Pulmonary rehabilitation: An exercise in improvement – combined clinical and organisational audit 2017

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Pulmonary rehabilitation: An exercise in improvement presents the findings from the snapshot pulmonary rehabilitation (PR) organisational audit (conducted between 3 January and 28 April 2017) and clinical audit (conducted between 3 January and 31 March 2017) across England and Wales.  

A quality improvement (QI) slide set, focused on the key findings from both the clinical and organisational audit, is also available.

Key recommendations

Reduce waiting times for enrolment to PR (from receipt of referral) with an achievement target of 85% of patients being enrolled within 90 days for each PR programme.

  • PR programmes should ensure that all patients referred for PR should be enrolled to the programme within 90 days of receipt of the referral.
  • PR services that solely run cohort programmes could consider switching to rolling programmes (or using a combination of both) to reduce waiting times.

Each PR service should ensure that all exercise assessments are performed to recommended technical standards. This includes the routine conduct of practice walks and the use of walking course lengths appropriate to the test used.

  • Care processes should be reviewed by PR programmes to ensure that they meet British Thoracic Society (BTS) guidelines and quality standards. Particular attention should be paid to ensure that:
    • exercise testing at assessment is performed to accepted standards
    • exercise training is accurately prescribed from an exercise test performed at assessment
    • patients are provided with a written, individualised exercise plan at discharge from PR.

PR programmes should achieve patient completion rates of 70% or more following assessment for PR.

  • System leaders should prioritise measures to enhance referral and completion of PR, including developing integrated referral pathways between PR services and other healthcare teams managing COPD.

How to use this report

Both results and data analysis reports contain the full data analyses from which the key findings and recommendations have been derived, along with the full methodology for the audits. The data are presented largely in tabular form, with explanatory notes throughout. Whilst these are available to the interested reader, it is not necessary to review them to appreciate the key messages within the national pulmonary rehabilitation combined clinical and organisational audit report.


National report

This is the national pulmonary rehabilitation combined clinical and organisational audit report. It contains key findings, quality improvement opportunities and recommendations based on both the snapshot clinical and organisational audits of pulmonary rehabilitation services conducted in England and Wales 2017.

Results and data analysis

The results and data analysis reports for both the organisational and clinical audit are available to download along with a document containing nationally benchmarked results for individual PR services.

QI focused slide set

This slide set pulls together the key findings of the report, with a QI focus.

The national reports from the previous PR clinical audit (conducted in 2015 and published in 2016) and organisational audit (conducted and published in 2015) are also available.