Because of the social importance of hospitals, characterized by energy-intensive users, large-scale refurbishment projects for these types of buildings are required. With the aim of helping researchers and designers, this paper proposes a multistage methodological approach for the optimization of retrofit designs based on energy, environmental, and economic indicators. Some guidelines are also highlighted thanks to the results obtained from a case study of a private hospital in Naples (Southern Italy, Mediterranean climate) located in a constrained landscape area. The first step consists of the calibration of a simulation energy model defined via in situ investigations, direct surveys and monitoring of energy loads and indoor quality. Then, the model is used to verify the effectiveness of several efficiency measures regarding the building envelope, the active energy systems, and the energy conversion from renewables in order to minimize the energy demand with acceptable economic profitability. This case study demonstrates that electricity demand can be reduced by up to 48% with an investment of around EUR 720,030.00; the payback time without national incentives is 10 years, but it can be halved with appropriate financial support.
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