Implementation of Lean healthcare methodology in designing an Intravitreal Injection Center: first Italian experience

Grassi, Maria Oliva; Furino, Claudio; Recchimurzo, Nicola; Vitis, Fabio De; Sborgia, Giancarlo; Sborgia, Luigi; Arianna, Meleleo; Molfetta, Teresa; Piepoli, Marina; Locatelli, Paolo; Boscia, Francesco; Alessio, Giovanni

doi:10.1007/s10792-020-01441-1

Cited by 5 publications

(20 citation statements)

References 25 publications

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“…Our study shows that there is a significant increase of the mean number of slots for IVIs, of patients treated and in the percentage of IVIs performed monthly, as reported in previous studies. 5,16 The time spent by each patient in Hospital for IVI has been significantly reduced with the new current settings (p = 0.00057). Three appointments are scheduled every 15 min, as there are only three main stops (admission, BCVA examination, macular OCT or OCT-A).…”

Section: Discussionmentioning

confidence: 99%

“…These results are in line with a previous study, which also has shown an increase of the weekly number of slots for IVIs available and of weekly IVIs sessions. 5 The IVIC optimizes time usage, resources and costs, increasing visual outcomes and reducing the waiting list for IVIs. Also, although not formally assessed with feedback questionnaires, an increased qualification and satisfaction in healthcare professionals working at the IVIC has been perceived.…”

Section: Discussionmentioning

confidence: 99%

“…The Lean is a management approach created for the manufacturing industry and then also applied in healthcare sector worldwide, 3 including Italy. 5,11 The goal is to improve the quality of healthcare offered by minimizing wastes. 12 As a result, any waste (transportation, inventory, motion, waiting, over-production, defects and skills) at the Eye Department of 'Ospedali Riuniti Area Vesuviana' (Naples, Italy) is identified and minimized.…”

Section: Lean Approachmentioning

confidence: 99%

“…1,6,7 Lean methodology has been previously utilized to design a new setting dedicated to the management of patients undergoing intravitreal injections (IVIs). 5 The intravitreal route has become an efficient approach for the delivery of anti-vascular endothelial growth factor (anti-VEGF) molecules at therapeutic levels in the vitreous cavity in order to limit systemic side effects. 8,9 Monthly IVIs during the loading phase are necessary to obtain a functional result.…”

Section: Introductionmentioning

confidence: 99%

“…Consequences are undertreatments (due to inadequate capacity of the system and poor patients' compliance) and lower visual outcomes compared with pre-existing clinical trials. 5 We introduced the Lean approach in our clinical practice to improve the management of patients undergoing IVIs for w-AMD at the Ophthalmology Department of Ospedali Riuniti Area Vesuviana. The aim of this study is to propose an innovative model to manage the IVI Service based on Lean methodology during the COVID-19 pandemic, in order to improve the quality of care in w-AMD patients.…”

Section: Introductionmentioning

confidence: 99%

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Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic

Verolino¹,

Grassi

Sosto³

et al. 2021

Ophthalmol Eye Dis

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Lean Approachmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic

Verolino¹,

Grassi

Sosto³

et al. 2021

Ophthalmol Eye Dis

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Comparative Study on Anti-VEGF in Wet Age-Related Macular Degeneration in the Setting Based on Lean Methodology from the Bari Intravitreal Injection Registry (BIVIR)

Grassi,

Viggiano,

Borrelli

et al. 2024

Ophthalmol Ther

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Introduction: Optimizing treatment protocols for wet age-related macular degeneration (wAMD) is an ongoing challenge, as it involves a delicate balance between achieving therapeutic efficacy and minimizing invasive procedures' frequency. This study aimed to apply the Lean methodology and evaluate the effectiveness of this new setting on intravitreal therapy for wAMD, employing different anti-vascular endothelial growth factors (VEGF) drugs (bevacizumab, brolucizumab, aflibercept, ranibizumab), drawing data from the Bari Intravitreal Injections Registry (BIVIR).Methods: This was a retrospective, monocentric, nonrandomized, comparative study. Lean methodology was employed to design the new setting and the BIVIR collected information from electronic medical records. Clinical data of four groups, stratified based on the first-line anti-VEGF agents used, were compared. Bestcorrected visual acuity (BCVA) and central retinal thickness (CRT) changes were compared between the four groups at 3 and 12 months. Results: Out of 4990 eyes and 41,323 intravitreal injections (IVs) recorded in BIVIR, 1421 eyes of 1182 patients were included. The mean number of IVs in first year was 6.1 ± 2.5, with no significant differences among the four subgroups. The mean change in BCVA was ? 6.2 letters [95% confidence interval (CI) 5.6-6.8] after two IVs, and ? 5.9 (95% CI 5.1-6.8) letters after three IVs; at three months, brolucizumab was associated with a greater mean increase in BCVA than bevacizumab (p = 0.050); aflibercept (p = 0.044) and ranibizumab p = 0.047). At the 1-year follow-up, the mean change was ? 6.3 letters (95% CI 5.4-7.2), brolucizumab and ranibizumab were associated with a superior improvement in BCVA compared to aflibercept (p = 0.033). Regarding the CRT, a significant reduction was observed in the subgroup treated with brolucizumab at the 3-month follow-up, compared to bevacizumab (p = 0.003), aflibercept (p = 0.015), and ranibizumab (p \ 0.001); Aflibercept exhibited a superior effect than

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Severe Visual Loss During Anti-Vegf Intravitreal Injections in Neovascular Age-Related Macular Degeneration: Timing, Prognosis, and Optical Coherence Tomography Findings

Grassi

Monteleone

Pozharitskiy

et al. 2023

Retina

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Purpose: Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard of care for neovascular age-related macular degeneration (nAMD). However, a small subgroup of patients still experience severe visual impairment, which may be related to the number of IVI administered.Methods: This retrospective observational study analyzed data from patients with sudden severe visual decline ($15 Early Treatment Diabetic Retinopathy Study [ETDRS] letters loss between two consecutive IVIs) during anti-VEGF treatment for nAMD. Bestcorrected visual acuity examination, optical coherence tomography (OCT), and OCT angiography (OCTA) were performed before every IVI and central macular thickness (CMT) and drug injected were collected.Results: 1,019 eyes received anti-VEGF IVI for nAMD from December 2017 to March 2021. Severe VA loss occurred in 15.1% after a median of 6 (range 1-38) IVI. Ranibizumab was injected in 52.8% and aflibercept in 31.9% of cases. Functional recovery after 3 months was significant, without further improvement at 6 months. Visual prognosis relative to the percentage of CMT change showed better visual outcome in eyes with no substantial change in CMT compared with an increase of .20% or a decrease of .5%. Conclusion:In this first real-life study exploring severe VA loss during anti-VEGF treatment in patients with nAMD, it was found that it was not unusual for a $15 ETDRS letters loss to occur between two consecutive IVIs, often within 9 months of diagnosis and 2 months after the last IVI. Close follow-up and a proactive regimen should be preferred, at least in the first year.RETINA 43:1081-1087, 2023N eovascular (wet) age-related macular degeneration (nAMD) is a chronic, progressive, degenerative disease and a leading cause of visual impairment among patients over 60 years. 1 To date, therapy with intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard of care; anti-VEGF therapy has spared many patients from legal blindness. 2 Several randomized clinical trials demonstrated the efficacy of intravitreal treatment in restoring or stabilizing visual acuity (VA), but a small subgroup of patients experienced visual impairment despite appropriate therapy. The Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab In the Treatment of Neovascular AMD (MARINA) and Anti-VEGF Antibody for the Treatment of Predominantly From the Eye Clinic, Azienda Ospedaliero-

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Implementation of Lean healthcare methodology in designing an Intravitreal Injection Center: first Italian experience

Cited by 5 publications

References 25 publications

Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic

Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic

Comparative Study on Anti-VEGF in Wet Age-Related Macular Degeneration in the Setting Based on Lean Methodology from the Bari Intravitreal Injection Registry (BIVIR)

Severe Visual Loss During Anti-Vegf Intravitreal Injections in Neovascular Age-Related Macular Degeneration: Timing, Prognosis, and Optical Coherence Tomography Findings

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