Staffing exercise sessions in pulmonary rehabilitation

There is no published standard for the ratio of staff to patients during exercise sessions in outpatient pulmonary rehabilitation. This lack of a standard raises concern about patient safety and the ability to monitor patients adequately.

Determine a staff-to-patient ratio standard by examining current practice.

The directors of the 46 outpatient pulmonary rehabilitation programs in Ohio were surveyed. Directors of 40 (87%) programs responded, and the responses from the 36 programs that conducted pulmonary exercise sessions separately from cardiac sessions were analyzed.

The maximum number of staff in an exercise session was 2, with a median of 1. The maximum number of patients in a session was 20, with median of 4. Directors were also asked to rank the importance of 8 factors in determining the reported ratio. From highest to lowest importance, the factors were patient safety, severity of pulmonary disease, availability of space or equipment, entry test data, pulmonary diagnosis, presence of cardiac problems, convenience, and other. Sixty percent of programs restricted the number of patients per session based on staff-to-patient ratio.

Statewide practice for staff-to-patient ratio in Ohio was described. The most common staff-to-patient ratio during exercise sessions was 1:4 or less (78%). Exercise staff work with small groups in order to assure patient safety, to deal with patients' health problems, and to provide adequate facilities. A majority of programs restrict the number of patients per session so as to enforce the reported ratio.