Electron Microscopy in Veterans Administration Hospitals:

Planning, Distribution, and Control Need Improvement

HRD-78-75: Published: Jul 19, 1978. Publicly Released: Jul 19, 1978.

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The electron microscope (EM) is a device which produces highly magnified images used in clinical diagnostic applications to examine the microstructure of thin sections of biological tissue. Individual EM's in Veterans Administration (VA) hospitals have cost up to $82,000, and a complete EM unit, including remodeled facilities, purchase and installation, darkroom, and photographic equipment and supplies may cost from $150,000 to $200,000. EM activities were reviewed at 15 VA hospitals in 8 of the 28 VA medical districts.

The VA central office has permitted the establishment of EM units in locations without adequately determining their need. VA has not followed its stated policy that specialized medical services, including electron microscopy, be planned and provided on a regionalized basis to avoid duplicating or overlapping these costly medical programs. Some of VA EM units are underused; from July 1974 to December 1976, 15 of 42 diagnostic EM units examined less than 250 specimens annually (the current use standard). Plans to install EM units have not been formally coordinated at the national, department, or medical district level. The current practice of assigning separate EM's to the Pathology Service and the Medical Research Service, both within the VA Department of Medicine and Surgery, impedes the most effective use of these instruments.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Administrator of Veterans Affairs should: (1) direct the Chief Medical Director to make a systemwide study to determine the feasibility of establishing joint Pathology and Medical Research Services utilization standards for both diagnostic and research electron microscopes; (2) ensure continuing compliance with VA regulations to terminate electron microscope programs when the programs cannot be justified on the basis of available work load; (3) require that the VA electron microscope inventory be updated to accurately reflect all electron microscopes within VA system; (4) direct that VA medical districts be given more responsibility for the planning, distribution, and utilization of EM's; and (5) require formal sharing agreements to make the best use of the medical district's resources.

    Agency Affected:

 

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