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Background: To introduce Lean approach principles in the management of patients undergoing intravitreal injections (IVIs) for wet age-related macular degeneration. Methods: Retrospective single-centre cohort study. Services location, IVIs scheduling, utilization of staff, data recording methods, ophthalmic examination and surgical procedures were analysed; a new Intravitreal Injection Centre (IVIC) was developed according to Lean principles. Mean number of daily IVIs performed, mean time between registration and discharge, mean turnover time in between patients, percentages of performed IVIs on the monthly scheduled IVIs and of patients rating their experience ⩾8/10 via standardized feedback questionnaires were retrospectively analysed. Results: The mean IVIs number per day increased from 20 ± 4.08 to 50 ± 7.07, and the mean time between registration and discharge of a patient decreased from 240 ± 14.14 to 60 ± 8.16 min ( p = 0.00057 and p < 0.00001, respectively). Mean turnover time in between patients decreased from 10 ± 1.41 to 8 ± 2 min ( p = 0.055). The percentage of monthly IVIs performed on the total of scheduled IVIs increased from 60% to 100%, and the percentage of satisfied patients who rated IVIC ⩾8/10 increased from 45% to 95% ( p = 0.0177 and p < 0.00105, respectively). Conclusion: The IVIC improved the quality, efficiency, speed of the overall procedures and clinical capacity of the IVI service through a fast one-way route for patients, limiting time wasted and total distance travelled. This model facilitates the creation of a one-stop clinic through the just-in-time management principle and may be relevant to other ophthalmology services.

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Maximizing energy efficiency within hospitals and healthcare facilities is a major challenge for sustainable development and energy saving objectives. In this study, the case study of the public hospital of Isernia (Italian backcountry city) is proposed, being typical of the hospital building stock developed in reinforced concrete all around Italy in the last 40 years. Starting from deep on-site investigations, based on direct surveys and documents, a transient energy model has been developed and calibrated, in order to reproduce the present scenario. This, in a next phase, has been modified for proposing a multi-target optimization of energy performances, by taking into consideration all main uses (heating, cooling, ventilation, lighting, domestic hot water), by refurbishing the building envelope, active energy systems and providing energy conversion from renewables. The whole energy retrofit, formulated on the basis of a multi-stage optimization problem, resulted technically efficient and economically feasible. Moreover, the peculiarities of the case study and of the method make that investigation repeatable with reference to both studying approach and outcomes.