Health Minister Edwin Poots has publicly criticised the Belfast Trust for its failure to plan to cope with pressures in its emergency department.
His damning comments of the trust management follows the findings of a review into unscheduled care across Northern Ireland.
The health watchdog report by the Regulation and Quality Improvement Authority (RQIA) identified planning and "systems failings" by the trust in the period leading up to a Major Incident at the Royal Victoria Hospital's A&E unit on January 8 this year.
The review contains a total of 16 recommendations for improvement.
The minister said he was disappointed by the trust's apparent "inability to identify and plan for anticipated pressures".
He said the management of the flow of patients both within the RVH and across the trust could have been "handled better". "I am very disappointed by the trust's apparent inability to identify and plan for these anticipated pressures," he said.
"I am contacting the chairs and acting chief executives of the Belfast Trust and the Health and Social Care Board to ask them to account for these systems failures."
Among the problems highlighted in the review was the 'journey' or 'flow' of patients who needed to be initially treated at the RVH and then transferred to Belfast City Hospital.
One of the key recommendations to improve the backlog is to have a specialty team set up to assess frail elderly patients at the City Hospital.
The RQIA said it wanted the first stage of the move in operation by November of this year.
It recommends all health trusts should review their escalation arrangements, particularly at predictably busy periods such as Christmas.
The RQIA also found that the Belfast Trust's declaration of the Major Incident on January 8 at the RVH was "appropriate".
The trust was forced to call in extra staff to cope with "extreme pressures" after a surge in attendances in the late afternoon and evening.
The situation led to more than 40 people having to wait on trolleys, with patients waiting to be seen spilling out of the crowded wards into the X-ray department.
Mr Poots announced that a regional task force is to be set up –headed by Chief Medical Officer Dr Michael McBride – to ensure the RQIA recommendations are implemented.
It will be co-chaired by Chief Nursing Officer Charlotte McArdle.
Mr Poots said: "I require their (trust chiefs) assurance that they have learnt lessons from the RQIA's findings and are taking steps to prevent these from happening in the future."
The review recommends systems should be designed to ensure that patients have access to the right care, in the right place, by those with the right skills – the first time.
The minister said it was wrong for the frail elderly to be waiting for hours on hospital trolleys to be treated.
A spokeswoman for the Belfast Trust said it welcomed the minister's statement and the recommendations from RQIA.
The review, by the Regulation and Quality Improvement Authority (RQIA) examined the reasons for patients getting stuck within the hospital system.
It highlighted three areas of care that are suffering the most – acute internal medicine, respiratory medicine, and particularly care of the elderly.
One of the key recommendations to improve the backlog is to have a specialty team set up to assess frail elderly patients at the Belfast City Hospital.
The RQIA said it wanted the first stage of the move in operation by November 2014 – before next winter.