Transcript Chapter 2: Health Care Administration in Athletic Training

Chapter 2: Health Care
Organization and
Administration in Athletic
Training
© 2011 McGraw-Hill Higher Education. All rights reserved.
System of Healthcare
Management
• Strategic Plan Development
– Determine why there is need for such a
program
– Determine function of program and what
the goals should be
– Decision of administrators will determine
extent of health care program in athletic
training
– Develop written mission statement to focus
direction of program
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Strategic Plan Development (cont.)
– Strategic plan development must include
administrators, other allied healthcare
providers, student-athletes, coaches,
physicians, athletic trainers, parents and
community health leaders
– Ongoing process that reviews strengths
and weaknesses of program
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Development of Policy & Procedures
Manual
– Creation of policies and procedures for all
involved in health care
– Policies = clear written out statements of
basic rules
• Critical element for operation of athletic training
clinic
– Procedures = describe the process
© 2011 McGraw-Hill Higher Education. All rights reserved.
Issues Specific to Athletic
Training Program Operations
• Scope of Program
– Who will be served by program?
– Athlete: to what extent and what services will be
rendered (systemic illness, musculoskeletal
injuries)
– Institution: who else can be served medically and
educationally and what are the legalities
– Community: outside group and community
organizations with legalities again being an issue
© 2011 McGraw-Hill Higher Education. All rights reserved.
Providing Coverage
• Facility Personnel Coverage
– Appropriate coverage of facility and sports
– Setup of treatments, rehabilitation, game
and practice coverage vary
• Sports Coverage
– Certified athletic trainer should attend all
practices and games
– Different institutions have different levels of
coverage based on personnel and risks
involved with sports
© 2011 McGraw-Hill Higher Education. All rights reserved.
Hygiene and Sanitation
• Athletic Training Clinic
– Rules concerning room cleanliness and
sanitation must be set and made known to
population using facility
– Operation should abide by policies set forth
by OSHA
– Examples
•
•
•
•
•
No equipment/cleats in the athletic training room
Shoes off treatment tables
Shower prior to treatment
No roughhousing or profanity
No food or smokeless tobacco
© 2011 McGraw-Hill Higher Education. All rights reserved.
– Cleaning responsibilities should be
addressed appropriately by athletic training
staff and custodial staff
– Division of responsibilities
– Maintenance crew
• Sweep floors daily, clean and disinfect sinks
and tubs, mop hydrotherapy room, empty
waste baskets
– Athletic Training staff
• Clean treatment tables, disinfect hydrotherapy
modalities daily, clean equipment regularly
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Gymnasium (general issues concerning
facility and equipment cleanliness)
– Facility
• Cleaning of gymnasium floors
• Drinking fountain and shower/locker facility
disinfecting
• Mats cleaned daily (wrestling)
– Equipment and clothing
• Proper fitting equipment
• Frequent clothing and equipment laundering
• Appropriate equipment for weather conditions
• Use of clean dry towels and equipment daily
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Athlete
– Promotion of good health and hygiene is
critical
•
•
•
•
•
•
•
Prompt injury and illness reporting
Follow good living habits
Showering after practice
Avoid sharing clothes and towels
Exhibit good hygiene practices
Avoid common drinking sources
Avoid contact with athletes with contagious
disease or infection
© 2011 McGraw-Hill Higher Education. All rights reserved.
Emergency Telephones
• Accessibility to phones in all major
areas of activity is a must
• Should be able to contact outside
emergency help and be able to call for
additional athletic training assistance
• Radios, cell and digital phones provide
a great deal of flexibility
© 2011 McGraw-Hill Higher Education. All rights reserved.
Budgetary Concerns
• Size of budget
• Different settings = different size budgets and
space allocations
• Equipment needs and supplies vary
depending on the setting (college vs.
secondary school)
• Continuous planning and prioritizing is
necessary to effectively manage monetary
allocations to meet programmatic goals
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Supplies
– Expendable
• Involves supplies that cannot be reused- first aid
and injury prevention supplies
– Non-expendable
• Re-useable supplies - ace wraps, scissors…etc)
– Yearly inventory and records must be
maintained in both areas
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Equipment
– Items that can be used for a number of
years
– Capital (remain in the athletic training
facility including ice machine, tables)
– Non-consumable capital (crutches, coolers,
athletic training kits)
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Purchasing Systems
– Direct buy vs. competitive bidding
– Lease alternative
• Additional Budget Considerations
–
–
–
–
Telephone and postage expenses
Utilities – heating/cooling, electricity
Contracts for outside services
Purchases relative to liability insurance and
professional development
© 2011 McGraw-Hill Higher Education. All rights reserved.
Developing a Risk Management
Plan
• Security Issues
– Accessibility to athletic training clinic (staff,
physicians, athletic training students)
– Athletic training students must be
supervised when in the clinical setting
– Coaches may have access in secondary
school settings
• Fire Safety
– Post evacuation plan in case of fire
– Smoke detectors/alarm system and fire
extinguisher should be tested and in place
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Electrical and Equipment Safety
– Major concern
– Be aware of power distribution system to
avoid accidents
• Emergency Action Plan
– Accessing emergency personnel outside
setting in the event of emergency
– Include transportation of athletes to
emergency facilities
– Meeting with outside personnel is necessary
to determine roles and rules regarding athlete
and equipment care
© 2011 McGraw-Hill Higher Education. All rights reserved.
Accessing Community Based
Health Services
• Must have knowledge of local and
community health services and
agencies in the event of referrals
• Referrals should be made with
assistance from a physician
• Parental involvement is necessary
when dealing with psychological and
sociological events
© 2011 McGraw-Hill Higher Education. All rights reserved.
Human Resources and
Personnel Issues
• Assembling appropriate personnel to achieve
program goals and objectives is critical to
success.
• Recruitment, hiring and retaining qualified
personnel is necessary to be effective
• Specific policies are established relative to
hiring, firing, performance evaluations and
promotions
– Must adhere to these principles
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Roles and responsibilities must be
established
– Job descriptions - job specifications,
accountability, code of conduct, and scope
• Head athletic trainer must serve as a
supervisor and work to enhance
professional development of staff
• Performance evaluations should take
place routinely
© 2011 McGraw-Hill Higher Education. All rights reserved.
Athletic Training Facility
Design
• Design will vary drastically based on
number of athletes, teams, and various
needs of the program
• Size
– Varies between settings
– Must take advantage and manage space
effectively
– Interact with architect relative to needs of
program and athletes
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Location
– Outside entrance (limits doors that must be
accessed when transporting injured
athletes)
– Double door entrances and ramps are
ideal
– Proximity to locker rooms and toilet
facilities
– Light, heat and water source should be
independent from rest of facility
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Illumination
– Well lighted throughout
– Reflective ceilings and walls will aid in
process
– Natural lighting is a plus
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Special Service Areas
– Treatment Area: area that accommodates
4-6 adjustable treatment tables, 3-4 stools,
and hydrocollator and ice machine
accessibility
– Electrotherapy Area: area that houses
ultrasound, diathermy, electrical stim units,
storage units, grounded outlets, treatment
tables and wooden chairs, under constant
supervision
© 2011 McGraw-Hill Higher Education. All rights reserved.
– Hydrotherapy Area: area with centrally
located sloping floor to drain, equipped with 23 whirlpools, shelving and storage space and
outlets 5 feet above the floor
– Exercise Rehabilitation Area: area that
provides adequate space and equipment to
perform reconditioning of injuries
– Taping, Bandaging & Orthotics Area: 3-4
taping tables and storage cabinets to treat
athletes with proximity to a sink
© 2011 McGraw-Hill Higher Education. All rights reserved.
– Physician’s Exam Room: space for
physician to work which may hold exam
table, lockable storage, sink, telephone
– Records Area: space devoted to record
keeping which may include filing system or
computer based database, that allows
access only to medical personnel
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Storage Facilities
– Athletic training facilities often lack ample
storage space
– Storage in athletic training room that holds
general supplies and special equipment
– Large walk-in storage cabinet for bulk
supplies
– Refrigerator for equipment, ice cups,
medicine and additional supplies
– Space should be designated for storage of
patient belongings
© 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 2-2
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Athletic Trainer’s Office
– Space at least 10x12 feet is ample
– All areas of athletic training facility should
be able to be supervised without leaving
office space (glass partitions)
– Equipment should include, desk, chair,
tack board, telephone, computer and
independent locking system
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Additional Areas
– Pharmacy Area: separate room that can be
secured for storing and administrating
medications (records must be maintained
concerning administration)
– Rehabilitation Pool: if space permits, must
be accessible to individuals with various
injuries, with graduated depth and non-slip
surface
– Restrooms: Should be at least one
available within the facility
© 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 2-1
© 2011 McGraw-Hill Higher Education. All rights reserved.
Issues Specific to Athletic Training
Program Operations in Clinic, Hospital
Corporate of Industrial Settings
• Staff must be prepared to provide care to a
wide range of patients
–
–
–
–
Pediatrics
Adolescents
Young adults and adults
Geriatric patients
• May also involve additional duties in
management, marketing, outreach, along with
fiscal and financial responsibilities
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Scope of Practice
– Diverse patient population
– In hospital settings time may be spent with inpatient, out-patient and/or ambulatory care
– Owner of out-patient facility will dictate patient
population seen at clinic
– The AT may be involved with patient care,
onsite employee fitness, ergonomics, work
hardening programs, outreach programs,
athletic event coverage
– Limitations and restrictions will be dictated by
state regulatory statutes
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Location of Clinic
– Patient base is critical and therefore
location is key to attracting patients
– Other factors
•
•
•
•
Zoning
Traffic concerns
Physician referrals
Will physicians use athletic trainers to provide
services
• Can the clinic provide additional services
relative to industrial rehabilitation and
workplace assessment
• Sports medicine coverage for schools
• Direct and indirect competition
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Hours of Operation
– Clinic will need to be opened at times that do not
conflict with normal working hours
• Early morning and evening hours
• Weekend hours may also be useful
• Clinic Personnel and Human Resource
Issues
– Athletic trainers will work with multiple healthcare
provider in clinical/corporate and hospital
treatment centers
– Formal job descriptions are critical for all
individuals working in environment
– Communication and team approach is critical
© 2011 McGraw-Hill Higher Education. All rights reserved.
Potential Athletic Training Duties
• Ergonomic Assessment
– Ergonomics is the science of designing products,
machines and systems to maximize comfort,
efficiency and safety
• Based on anthropometry and biomechanics
• Applied to industrial engineering
• Used to design, adapt and alter workplace
environments to accommodate to a person’s strengths,
limitations, sizes and shapes
– Primary goal often involves injury and accident
prevention in workplace by minimizing risk
factors
• Postures, vibration, repetition & force
© 2011 McGraw-Hill Higher Education. All rights reserved.
– An athletic trainer may work
with an occupational therapist
or ergonomist to assess
environment
– Will provide assessment,
make recommendations,
provide instruction on injury
prevention techniques
– Report is generated and
provided to site administrators
with follow-up reviews often
conducted to ensure
implementation of
recommendations
Figure 2-3
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Work Hardening/Conditioning Programs
– Intensive outpatient therapy for individuals
injured on the job
• Work conditioning = treatment 3 hours/day, 3
days/week
• Work hardening = 8 hours of treatment daily, 5
days/week
– Goal is to restore functionality and return to
full duty capacity
– Both an evaluation and report are
assembled and are used to develop a
rehabilitation plan
© 2011 McGraw-Hill Higher Education. All rights reserved.
• The evaluation involves:
– Musculoskeletal examination
(strength, posture, flexibility, gait,
neurologic screening)
– Functional capacity evaluation
•
•
•
•
•
Prolonged sitting, standing
Hand grip strength and lifting abilities
Ability to perform repetitive tasks
Carrying capabilities
Balance
– These elements are continually
monitored and allow for program
adjustment in order to facilitate
the patient’s return to appropriate
levels of performance
Figure 2-4
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Wellness Center
– Athletic trainers may be involved in organizing
wellness screenings and workshops for:
•
•
•
•
•
Asthma & diabetes
Hypertension & stroke
Cholesterol
Osteoporosis
Prostate/skin cancer
– Designed for early detection, awareness and
prevention
– Programs designed to educate individuals on
nutrition, health and safety may be offered
– Health fairs are often an effective means of
providing screenings and education
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Community Outreach and Marketing
– Some athletic trainers may be clinic or
hospital based in the morning and may
provide athletic training coverage in
afternoons and evenings
– Outreach may occur in the collegiate
setting, secondary schools or for single
athletic events
– Serves as an effective marketing tool to
promote and advertise clinic
– Also provides visibility for the clinic to other
healthcare providers and potential future
consumers/patients
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Corporate Fitness Programs
– Involves in-house fitness
programming for employees
– Provides numerous healthrelated benefits to employees
– Also serves to reduce health
costs, increase productivity,
reduce absenteeism, improve
morale, lower healthcare
expenditures and reduce sick
leave
– Often involves fitness screening
and individual program design
Figure 2-5
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Drug Testing Programs
– Athletic trainers may be asked to oversee drug
testing programs
– Program may act as a deterrent to employees
coming in unfit for duty
– May be necessitated by federal guidelines or
pre-employment screenings
– Legal defensibility is the most important
aspect of any drug-testing program
– The corporation should use federally certified
testing laboratories with all positive tests
results confirmed via a medical review
department
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Fiscal Management
– Having a basic understanding of business
practices may be necessary in for-profit
clinical settings
– Knowledge of billing practices is critically
important
– Maintaining positive accounts payable vs.
accounts receivable ratio is the goal of all
successful businesses
– Other responsibilities may include
•
•
•
•
Financial planning
Establishing contractual obligations
Efficient billing and collection systems
Budget formulation © 2011 McGraw-Hill Higher Education. All rights reserved.
Record Keeping
• Major responsibility
• The rule not the exception - accurate
and up-to-date
• Medical records, injury reports,
insurance information, injury
evaluations, progress notes, equipment
inventories, annual reports
© 2011 McGraw-Hill Higher Education. All rights reserved.
Maintaining Confidentiality in
Record Keeping
• Release of Medical Records
– Written consent is required
– Waiver must be signed for any release
(include specifics of information to be
released and to whom)
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Health Insurance Portability and
Accountability Act (HIPAA)
– Regulates dissemination of personal
history information (PHI) by coaches, AT’s,
physicians or other members of sports
medicine team
– Guarantees athlete access to information
and control over disclosure
– Athlete may provide written authorization
for release of information
© 2011 McGraw-Hill Higher Education. All rights reserved.
• HIPAA Authorization
– Description of information to be disclosed
– Identification of parties authorized to
provide and make use of PHI
– Description of each purpose of the use or
disclosure
– Expiration date or event
– Individual’s signature
– Description of his/her authority to act for
the individual if signed by personal
representative
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Family Educational Rights and Privacy
Act
– FERPA = law protecting privacy of student
education records
– Provides parents with certain rights with
respect to child’s educational records
– When child turns 18 rights are transferred
to student
– School must have written permission prior
to releasing information
© 2011 McGraw-Hill Higher Education. All rights reserved.
Administering Pre-participation
Examinations
• Initial pre-participation exam prior to start
of practice is critical
• Purpose is to identify athlete that may be
at risk
• Should include
– Medical history, physical exam, orthopedic screening,
wellness screening
• Establishes a baseline
• Satisfies insurance and liability issue
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Examination by Personal Physician
– Yields an in-depth history and ideal
physician-patient relationship
– May not result in detection of factors that
predispose the athlete to injury
• Station Examination
– Provides athlete with detailed exam in little
time
– Team of nine is ideal (2 physicians, 2 nonphysicians and 5 managers/student athletic
trainers)
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Medical History
– Complete prior to exam to identify past and
existing medical conditions
– Update yearly and closely review by medical
personnel
– Collect medical release and insurance info at
the same time
• Physical Examination
– Should include assessment of height, weight,
body composition, blood pressure, pulse,
vision, skin, dental, ear, nose, throat, heart,
lungs, abdomen, lymphatic, genitalia,
maturation index, urinalysis and blood work
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Maturity Assessment
– Means to protect young, physically active
athletes
– Methods
• Circumpubertal (sexual maturity)
• Skeletal
• Dental
– Tanner’s five stage assessment is most
expedient
• Orthopedic Screening
– Part of physical exam or separate
– Various degrees of detail concerning exam
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Wellness Screening
– Purpose is to determine if athlete is
engaged in a healthy lifestyle
• Sport Disqualification
– Certain injuries and illnesses warrant special
concern when dealing with sports
– Recommendations can be made
– American with Disabilities Act (1990)
• Dictates that athlete makes the final decision
– Potential disqualifying factors should be
determined during the pre-participation exam
© 2011 McGraw-Hill Higher Education. All rights reserved.
Personal Information Card
• Contains contact information for family,
personal physician, and insurance
information
Injury Reports and Injury Disposition
• Injury reports serve as future references
• Reports can shed light on events that may be
hazy following an incident
• Necessary in case of litigation
• All reports should be filed in the athletic
training room
© 2011 McGraw-Hill Higher Education. All rights reserved.
Treatment Log
• Sign-in to keep track of services
• Daily treatments can be recorded
• Treatment of daily therapies can be
monitored along with compliance
• Can be used as legal documentation in
instances of litigation
© 2011 McGraw-Hill Higher Education. All rights reserved.
Injury Evaluation and
Progress Notes
• Injuries and progress should be
monitored by athletic trainer and recorded
• SOAP note format
– S: Subjective (history of injury/illness)
– O: Objective (information gathered during
evaluation)
– A: Assessment (opinion of injury based on
information gained during evaluation)
– P: Plan (short and long term goals of rehab)
© 2011 McGraw-Hill Higher Education. All rights reserved.
Supplies and Equipment
Inventory
• Managing budget and
equipment/supplies is critically
important
• Inventory must be taken yearly in order
to effectively replenish supplies
© 2011 McGraw-Hill Higher Education. All rights reserved.
Annual/Seasonal Report
• Summary of athletic training program
functions
• Can be used to evaluate recommend
potential changes for program
• Includes number of patients and types
of injuries seen/treated
© 2011 McGraw-Hill Higher Education. All rights reserved.
Computer as Tool for Athletic
Trainer
• Indispensable tool
• Can make the job
more efficient with
appropriate software
• Must maintain
security
• Must determine for
what computer will be
used
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Should consult experts in order to
determine what systems are appropriate
for specific use
• Factors to consider
– Access to mainframe and internet
– Hardware (desktop, laptop, personal digital
assistants)
– Software – various programs for multiple
uses
• Record keeping needs
• Word processing, budget maintenance
• Educational software
– World Wide Web and access to email
© 2011 McGraw-Hill Higher Education. All rights reserved.
Collecting Injury Data
• Accident - unplanned event resulting in loss
of time, property damage, injury or death
• Injury- damage to the body restricting
activity
• Case study- looks at specific incident of
injury
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Epidemiologic studies may assess
various areas
–
–
–
–
Age or gender
Body part
Occurrence in different sports
Contact, non-contact, limited contact,
collision sports
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Catastrophic Injuries
– 98% of injuries requiring hospital
emergencies are treat and release relative
to sport
– Sports deaths (struck with object, heat
stroke)
– Catastrophic injuries also include spinal
cord trauma, cardiorespiratory
injuries/problems
– Most injuries are related to appendages
• Strains, sprains, contusions, fractures,
abrasions
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Current National Injury Data-Gathering
Systems
– State of the art injury surveillance is still developing
– Ideal situation involves epidemiologic approach
• Epidemiology
– Takes an evidence-based approach for identifying risk
factors for injury and determining optimal treatment methods
in clinical practice
– Serves as foundation for intervention in interest of public
health and preventive medicine
• Extrinsic factors (activity, exposure, equipment)
• Intrinsic factors (age, gender, neuromuscular aspects,
structural aspects….etc)
– Number of different surveillance systems in place
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Surveillance Systems
– National Safety Council
• General sports injury data
– Annual Survey of Football Injury Research
• Public school, college, professional, sandlot
football injury data
– National Center of Catastrophic Sport
Injury Research
• Tracks catastrophic injuries in all levels of
sports
© 2011 McGraw-Hill Higher Education. All rights reserved.
– NCAA Injury Surveillance System
• Data collected on most major sports- ATC data
collection
• Converted to web-based data collection system
– National Electronic Injury Surveillance
System
• Monitor injuries relative to different products -consumer safety, determine if products are
hazardous or defective
© 2011 McGraw-Hill Higher Education. All rights reserved.
Using Injury Data
• Valid and reliable data can be utilized to
decrease injuries
• May allow for:
– Rule modification
– Assist coaches and players in
understanding risks
– Help manufacturers
– Educate parents, athletes and the public
on inherent risks associated with sport
© 2011 McGraw-Hill Higher Education. All rights reserved.