Response by Joseph Goss, Delegate
Thank you for your comment on setting a definitive number of respiratory therapists providing care to ventilated patients. Chapter 43G subchapter 31.5 (N.J.A.C. 8:43G-31.5) of the NJ Hospital Licensing Standards states “[t]here shall be at least one licensed respiratory care practitioner assigned primarily to patients in licensed critical care units. Assignments shall be based on the acuity level of patient illness assessed each shift.” Therefore, all hospitals should have this acuity system in place for intensive care units. But the law does not provide for a set ratio for therapists to ventilated patients. It only identifies the department has a system in place to address a ratio.
California is the only state we are aware that has a set patient to therapist ratios. “In critical care units, burn units, labor and delivery, post anesthesia units, and any other specialty units, one respiratory therapist per four patients who are receiving respiratory care as ordered by a physician.” There is no acuity requirement for the ratio. This is the opposite of New Jersey’s approach of permitting the department to better judge staffing needs.
The CA law’s ratio approach might sound great on paper but what if acuity changes? Should there be more or less therapists during a given shift? How does this affect budgeting? Would a hospital take services away from respiratory care and reassign them to another department?
The problem is the lack of evidence to support a patient to therapist ratio. A study out of Johns Hopkins University published in 2013 noted “a multi-component intervention, including an increase in RT/patient ratio, improved RT orientation, and the establishment of a core staffing model was associated with increased respiratory resource utilization.”1 The article alluded to a ratio of 1 to 9 as being ideal but that did not account for acuity. It also did not identify whether this was for all patient care areas or just ICUs.
An unpublished report by Robert Chatburn noted “[t]here are neither official AARC Guidelines nor benchmark data suggesting appropriate staffing levels in hospital ICUs.” “This leads to a continual situation of either over- or under-staffing, resulting in either inefficiency or poor staff morale / reduced patient care standards.”2 Once again, research is unclear on the approach to staffing based on ratios.
The best solution to utilizing therapist time is for department directors to use an objective acuity system in planning shift staffing.
- Parker, Ann M; Xinggang Liu; Anthony D Harris; Carl B Shanholtz; Robin L Smith; Dean R Hess; Marty Reynolds and Giora Netzer; Respiratory Therapy Organizational Changes Are Associated With Increased Respiratory Care Utilization. Respiratory Care March 2013, 58 (3) 438-449; DOI: https://doi.org/10.4187/respcare.01562
- Chatburn, Robert L. Report: Staffing of Respiratory Care Practitioners in the ICU. Report Date: 3/2/16