https://doi.org/10.4081/ecj.2026.15503
Emergency department overcrowding in low- and middle-income countries: extending the decalogue to resource-limited settings
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Accepted: 28 May 2026
Published: 14 July 2026
Dear Editor,
We were very intrigued to read about the "decalogue" by Cipriano et al. that provides a plan to respond to the continuing problem of overcrowding and operational stress experienced within Emergency Department (ED). They present a well-timed, organized, structured plan that includes a number of systems-level recommendations to help reduce the persistent problem of overcrowding and operational stress in EDs.1 While the strategies included in their article have significant relevance to high-resource settings, each strategy needs to be considered carefully for Low- and Middle-Income (LMIC) settings, as there are important contextual differences for LMIC settings when compared with high-resource settings. [...]
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1. Cipriano A, Zaboli A, Ghiadoni L, Turcato G. A decalogue for saving Italian emergency departments. Emerg Care J 2026;22:14595. DOI: https://doi.org/10.4081/ecj.2026.14595
2. Sprivulis PC, Da Silva J, Jacobs IG, et al. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust 2006;184:616. DOI: https://doi.org/10.5694/j.1326-5377.2006.tb00416.x
3. Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 2011;342:d2983. DOI: https://doi.org/10.1136/bmj.d2983
4. Sun BC, Hsia RY, Weiss RE, et al. Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med 2013;61:605-611.e6. DOI: https://doi.org/10.1016/j.annemergmed.2012.10.026
CRediT authorship contribution
Pratik Kanani, conceptualization; critical revision; Varsha Shinde, conceptualization; critical analysis; final approval, supervision; Keyur Bhimani, writing – review & editing; writing – original draft. All authors meet all authorship criteria and approve the final version of the manuscript.
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