Dr Edwin Borman, director for clinical effectiveness at Shrewsbury and Telford Hospital NHS Trust, said an increase in demand has led to 'crowding' in the county's emergency departments.
Whilst giving an update on mortality rates at the trust to Shropshire Clinical Commissioning Group's governing body, he said it was important to check this was not going to lead to a large change in patient deaths.
It came as the CCG's chairman told the board on Wednesday that he would be raising concerns with Sir Neil McKay, chair of the Shropshire, Telford and Wrekin Sustainability and Transformation Partnership (STP) – which is responsible for transforming health and social care for residents across the county.
More than 220 patients so far this month have faced trolley waits of more than 12 hours at the A&Es at Princess Royal Hospital in Telford and Royal Shrewsbury Hospital.
Dr Borman said: "I am worried about the increase in stay of patients in the emergency departments.
"I am worried about the extent to which the increase in demand has meant we do have crowding in the emergency departments.
"Hence it's more difficult for our colleagues, however good they are, however much they try to do their best for their individual patients and ideally for all of the patients in the unit, it's really difficult when we've seen, and I've experienced it for the first time I've been at SaTH, more than 100 patients in each of our emergency departments at one time.
"This is the first time ever that we've had more than 100 patients in each of the ED sites.
"So something fundamentally has changed and we need to check that that is not going to have an appreciable change in mortality of patients, particularly the elderly patients who are more susceptible."
Keith Timmis, lay member on the CCG board, said the figures were "really shocking" and way beyond anything he had experienced in more than five years at the CCG.
Christine Morris, chief nurse for the CCG, said the group had been holding the trust to account through clinical quality review meetings, but it had been a "challenge".
She said: "We don't have the resources that the Care Quality Commission have to bring large teams into the trust to do the depth of investigation which they do.
"We certainly have been doing the visits, we have been holding them to account through the clinical quality review meetings, but that has been a challenge.
"There's been changing personnel around the table and sometimes the threads have not always been carried through within the conversations within the trust."
Dr Julian Povey, chair of Shropshire CCG, said he had concerns and would be writing to the chair of the STP to see what can be done as a "system" to make improvements.
All health organisations, both commissioners and providers, are members of the STP, along with Shropshire Council and Telford & Wrekin Council.
Dr Povey said: "It's not as simple as just demand, it's about the mismatch between demand, capacity and workforce.
"We are seeing a year on year rise in activity but, we've heard when you compare the two weeks over Christmas this year with last year, there were fewer admissions and fewer A&E attendances, yet we had limited numbers of 12 hour breaches.
"What we are asked to do for this meeting is actually be assured that CCG actions will recover performance and quality in these areas. I'm not sure that's right at the moment, I think our actions are there to maintain safety, and to make sure the patient experience and the harm done to patients is recognised and we are working with our partners to improve that.
"These people who work in the hospital and around the hospital system, and the system are working incredibly hard, and yet they are seeing the performance figures, but at the heart of it there are also patients who are individually suffering."
He added: "We do need that single emergency department where we can concentrate the decision makers, where we can attract and retain high quality staff and provide high quality services to our patients.
"I'm happy to write on behalf of the board, and we can draft a letter to Sir Neil asking what we can do as a system to try and move things forward."