OBJECTIVE:Emergency Departments (EDs) worldwide face the challenges of crowding, waiting times, and cost containment. This review aims to provide a synthesis of the current literature focused on how Lean Thinking Principles and tools can be applied in an ED to address overcrowding and hospital admissions. MATERIALS AND METHODS:Primary studies showing Lean interventions and implementation in ED visits, not requiring additional resources measuring specific outcomes (i.e. length of stay, patient volume, patient satisfaction, waiting times for the first visit, waiting times for diagnostic results, left without being seen) were selected. PubMed, Scopus, CINAHL, EconLit, NHS Economic Evaluation Database, Business Sources Complete, and Health Technology Assessment were used to conduct searches. Full-text articles of all potentially relevant publications were reviewed for eligibility. Discrepancies were resolved through discussion by all reviewers. Quality assessment and critical appraisal of selected studies were also evaluated by applying the Quality Improvement Minimum Quality Criteria Set. RESULTS:Nine before-and-after studies met these eligibility criteria. Management of patient flow was the main intervention. Almost all studies showed EDs performance improvement: increased patient volume, decreased length of stay and number of patients left without being seen, reduced costs, and increased patient satisfaction. Only one case reported worse results after Lean intervention implementation. CONCLUSIONS:Though Lean Principals have been used in healthcare for many years conclusion of their effects could still not be drawn. Surely, human-centered approach, top management support, work standardization, resources allocation and adaptation to the local context seem to be crucial for success. Furthermore, higher quality studies are needed: specific research design, appropriate statistical tests and outcome measures are needed. Before large-scale implementation, further studies are needed to evaluate the true ability of Lean interventions to improve healthcare delivery.

ResultsResults of the analyses showed that the CRC screening programme is cost-effective in Flanders with an ICER of E1,277/QALY (95%CI: ÀE3,461 -E5,397) in males and E5,397/QALY (95% CI: E260 -E25,847) in females.Mortality reduction over a period of 20 years was 21% (95% CI: 16%-24%) in males and 15% (95% CI: 12%-18%) in females.Sensitivity analyses identified the test-characteristics of the iFOBT to be the most influencing parameters, but in all cases screening remained cost-effective. ConclusionsThis health economic analysis has weighted the advantages and disadvantages of organised CRC screening and has shown that despite the possible adverse effects of screening, the population-based screening programme for CRC in Flanders is costeffective and should be maintained.

Background Integrated care models respond to the complexities of long terms conditions, in particular the increasing prevalence of multiple morbidity and poly-pharmacy. The integration of care across primary, intermediate and secondary care providers could help reducing duplication or gaps in services, emphasize the continuity and coordination of care, improve the efficiency of care for both health professionals and patients. For complex patients (eg. elderly) were experienced in most European countries. This study is aimed at …

Background An Integrated Care Pathway (ICP), also known as Care or Clinical or Critical Pathway is a multidisciplinary care plans which detail the essential steps of a specific clinical problem. The introduction of ICPs in healthcare organizations should provide better healthcare to patients and reduce unnecessary variations in practice. While there is a huge literature on definition, design and managing of an ICP, criteria to select the health problems are lacking. Therefore we aimed to define …

Issue: In all European Countries, it’s necessary to set the improvement of public health as a priority. An evidence-based priority setting process is imperative for funding decisions about primary and secondary prevention. Description of the problem On July 2012, on behalf of CCM (Centre for Disease Prevention and Control of the Italian Ministry of Health), we were appointed to build up a policy framework aimed at helping Regional policy makers to identify ineffective and/or inefficient (hereinafter …

Data on all somatic specialist hospital admissions in Finland, both public and private, in 1998-2010 were obtained from the Hospital Discharge Register. The register data were limited to patients aged 25-85 years. Patients’ disposable family income each year was individually linked to each admission from the Employment Statistics and adjusted for family size. Main disease categories were formed using DRG classification. Agestandardised admission costs and cost per bed day were calculated per 100 000 person years for men and women separately and deflated for 2010. Time trends were analysed using concentration index. Results Hospital admission costs reduced with increasing income. The differences between the extreme quintiles widened from 1998 to 2010. In 1998, men in the lowest income group had on average EUR 552 (12%) higher admission costs than men in the highest, while in 2010, the difference was EUR 1187 (24%). The corresponding figures for women were EUR 444 (12%) and EUR 814 (18%). A similar pattern was found in main DRG disease categories and number of bed days. A reverse pattern was found in costs per bed day. In 1998, the highest income group among men had EUR 104 (21%), and in 2010, EUR 222 (28%) higher costs per bed day than the lowest. The results were similar for women. The differences between income groups were prominent in disease categories involving surgery, while less evident in non-surgical disease categories such as diseases of the nervous and respiratory system. Discussion One of the main reasons for the differences in hospital costs between income groups is likely to be the observed differences in length of stay. The shorter length of stay among highincome earners may originate from their overall better health. The higher costs per bed day among high-income patients may originate from differential morbidity profiles or inequality in the use of more costly health care technology. Key messages An inverse stepwise gradient was found between income groups as reported by earlier research. However, according to our results this is likely to be due to longer length of stay. High-income groups were found to have higher costs per ded day, which may be due to use of more costly health care technology.

The primary purpose of this study is to analyse the costs related to childhood obesity (CO) with reference to different models of healthcare systems. A systematic review of the economic impact of CO on healthcare systems was conducted by searching the main electronic scientific databases. Cost-of-illness (COI) analyses of children aged under 18 years who had been diagnosed as overweight or obese published up to July 2010 were considered. Short- and long-term consequences of CO were taken into account. In order to appraise the quality of the included studies, the British Medical Journal referees' checklist was used. About 3,844 COI analyses were initially found and 10 were finally considered in the current review: two studies referred to Beveridge and eight referred to Voluntary health insurance models. No studies have been conducted within a Bismarck model. Six studies considered in-patient costs, four studies estimated outpatient and primary care costs and seven studies considered pharmaceutical costs. The average quality of the included analyses was medium. The analysis confirmed the significance of CO related costs and the heterogeneity among available studies, which made it impossible to compare the different healthcare models.