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
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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
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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
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
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