Transcript ch 2
Chapter 2: Health Care
Organization and
Administration in Athletic
Training
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
► 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
► Development
Manual
of Policy & Procedures
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
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
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
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
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
► 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
► 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
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
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
► 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
► 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)
► 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
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
► 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
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
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
► 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
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
► 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
► Illumination
Well lighted throughout
Reflective ceilings and walls will aid in
process
Natural lighting is a plus
► 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
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
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
► 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
Figure 2-2
► 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
► 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
Figure 2-1
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
► 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
► 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
► 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
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
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
► 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
► 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
► 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
► 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
► 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
► 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
► 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
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
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)
► 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
► 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
► Family
Act
Educational Rights and Privacy
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
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
► 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)
► 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
► 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
► 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
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
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
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)
Supplies and Equipment
Inventory
► Managing
budget and
equipment/supplies is critically
important
► Inventory
must be taken yearly in order
to effectively replenish supplies
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
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
► 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
Collecting Injury Data
► Accident
- unplanned event resulting in loss
of time, property damage, injury or death
► Injury-
damage to the body restricting
activity
► Case
injury
study- looks at specific incident of
► Epidemiologic
various areas
studies may assess
Age or gender
Body part
Occurrence in different sports
Contact, non-contact, limited contact,
collision sports
► 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
► 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
► 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
sports
catastrophic injuries in all levels of
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
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