RESUMO
Selection, standardization, and implementation of instrumentation and reagents throughout a health care facility network can often be a difficult process. However, in today's ever-changing health care setting, it is often mandated. The Veteran's Integrated Systems Network 16 (VISN 16) was faced with such a task early in 1999, with the targeted area being its coagulation laboratories. The plan outlined in this paper was drafted to help facilitate the selection, standardization and implementation of coagulation systems for 17 health care facilities that make up the VISN 16 network. The VISN, encompassing 170,000 square miles, has 10 tertiary care hospitals, six of which have close relationships with affiliate universities. There are 299,733 patients enrolled in this health delivery system. The facilities range from large institutions performing both tertiary and outpatient care to small outpatient clinics. Because of the plan's detailed, comprehensive content, which included analyses of a large number of performance parameters as well as cost-efficiency, the selection process was carried out using a checklist that could be helpful to other organizations selecting equipment and reagents for coagulation studies. An implementation process was devised, resulting in coagulation standardization across the Integrated Health Network.
Assuntos
Testes de Coagulação Sanguínea/instrumentação , Testes de Coagulação Sanguínea/métodos , Hospitais de Veteranos/organização & administração , Laboratórios Hospitalares/organização & administração , Patologia Clínica/instrumentação , Serviço Hospitalar de Compras/organização & administração , Autoanálise/instrumentação , Autoanálise/normas , Serviços Centralizados no Hospital , Proposta de Concorrência , Coleta de Dados , Tomada de Decisões Gerenciais , Hospitais de Veteranos/normas , Humanos , Indicadores e Reagentes/normas , Laboratórios Hospitalares/normas , Teste de Materiais , Serviço Hospitalar de Compras/normas , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estados Unidos , United States Department of Veterans AffairsRESUMO
Crohn's disease can involve any portion of the digestive tract, but isolated gastric Crohn's disease is a rare entity. In the few previously reported cases, the inflammatory disorder has involved only a portion of the stomach. Herein we describe a patient with diffuse involvement of the entire stomach and an associated gastrosplenic fistula but no evidence of involvement elsewhere in the gastrointestinal tract. Usually, a patient with isolated Crohn's disease of the stomach will have the clinical symptoms of nausea, vomiting, and epigastric pain and radiographic evidence of a small contracted stomach (or, occasionally, a huge dilated stomach). Because the condition may suggest the presence of a malignant lesion and biopsy specimens often reveal nonspecific inflammation, surgical resection is usually necessary for diagnosis of isolated Crohn's disease of the stomach.
