Department of Cellular Pathology, Leicester Royal Infirmary, Leicester, UK.
J Clin Pathol. 2012 Apr;65(4):357-61. doi: 10.1136/jclinpath-2011-200601. Epub 2012 Jan 28.
Electron microscopy (EM) remains essential to delivering several specialist areas of diagnosis, especially the interpretation of native renal biopsies. However, there is anecdotal evidence of EM units struggling to survive, for a variety of reasons. The authors sought to obtain objective evidence of the extent and the causes of this problem.
An online survey was undertaken of Fellows of the Royal College of Pathologists who use EM in diagnosis.
A significant number of EM units anticipate having to close and hence outsource their EM work in the coming years. Yet most existing units are working to full capacity and would be unable to take on the substantial amounts of extra work implied by other units outsourcing their needs. Equipment and staffing are identified by most EM units as the major barriers to growth and are also the main reasons cited for units facing potential closure.
In the current financial climate it seems unlikely that units will be willing to make the large investment in equipment and staff needed to take on extra work, unless they can be reasonably confident of an acceptable financial return as a result of increased external referral rates. The case is thus made for a degree of national coordination of the future provision of this specialist service, possibly through the National Commissioning Group or the new National Commissioning Board. Without this, the future of diagnostic EM services in the UK is uncertain. Its failure would pose a threat to good patient care.
电子显微镜（EM）仍然是提供几个专业诊断领域的关键，特别是对原生肾活检的解释。然而，有一些传闻证据表明，由于各种原因，EM 部门难以生存。作者试图获得客观证据来证明这个问题的程度和原因。
对使用 EM 进行诊断的皇家病理学院研究员进行了在线调查。
相当数量的 EM 部门预计在未来几年将不得不关闭并将其 EM 工作外包。然而，大多数现有部门都在满负荷运转，如果其他部门将其需求外包，他们将无法承担大量额外的工作。设备和人员配备是大多数 EM 部门认为是增长的主要障碍，也是面临潜在关闭的部门主要提到的原因。
在当前的财务环境下，除非他们能够合理地确信由于外部转诊率的增加而获得可接受的财务回报，否则部门似乎不太愿意对设备和人员配备进行大量投资以承担额外的工作。因此，有必要在一定程度上对未来提供这项专业服务进行国家协调，可能通过国家委托小组或新的国家委托委员会来实现。如果没有这种协调，英国诊断性 EM 服务的未来将是不确定的。它的失败将对良好的患者护理构成威胁。
