Frail patients were left waiting in the cold on ambulance trolleys to be admitted to a hospital that was under "extreme pressure" because of the high number of patients, inspectors said.

A team from Healthcare Improvement Scotland (HIS) said more must be done to address "pressures within the system" after visiting Crosshouse Hospital in Kilmarnock.

During the unannounced visit last October, inspectors witnessed two frail patients, one of whom had dementia, on ambulance trolleys in the reception area for the combined assessment unit waiting to be admitted.

"This area was cold and the patients had to be provided with blankets by the ambulance crews," they added.

Another patient was seen on a trolley next to the nursing station in the admissions unit as there were no cubicles or rooms available within the department, the report said.

Inspectors also saw relatives' rooms being used as additional patient areas within wards, which "raises safety, and dignity and respect issues".

HIS said: "Throughout the inspection, it became clear that the hospital was under extreme pressure from the number of patients and that this had a direct effect on all aspects of care that we observed.

"We observed aspects of patient care that we believe had an impact on patients' dignity and respect and had the potential to impact on patient safety.

"We were told that staff are frustrated at not being able to deliver the care that they would like due to capacity and flow issues within the hospital."

HIS said NHS Ayrshire & Arran should ensure more is done to address the "pressures within the system" as this can impact on "staff ability to maintain patient dignity and respect and to deliver safe, high-quality care".

Inspectors also said the health board must ensure elderly patients are assessed within the standard recommended time, after discovering one patient was not screened for risk of malnutrition until 27 days after being admitted.

The Malnutrition Universal Screening Tool should be completed within 24 hours of admission.

Adults with Incapacity certificates, which are used to authorise treatment for patients who are unable to give consent for themselves, were generally "not well completed", the report added.

Claire Sweeney, interim director of quality assurance at HIS, said: "While we do not underestimate the significant operational issues affecting the hospital, NHS Ayrshire & Arran has a duty to ensure that the care provided to patients under its care is appropriate."

NHS Ayrshire & Arran nurse director Professor Hazel Borland said the organisation is "committed to the provision of high standards" to ensure patients receive safe and dignified care.

She added: "Our teams have a strong focus on ensuring that improvements are made to deliver the best possible care across health and social care services.

"Many areas highlighted by the visiting team were part of our ongoing improvement work and this has been reflected in our action plan.

"We are pleased that the inspection team observed and have reflected the positive feedback received from patients and carers about the standard of care, respect, dignity and compassion they were experiencing during their time in University Hospital Crosshouse."