.
It said all public hospitals must consider the findings of the report and benchmark their own services against what it reveals.
The review of University Hospital Limerick arose from concerns HIQA identified in 2011 and 2012 regarding the quality and safety of patient services in the ED.