HEREFORD County Hospital's accident and emergency department is still a "big concern" for bosses as patient numbers and waiting times rise.
Earlier this month, the longest waiting time to be seen by a doctor in the department was more than 15 hours, the trust said.
And that comes on top of higher patient numbers.
At this month's board meeting on the Wye Valley NHS Trust, the public body which runs the hospital, an integrated performance report and dashboard document said A&E was a concern.
During February, urgent and emergency care performance remained a "significant challenge", the report said.
It added that ongoing issues with Covid attendances, Covid outbreaks, restrictions due to infection protection control issues, an increase in the daily attendances and discharge delays due to an increase in medical fit for discharge required intensive efforts by operational and clinical teams to resolve during the month.
More beds and keeping patients who had just finished Covid isolation in isolation wards were among the measures taken to combat challenges.
The report said: "Despite these actions continued challenges and congestion within ED remains a significant concern for our patients and staff."
Glen Burley, the trust's chief executive, said A&E attendances were up 10 per cent comparing September to February 2019/20 to the same period in 2021/22.
The department, the only one in Herefordshire and which also serves Powys, had recently seen peaks of up to 100 patients.
"These high levels of activity along with continued significant numbers of Covid attendances and admissions, continued Covid restrictions and IPC [infection protection control] measures and issues with medical and nursing sickness have led to a particularly challenging time for the division," he said.
"However, despite these challenges, the division has had a number of successes over the last six months that are making good progress toward improving patient's pathways and delivering services in new and innovated ways."
Those ways included increasing capacity, "albeit at stretch", and having a senior decision-maker review at the front door to see patients.
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