Clausen, Jack L.

Gardner, Reed M.

English

The University of Utah: J. Willard Marriott Digital Library

--. American Thoracic Society 74-B Pulmonary Function Laboratory Personnel Qualifications Tms POSITION PAPER WAS ADOPTED BY THE ATS BoARD OF DIRECTORS, NovEMBER 1982. The clinical pulmonary function laboratory is a vital area which provides physiologic data to assess the pulmonary status of those pa-tients with pulmonary diseases. It is extremely important that the results of the physiologic tests reported from the clinical pulmonary fun ction laboratory be accurate and timely. Each clinical pulmonary function laboratory must have a Medical Director who is respon-sible for the training of the personnel, the quality and functional status of the equip-ment, as well as for the accuracy and interpre-tation of the results, which must be provided in a timely fashion to the clinicians who or-der the tests. The Medical Director must pos-sess expertise in pulmonary physiology, pos-sess a detailed know lege of pulmonary func-tion equipment, and be able to interpret pulmonary function test results within the context of the clinical setting (1). The ATS Committee on Proficiency St.ar)dards for Clin-ical Pulmonary Function Laboratories wishes to reaffirm the strong position the ATS has taken previously concerning the qualifications and responsibilities of the Medical Director of the pulmonary function laboratory (1). The ATS Committee on Proficiency Stan-dards for Clinical Pulmonary Function Laboratories has reviewed the existing infor-mation on personnel qualifications for those who work in the clinical pulmonary function laboratory (2-7). There are no data specify-ing the educational level necessary to initiate training of the technical staff. A recent sur-vey of pulmonary function personnel found that 25 o/o possessed a bachelor's degree, 63% had attained at least one year of education above high school, and 85% had received at least a high school education (2). Although the specific educational background of the remaining 15% was not determined, it was felt that virtually all were high school gradu-ates or the equivalent (2). Data do not exist stating the time necessary for the technical staff to become competent to run the tests or successfully troubleshoot the equipment. Also, no data have been gathered to deter-mine the educational background, tr.aining period, and experience necessary to become a competent supervisor or chief pulmonary function technologist (or technical director) . Thus, the Personnel Qualifications for the Pulmonary Function Laboratory Technical Staff (table 1), Supervisory Staff (table 2), and Chief Pulmonary Function Technologist (or Technical Director) (table 3) have been de-veloped from information supplied by physi-cians, pulmonary technologists, and respira-tory care personnel who direct or supervise the operations of the clinical pulmonary func-TABLE 1. PERSONNEL QUALIFICATIONS: TECHNICAL STAFF Minimal Educational Suggested Time Suggested Training Background to of Laboratory Time for Initiate Training• Trainingt (1) Trouble-Shooting (1) 1. ABG High School (HS) 6 mos. 1'12 yrs . 2. Spirometry H.S. 6 mos. 1 yr. 3. Flow volume studies H.S. 6 mos. 1 yr. 4. Lung volumes H.S. 6 mos. 1 yr. (dilutional techniques) 5. Plethysmography H.S. 6 mos. 1112 yrs. 6. DLCOss H.S. 9 mos. 1V> yrs. 7. DLCOss H.S. 12 mos. 2 yrs. 8. Exercise Testing H.S. 12 mos. 2 yrs. • A strong background in mathematics is recommended for the high school graduate; one year or more of college in tho physical and biologic sciences preferred. t Under the direction and responsibility of the Medical Director of the pulmonary function laboratory (1). Training is concurrent for each test . · TABLE 2. PERSONNEL QUALIFICATIONS: SUPERVISORY STAFF Minimal Educational Background • Pulmonary Function Laboratory Training and Experience t (1) Credentiart 1. ABG Pulmonary function technology; Respiratory therapy education ; or 2 yrs. of college in 2 yrs. Strongly recommended 2. Spirometry 3. Flow volume studies 4. Lung volumes (dilutional techniques) 5 . Plethysmography 6. DLCOss 7. DLCOss 8. Exercise Testing biological sciences and mathematics 2 yrs . 2 yrs. 2 yrs. 3 yrs . 2 yrs. 3 yrs. 3 yrs. Strongly recommended Strongly recommended Strongly recommended Strongly recommended Strongly recommended Strongly recommended Strongly recommended • B.S. or higher degree in the sciences or substantial experience in pulmonary function technology. t Under the direction and responsibility of the Medical Director of the pulmonary function laboratory (1). Training is concurrent for each test. :1: Credentials that are based on appropriate examinations in pulmonary function technology and are granted tiy rslevant profes-sional bodies. tion laboratory. These guidelines usually rep-resent neither the highest nor the lowest qualifications in each category, but are some-where in between. The recommended qualifications for the technical staff of the clinical pulmonary func-tion laboratory are shown in table 1. It is a consensus that a high school education with a stro11g mathematical background should be the minimum education for the techni-cal staff, although more preferable is one year or more of mathematics and the physical and biological sciences at a college level. The du-ration of training required before an individ-ual becomes competent to perform each pul-monary function test with minimal supervi-sion will vary according to the individual's backgmund, intelligence, aggressiveness, and the number of tests he or she has performed under supervision. The suggested length of laboratory training for the tests listed in ta-ble 1 was developed with the ·consideration that training for all tests performed in any pulmonary function laboratory would be con-current. Certainly, if the laboratory only per-formed arterial blood gases and/or simple spirometry, the training period necessary for the technical staff to become competent would be reduced considerably. The trainin& period necessary to reach competency in pulmonary function . test ing will be shortened also if the individual is a graduate in pulmonary func-tion technology independent ~f, or within, a respiratory therapy program. The training period necessary may be shortened if the in-dividual has graduated from a professional nursing program, or has accumulated a sub-stantial college background in mathematics and the physical and biological sciences. The Reprints may be requested from your state or local Lung Association. 623 G:Z4 TABLE 3. PERSONNEL QUALIFICATIONS: CHIEF PULMONARY FUNCTION TECHNOLOGIST (OR TECHNICAL DIREC1DR) PF Laboratory Minimal Training Educational and Supervisory Background• Experience t Credentiart: Experience 1. Lab performing spirometry Pulmonary function 3 yrs. Strongly 2 yrs. Strongly and/or ABGs technology; Res- recommended recommended piratory therapy education; or 2 yrs . of college in biological sci-ences and mathematics 2. Lab performing #1-4 4 yrs. Strongly 2 yrs. Strongly recommended recommended 3. Lab performing #1-5, 4 yrs. Strongly 2 yrs. Strongly !1 1-6 or #1-7, or #1-8 recommended recommended • B.S. or higher degree in the sciences or substantial experience in pulmonary function technology. t Under the direction and responsibility of the Medical Director of the pulmonary function laboratory. * Credentials that are based on appropriate examinations in pulmonary function technology and are granted by relevant profes-sional bodies. same statements apply to the training time required to become competent to troubleshoot pulmonary function equipment (table 1). The technical staff working in a p~diatric pulmo-nary function laboratory will need special training to instruct and test pediatric patients. Separate training in pulmonary function testing may of necessity be acquired outside of the individual's laboratory if no physician or qualified technologist is present to super-vise the training. As one progresses through training in the pulmonary function labora-tory, it is desirable that the individual enhance his background knowledge by acquiring col-lege credits, particularly in algebra, statistics, electronics, and physiology. The personnel qualifications for a super-visor working in the pulmonary function lab-oratory are listed in table 2. A supervisor in a large pulmonary function laboratory should have at least one of the following qualifica-tions: (1) an educational background in pul-monary function technology or respiratory therapy, (2) substantial experience in pulmo-nary function testing, (3) at least two years of college education in mathematics and the physical and biological sciences. An individual possessing a Bachelor of Science degree would be preferable. Before becoming a supervisor, an individual should have at least two years of training and experience performing tests if only arterial blood gases, spirometry, and di lutional lung volumes are performed. If more sophisticated tests are performed, the supervisor should have up to four years ex-perience (table 2). A supervisor should be able ro supervise the laboratory operations in-dependently and follow the protocols estab-lished by the Medical Director and the chief pulmonar·y' function technologist (or techni-.:al director). It is strongly recommended that a supervisor acquire a credential which is based on appropriate examinations that in-clude pulmonary function technology and which is granted by a relevant professional body. Regardless of whether or not a creden-tial has been attained, continuing education is essential. -The personnel qualifications for" the chief pulmonary function technologist (or techni-cal director) are listed in table 3. The educa-tional background of the chief pulmonary function technologist should be broader than that of a supervisor and, preferably, the in-dividual should possess a Bachelor of Science degree. The chief pulmonary function tech-nologist (or technical director) should have at least two years of supervisory experience in addition to the training and experience necessary to become a supervisor. It is strongly recommended that a chief technologist (or technical director) acquire a credential which is based on appropriate examinations that in-clude pulmonary function technology which is granted by a relevant professional body. Regardless of whether or not a credential has been attained, continuing education is essen-tial. Under the aegis of the Medical Director, a chief pulmonary function technologist (or technical director) should be able to write quality control protocols and assume respon-sibility for meeting federal, state, and the Joint Commission on Accreditation of Hospitals (JCAH) laboratory requirements. Although the Medical Director is responsible for qual-ity control within the laboratory, for statisti-cal analysis as applied to the quality control and operation of the laboratory, and for com-plying with the laboratory regulations of state, federal, or national regulatory agencies, the Medical Director may share this responsibil-ity with the chief pulmonary funct ion tech-nologist (or technical director), or with an-other individual so identified. The Medical Director is responsible for the decisions concerning the specifi.c pulmonary function tests offered by the laboratory (ta-bles 1 and 2) as well as the number of person-nel available to perform these tests. Those tests offered should meet the needs of the physi-cians involved in patient care in the area served by the laboratory. The majority of pulmo-nary function laboratories offer spirometry, arterial blood gases, and dilutionallung vol-umes, although the number of studies per-formed on a monthly basis may be small (7). Not every laboratory will need supervisory personnel or a chief pulmonary function tech-nologist (or technical director). Even though the majority of pulmonary function labora-tories ~equire few personneL(2, 7), these per-sonnel must be competent to provide accurate results. · It is our intent that these qualifications will apply to small and large clinical pulmonary function laboratories, whether located in the clinic, in a community hospital, or within a university medical center. Revision of these personnel qualifications will occur as more data become available. This position paper was prepared by the Committee on Proficiency Standards for Clin-ical Pulmonary Laboratories. Members of the Committee are: REED M. GARDNER, PH.D., Chairman JACK L. CLAUSEN, M.D. GARY EPLER, M.D. JOHN L. HANKINSON, PH.D. SOLBERT PERMUTT, M.D. ALAN L. PLUMMER, M.D. References I. George RB, et al. ATS Respiratory Care Com-mittee position paper: Director of the pulmonary function laboratory. ATS News 1978, 4:6. 2. National Board for Respiratory Therapy and the National Society for Cardiopulmonary Tech-nology. Pulmonary Function. Personnel Survey, 1982. 3. Abramson JF, Van Kessel AL. Laboratory management: Qualifica tions of personnel. In Clausen JL, ed, Pulmonary function testing guide-lines and controversies: Equipment, methods, and normal values. A project of the California Tho-racic Society. New York: Academic Press, 1982, pp. 7-14. 4. Kanner RE, Morris AH, eds, Clinical pulmo-nary function testing. Intermountain Thoracic So-ciety, 1975. 5. Ferris BG. Epidemiology standardization proj-ect. Am Rev Respir Dis 1978; 118:1-120. 6. Schweisinger DW. Pulmonary and blood gas laboratories: laws. regulations, standards, and safety. Los Angeles: Brentwood Publishing Co., 1981. 7. American Associat ion of Respiratory Therapy. Pulmonary function laborawry: quality control questionnaire, 1980. 

Pulmonary Function Laboratory Personnel Qualifications

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Pulmonary Function Laboratory Personnel Qualifications

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The University of Utah: J. Willard Marriott Digital Library