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The Commission for Health Improvement's clinical governance review of the Royal Surrey County Hospital trust has found that patients can remain in the accident and emergency department for four days because of bed shortages. Highlighting the need for urgent action on delayed discharges, the report says: 'A&E functions like a ward, where the food trolley and drug rounds take place because of the length of time patients have been there.' Operations are delayed and patients placed on inappropriate wards because of delayed discharges which have caused huge problems across West Surrey health authority. The trust came in for praise for a number of clinical areas and initiatives and said 'the resolution of the unacceptable situation in A&E is recognised by the trust board as a priority'.