More than 100 patients waited at least 12 hours for treatment at the Dudley hospital during January as a lack of available beds led to numbers needing to be seen piling up.
It came as the first coronavirus case in Dudley was confirmed and a patient died after testing positive for the virus in Wolverhampton.
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Health bosses have also complained about the slowness in which patients well enough to leave hospital are being provided with care home places.
Chiefs at the Dudley Group NHS Trust, which runs Russells Hall, are now looking at expanding the number of beds in a bid to tackle the problem.
Preparations are also being made for a severe outbreak of coronavirus in the region, as the number of cases continues to rise. Government officials have warned a rapid spread is likely and such a scenario would only add to the problems at Russells Hall and other hospitals in the region.
Some 115 patients waited at least 12 hours in January, the same total as the previous month.
Performance for patients seen within four hours was 80 per cent in January, though this figure includes the urgent care centre where almost all patients are seen within that period. The national NHS target is 95 per cent.
A new Dudley NHS trust board report said: "The executive team remain focused on improving the emergency access target and have been working with clinical teams to do this.
"Work is under way to develop a business case for further acute and general beds on the Russells Hall site. Occupancy within acute medicine is over 95 per cent and this is impacting on flow from the emergency department in to the bed base.
"External issues relating to social care funding and delays in packages of care being available to medically fit patients is also having a significant impact due to the numbers.
"We are working in partnership as a system to resolve this but it is anticipated that this will be an ongoing issue."
The report said preparations were being made for people arriving with coronavirus symptoms and that the trust was currently following "national guidance".
Trust chief executive Diane Wake said: "There is a need for more acute and general beds at Russells Hall Hospital as we face increasing demand, patients who require longer stays due to more complex conditions, and delays in discharging medically fit patients while we wait for packages of care to be agreed. Work is therefore underway to develop a business case for funding to provide more beds.
"We are seeing unprecedented demand on our services. Our emergency admissions increased by 62 per cent in December compared to the previous December while the number of most critically ill patients increased by 23 per cent over the same period."