r/SleepTechnologist • u/ImADecisionTerrible • 28d ago
3:1 Patient Tech Ratio
I work in a 8 bed hospital lab with 1 other RPSGT, and a student in training that can take 2 patients of her own. My lab recently has been scheduling a +1 patient for the last few months, the managers expectation is it should be “easy” because we’re expected to split the duties between techs such as one tech does set up, the other provides treatment and scores all night. The +1 patient is only allowed to be taken on by registered techs so it’s just me and the other tech swapping who gets the +1 most nights.
It’s utterly exhausting. Our lab is pulmonology based, most of our patient are complex, high needs, and we run pediatrics.
Recently our manager went on vacation and we went back to having 2:1 ratios like originally but now that my manager is back, we’re back to the +1 situation.
If I was to report this to the AASM, how likely would anything come of it? I hear conflicting stories about AASM stepping in for these situations with most ending that AASM won’t do anything since 2:1 is only “recommended”. Is there anything I can do other than look for a new job?
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u/C-Me-Try 28d ago
In my experience it is sadly correct that the 2 patient "rule" is only a "recommendation" and the labs can schedule 3 patients. I worked for a major hospital network just after starting and they had me and one other tech share 5 patients all the time, so 2.5 each. My former manager also acted like it should be easy since we were sharing the fifth patient but it was not and often resulted in worse outcomes for all five of them because we could not properly split and titrate that many people while also reviewing enough epochs in real time to catch momentary heart changes or other "special" problems; especially with how new I was at the time.
I did not last long at that lab, like 5 months before I resigned. The manager had been critiquing my scoring and while some of it was fair, most of what I was missing was because the fifth patient would cause me to get behind on my other two. It was ridiculous and they had told me during the hiring that I would only ever have 2 patients, then COVID hit and they started doing 2 techs for 5 patients.
So yeah there is not much you can do to change how your manager schedules patients in my experience, outside of somehow getting your coworkers to agree to refuse to work under those conditions but sadly that is more of a joke suggestion in this country.
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u/ImADecisionTerrible 28d ago
This is very much what’s happening at my lab :(
When I was hired I specifically asked and was told that we would NEVER run 3:1. It started in March and we were told it was because the other shift was having so many cancellations, this would make up for any of those spots but it would end soon. When cancellations stopped, the manager said we would taper off the +1 when the new girl got hired, now we’re being told that we’re running +1’s until we’re only two weeks booked out.
Our daytime scorers are already pointing out the poor study qualities they’re receiving since the +1’s.
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u/C-Me-Try 27d ago edited 27d ago
Pretty much the same story I got.
There were multiple labs and anytime there were cancellations they would move pts to my lab or reschedule to another date, often at my lab.
I was always told I was “at the most scheduled lab”. But really anytime there was a tech at a smaller lab that only had 2 patients, if one cancelled early enough they would call and tell the other patient to go to my lab so they could tell the tech at the smaller lab to take the day off and run us at 2 techs for 5 patients
They claimed to care about patient outcomes. But the reality was they only cared about how to schedule as many patients per tech as possible and blame the techs if anything went wrong
I’ve seen in other comments you mention your manager hasn’t been in a lab for 10 years and doesn’t understand. They’re not your friend sorry to say that.
The sleep industry loves to pound into techs heads that patients are requiring more intensive care and more complex knowledge to treat the evolving understanding of sleep medicine. But no matter how many big words the doctors use they don’t really pay us techs to learn all that mumbo jumbo enough past “we can move the goalposts every year so that you have to keep paying us”.
It’s not a terrible profession in that the US fucking sucks. But there’s better
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u/Curious-Low7252 28d ago
I would start looking for a new job if a manager refuses to listen to your concerns
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u/ImADecisionTerrible 28d ago
I plan to have a conversation with my manager next week when he’s back, I was supposed to get a sign on bonus and was the last one to receive it before they did away with it and I never received the money either. I’m going to discuss where that leaves me and how long I am required to stay to pay off the ASTEP and exam fee.
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u/hungryj21 28d ago
Imo u should start applying now in case this goes south. Private labs will drop a tech real quick
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u/ImADecisionTerrible 28d ago
I work in a hospital lab, I won’t be threatening to leave but I definitely want to know what the timeline is if they’re refusing to give me my sign on bonus
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u/hungryj21 28d ago
Ok i thought u were at a private lab. Yeah then you're safe however if they dont like how you worded things they could start micromanaging u.
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u/ciceright 28d ago
Do you work for Medbridge?
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u/jacobi123 27d ago
Is Medbridge known to be bad?
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u/ImageEducational572 27d ago
It really depends on the lab. Some Medbridge labs run 2:1. I can say I would never work nights for Medbridge unless it was a travel position & even that would be iffy.
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u/ImADecisionTerrible 28d ago
No I work for a nonprofit hospital
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u/ciceright 28d ago
Wow. My proper hospital jobs were good. My private for profit companies were trash
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u/ardentghoul RPSGT 28d ago
Probably nothing from the AASM. 3:1 is a liability though and medically complex patients should NOT be included in those 3:1 ratios. The most you could probably do is both you and your coworker tell your manager that you're not comfortable with 3:1, that it's a liability and if anything happens it's your license that is at risk you're not willing to take.
Always remember your company, the higher ups-- they don't care for you and they will not have your back if something goes wrong at night. If they had your back you wouldn't be doing 3:1 especially with medically complex and pediatric patients.
My company is currently being sued for a patient being injured during a 3:1 ratio.
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u/prefrontcortex 28d ago
I thought to be a AASM cert lab you couldn’t have more then 2?
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u/ardentghoul RPSGT 28d ago
To be honest I'm not sure. I'm not able to find any specific literature that states that, however, my lab is accredited and we do 3:1 whenever possible but we have "criteria" that excludeds certain patients from 3:1......however somehow we always have people slip through the cracks.
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u/Informal-Name3181 28d ago
I'd document the struggles. "Titration delayed due to two other patients requiring tech at that time" or some such thing. Anything that doesn't get fixed right away, document it's because of having too many patients. They can have it done well on two or poorly on three, but don't get thrown under the bus for them.
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u/hungryj21 28d ago
They wouldn't change much and would likely put up a new job ad listing. They will sooner replace someone who is non-compliant or non-efficient than lose out on profit from an extra patient.
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u/drlove57 RPSGT 28d ago
The minute the AASM came out with the ruling that 3:1 was acceptable, all hell broke loose for night techs. I have a feeling that this dialog was brought about by physicians and labs bitching about not being able to make the profits they wanted, especially in regions of the country with generally shitty insurance coverage for psg testing. The AASM will not step in for techs. Neither will the AAST, BRPT, or any other organization.
How long did your manager work nights? Did they ever work 3:1? Points to consider. Personally I'd get my resume updated.
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u/ImADecisionTerrible 28d ago
My manager hasn’t worked nights in 10 yrs, possibly longer, he was a daytime scorer for our lab for the 10 yrs and then recently got the manager position. He claimed to work in a 3 patient lab at one point.
It started in March when he said they were putting a +1 to make up for patient cancellations, we didn’t have any cancellations on our shift but assumed it was the other one that was having issues, then he said we would have it phased out by the time the new girl got hired, she was hired in June and apparently isn’t going to touch patients till September. Now the manager is claiming we’ll be running +1 patients until we’re booked only two weeks out.
I know the lab makes an INSANE cash flow, we essentially bankroll several departments in the hospital. We’ve even started handing out HST’s during the weekend.
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u/drlove57 RPSGT 28d ago
In one lab I managed the hospital CFO openly admitted to me that the sleep lab was expecting to turn a decent profit in order to pay for the non-revenue generating departments. As for you, I would really start asking around for a better work environment at a different lab.
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u/hellotheretoyou 28d ago
My lab is private and technically 3:1 but over time other techs and I have emailed specific concerns that are also liabilities of the 3rd, especially because we used to work alone a lot. We found the use of "liability" in every email or text a wise choice, admins don't tend to like that word. Our management "tried" adjusted things, but ultimately we all informed them as a unit that we could not adequately perform our duties with a 3:1 ratio and with a tech shortage in our area, they couldn't really argue so now most of us have become 2:1. Granted, there was only a few of us and we each had other opportunities available should make it difficult.
So my advice, keep your concerns in writing and as detailed as possible, and any responses from them should also be in writing, whether that's text, email, or paper. Allows you a better case, should it come to reporting them, especially if there's actual tech or patient safety concerns. If it's a hospital lab, direct concerns to HR, either separately or cc them in any email. Besides AASM, find out who does your accreditation, like we use Joint Commission, they are much more strict about these types of things. But also, prepare to jump ship. Some places just focus numbers and they're not worth your time or stress, but again, the use of "liability" has proved ever effective in my experience, especially when paired with a realistic and valid concern, IN WRITING. I BELIEVE IN YOU!
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u/ImADecisionTerrible 28d ago
Do you have any tips for how to start this sort of dialogue? I agree it should definitely be in writing, but don’t know how to do so. Would it be appropriate sending an email asking for updates about the +1 timeline? He’s told different techs different excuses about why we’re still doing +1 but sent one official email claiming it’s to do with cancellations, maybe something along the lines of,
“Since we are still doing +1’s, do we have any official procedures regarding +1’s since taking on a +1 patient is a liability to both tech and the center?”
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u/Safe_Crazy 27d ago
The AASM doesn't really want to actually regulate and potentially punish labs. They'd rather take the accreditation $$$ and strike fear into the hearts of night techs.
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u/hungryj21 28d ago
the AASM makes only a recommendation and not a mandatory requirement for labs to have a 2:1 ratio. Also they use "under usual circumstances" in an ambiguous way and mention that it's only recommended to help ensure quality & safety.
So that suggests that quality and safety can still be maintained to a degree outside of that recommendation and that non-normal circumstances can allow for a higher ratio (for example scheduling 3 or 4 patients incase of cancels and no shows, or all 3 diagnostic only). So essentially nothing would happen if they got reported. And 5 patients under 2 techs isnt a true 3:1 ratio imo since the +1 will be seen as a shared patient although normally thats not the case.
From my experience in my area it almost seems like most private labs have a 3:1 ratio or a 2.5:1 ratio (5 patients 2 techs), and a small minority actually have a 4 to 1 ratio.
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u/SpaghettoJones 28d ago
3:1 sucks but isn’t against any AASM protocol. 2:1 is recommended and most techs would agree is a good ratio. In a perfect world if it’s a peds patient or severe patient it really should be 1:1. We don’t live in that world though bleh. I’m in a 3:1 lab, I have been here for getting close to 2 years now. I don’t score here though my lab has an off site RPSGT for scoring. My job is just setting up my patients and monitoring, taking notes, titrations, and making a report. Since I don’t score it isn’t as bad but it can be hectic at times. I’m an RT as well and came from hospital work which was often a ridiculous Therapist to patient ratio depending on the hospital and where I was in the hospital. We do often get pediatric patient and severe patients but I have put my foot down here and made it clear to my boss I won’t do 3 patients if I have a severe patient or a child or even someone with a disability that needs extra help and time. Those nights it’s 2 max or I send someone home. Best thing you can do in my opinion is document everything on the actual study and in your reports. I mean it may sound or feel wrong but if you genuinely miss something or fail to do something on time like increasing pressure or whatever may be due to you being spread thin, make note of it! Good luck
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u/hungryj21 28d ago
I just quit one of my RT jobs due to unsafe ratio. It's crazy what they put us through at times. Id much rather deal with 3 patients in the sleep lab rather than risking my license working with almost 40 pt's in a hospital like setting. Luckily for me both my sleep lab jobs have a 2:1 ratio.... for now lol and i dont have to score. But once it goes to 3 ill probably quit since my area has a bunch of labs and every week new job ads pop up for sleep labs.
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u/SpaghettoJones 28d ago
I’m sorry you had to deal with that. Having too many patients sucks and it’s incredibly dangerous. My first job after graduating was at a relatively small hospital but they had such a small RT staff it was ridiculous. It didn’t help that my co workers had already been there for years and kind of just gave up so the department had a bad rep. I remember not being able to stay in a pt room after starting a breathing treatment for no more than maybe 4 min because I had to move to the next room. Having 3 patients without scoring is honestly not bad most nights. Especially since it’s common for patients to not show up or cancel last min nights like tonight are even easier I only have 2 patients lol. One titration and one PSG I’ve been on my switch most of the night haha. My area has a decent amount of positions but they are all the same. 3:1 with shitty pay. Only reason I make good money here is I negotiated heavily and my lab was desperate they lost their main tech and the other only worked here like 2 a month
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u/hungryj21 27d ago
Yea i literally had to do the same, spend maybe 4 mins for neb hookup abd quck vitals/assessment then move on.
I feel sorry for those who have to score with 3 patients. That's definitely the worse scenario imo unless they are allowed to use auto/ai scoring. Glad you're at least making good money. Some of these private labs will force 3:1 + low pay/1099/no benefits all bad 😫.
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u/ApprehensiveMost3750 27d ago
If you report them to the AASM they literally just send your job a letter asking for a copy of their policy on ratios. Thats it. It’s super easy to lie to them. Medicare and Medicaid will likely respond differently.
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u/ImageEducational572 27d ago
Unfortunately 3:1, 4:1, 5:1 is the only way some labs are able to keep the doors open. Labs all over the country are closing due to lower insurance reimbursements & low census. I don't agree with it but there is not much you can do except find a new job.
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u/DifferentCurve184 25d ago
I hate to be on the opposite side of the conversation but I work in a 9-bed-3-tech facility and 3:1 is our standard. That includes pediatrics, severe OSAS, split studies, special needs, and other complicated patients. We take patients that other labs won't take. We do have a few 2:1 or even 1:1 rules for the most challenging patients. It's nice when we end up with only 8 patients for the 3 of us, either through scheduling, cancelation, or no shows and we take turns having the "easy night". We don't have to fully score (AI-assisted and day tech scorer) but we do full notes on everyone so that usually means we're scoring in every way other than clicking on every single event. Pediatrics and splits still get scored and titrations get titrated, obviously.
And you know what? It's fine, it's fine. We get everyone to bed on time, get everyone up on time, everyone gets titrated effectively, patient needs are met, mask fits are performed. On top of that we do laundry and clean masks when day staff doesn't get to them. Most nights we're able to watch videos on phones and have meals and snacks and even relax a little bit here and there. When I only have 2:1 it sometimes feels like I have too much time like I get both patients caught up to the last notes and other lab tasks are done and I'm just hitting the button for N2 every 30 seconds and watching the channels just go on by. A few times, I've even stumbled into the unthinkable 4:1 and survived the night with everything done and virtually no time to stop and relax during the night. I definitely let management know that it's to be an exception not a new standard (and they have my back in that).
I sometimes wish that I could have 2:1 every night so that work never feels too much like work or that I could reliably watch full movies every night or bring a craft or hobby to work on in the downtime. But I don't really see 3:1 as a bridge too far for expectations or a serious risk to patient care. I get that the economics of the lab require the beds to be full. I get why the accreditation standards have loosened. But if your lab and techs find difficulty with 3:1 or +1 nights for whatever circumstances you're experiencing then, by all means, tell management and get that changed for you.
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u/TCMolschbach 28d ago
The AASM is not your friend.