Accident and emergency departments should discharge or admit patients to a bed within six hours of their attendance at a casualty unit, the Health Service Executive's Task Force on A&E services has recommended.
According to the findings of the unpublished report, obtained by RTÉ News, hospitals should start counting how long a patient is waiting from the moment they register at A&E, not from the time a decision is made that they be admitted, which is the current system.
The report does not set a timescale for the six hour 'discharge or admit' system but does recommend that the executive set targets during the first three months of this year.
Among the main problems identified in hospitals were a shortage of facilities, poor management of wards and A&E departments deemed not fit for the task.
The task force, set up in March 2006, makes system wide recommendations as well as recommendations for around 15 individual hospitals which regularly face difficulties with overcrowding.
It calls for the development of GP services, including clinics for chronic illnesses such as heart disease and respiratory conditions, to keep patients out of hospital, or to ensure that they are admitted quickly to a bed if necessary.
It also recommends the development of long stay care, so that patients who have finished their acute care can be moved to a nursing home bed, a particular problem for Dublin hospitals.
According to the task force, work practice changes are required not just by consultants but also in the areas of nursing, the availability of diagnostic services such as x-rays and security.
It recommends that, where possible, laboratory services should be outsourced to speed up medical tests.
In relation to specific hospitals visited by the group, the task force says there is no one quick fix and that a range of issues affect their ability to deliver an efficient A&E service.
It says that hospitals as a whole must be responsible for helping A&E services operate to their most efficient level.
The terms of reference for the group did not involve examining bed capacity as this is the subject of a separate review commissioned by the HSE.
