Transcript Chapter 2: Health Care Administration in Athletic Training

Chapter 2: Health Care
Organization and
Administration in Athletic
Training
© 2009 McGraw-Hill Higher Education. All rights reserved
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What should one do to organize
and operate an athletic training
room?
Facility Design
Policies & Procedures
Budget
Personal Management
Record Keeping
Doing all the Roles & Responsibilities of
an Athletic Trainer
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• Development of Policy & Procedures
Manual
– Creation of policies and procedures for all
involved in health care
– Policies = clear and accurate written out
statements of basic rules
• That What and Why
– Procedures = describe the process
• The How
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Issues Specific to Athletic
Training Program Operations
1. Scope of Program: Who will be served by
program?
– Athlete: to what extent and what services will be
rendered (systemic illness, musculoskeletal
injuries, in season, out-of-season, club sports)
– Institution: who else can be served medically and
educationally and what are the legalities
• (Students, Faculty, Staff, Spectators)
– Community: outside group and community
organizations with legalities again being an issue
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2. Providing Coverage
• Facility Personnel Coverage
– Dependant upon when the Athletic Trainer/Adult
First Responder is there (All day, weekends, just
during games, practices etc)
• Sports Coverage
– Certified athletic trainer should attend all practices and
games
• Most High School AT’s are assigned to football
home/away, therefore Adult First Responders cover other
events that are being played at home fields (soccer, field
hockey, volleyball)
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3. Hygiene and Sanitation
• Athletic Training Facility
– Operation should abide by policies set forth
by OSHA (Occupational Safety & Health
Administration) due to blood and bacteria;
Cleaning both by custodial staff and
athletic training staff.
– Examples of Policies
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No equipment/cleats in training room
Shoes off treatment tables
Shower prior to treatment
No roughhousing or profanity
No food or smokeless tobacco
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• 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
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• Athlete
– Promotion of good health and hygiene is
critical
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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
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4. Emergency Telephones
• Accessibility to phones in all major
areas of activity is a must
• Landline in case wireless isinterupted
• Radios, cell and digital phones provide
a great deal of flexibility
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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)
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• 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
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• Equipment: Items that can be used for
a number of years
– Capital: remain in the athletic training
clinic (including ice machine, tables)
– Non-consumable capital:
– reusable but leaves the
– athletic training room
(crutches, coolers, training kits)
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• Purchasing Systems
– Direct buy: going straight to a vendor and
making an order
– vs. Competitive bidding: usually for more
expensive purchases, getting multiple bids
and buying the least expensive
– Lease alternative (borrowing for set time)
• Additional Budget Considerations
– Telephone, Utilities, Contracts for outside
services, Insurance (if not covered by
employer) and professional development
for CEU’s
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Developing a Risk
Management Plan
1. Security Issues
– Accessibility to 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
2. Fire Safety
– Post evacuation plan in case of fire
– Smoke detectors/alarm system and fire extinguisher
should be tested and in place
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3. Electrical and Equipment Safety
– Major concern (GFIs)
– Be aware of power distribution system to
avoid accidents
4. 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
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Athletic Training Clinic Design
• Multipurpose area for first aid, therapy/
rehabilitation, injury prevention, medical
procedures and administration
1. Size
– Varies between settings
– Must take advantage and manage space
effectively
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2. Location
– Outside entrance (limits doors that must be
accessed when transporting injured
athletes)
– Double door entrances and ramps are
ideal- getting athletes in and out
– Proximity to locker rooms and restroom
facilities
– Light, heat and water source should be
independent from rest of facility
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3. Special Service Areas
A. Treatment Area: area that accommodates
4-6 adjustable treatment tables, 3-4 stools,
and hydrocollator (heat packs in water) and
ice machine accessibility
B. Electrotherapy Area: area that houses
ultrasound, electrical stim (e-stim) units,
storage units, grounded outlets, treatment
tables and chairs, under constant
supervision
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C. 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
D. Exercise Rehabilitation Area: area that
provides adequate space and equipment to
perform reconditioning of injuries
E. Taping, Bandaging & Orthotics Area: 3-4
taping tables and storage cabinets to treat
athletes with proximity to a sink
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F. Physician’s Exam Room: space for
physician to work which may hold exam
table, lockable storage, sink, telephone
G. Records Area: space devoted to record
keeping which may include filing system or
computer based database, that allows
access only to medical personnel (ideally
will be a separate office off of the AT
Room)
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4. Storage Facilities
– Athletic training clinics often lack ample
storage space
– Storage that holds general supplies and
special equipment
– Large walk-in storage cabinet for bulk
supplies
– Refrigerator for supplies, freezer for ice
cups, medicine and additional supplies
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5. Athletic Trainer’s Office
– Space at least 10x12 feet is ample
– All areas of training room 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 (filing cabinet)
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6. 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
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When designing an athletic
training room what are the 6 main
parts one must have in their
design?
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Size
Location
Special Service Areas
Storage Facilities
Athletic Trainer’s Office
Others
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Assignment: Design your own
athletic training room
• See handout and grade sheet
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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
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• Scope of Practice
– Diverse patient population
– In hospital settings time may be spent with inpatient, out-patient, or emergency care.
– Owner of out-patient facility will dictate patient
population seen at clinic
– The ATC may be involved with patient care,
onsite employee fitness, ergonomics, outreach
programs, athletic event coverage
– Limitations and restrictions will be dictated by
state regulatory statutes
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Potential Athletic Training Duties
Outside the Scope of Athletics
A. Ergonomic Assessment
– Ergonomics is the science of designing products,
machines and systems to maximize comfort,
efficiency and safety
– Primary goal often involves injury and accident
prevention in workplace by minimizing risk
factors
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B. 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
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C. Wellness Center
– ATC may be involved in organizing wellness
screenings and workshops for:
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Asthma & diabetes
Hypertension & stroke
Cholesterol
Osteoporosis
Prostate/skin cancer
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D. 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
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E. Corporate Fitness Programs
– Involves in-house fitness programming for
employees
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F. 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
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What are the 6 potential duties
an athletic trainer maybe asked
to do?
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Ergonomic Assessment
Work Hardening/Conditioning Programs
Wellness Center
Community Outreach and Marketing
Corporate Fitness Programs
Drug Testing Programs
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Record Keeping
• Major responsibility
• The rule not the exception - accurate
and up-to-date
• Records Include: Medical records,
injury reports, insurance information,
injury evaluations, progress notes,
equipment inventories, annual reports
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Maintaining Confidentiality in
Record Keeping
1. 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 including coaches,
staff, colleges, professional organizations)
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2. Health Insurance Portability and
Accountability Act (HIPAA)
– Regulates release of Personal History
Information (PHI) by coaches, ATC’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
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3. Family Educational Rights and Privacy
Act
– FERPA = law protecting privacy of student
education records, may contain medical
– When child turns 18 rights are transferred
to student
– School must have written permission prior
to releasing information
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Administering Pre-participation
Examinations
• Initial pre-participation exam prior to start
of practice is critical, gives baseline
• Purpose it to identify athlete that may be at
risk
• Should include
– Medical history, physical exam, orthopedic screening,
wellness screening, cardiovascular screening &
maturity assessment
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• 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
VS.
• Station Examination
– Provides athlete with detailed exam in little
time
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1. Medical History
– Complete prior to exam to identify past and
existing medical conditions
– Update yearly and closely review by medical
personnel
2. 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
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3. Cardiovascular Screening
- 1996 American Heart Association
recommended in order to recognize
abnormal heart sounds and other signs
4. Orthopedic Screening
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Part of physical exam or separate
Various degrees of detail concerning
exam
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5. Wellness Screening
– Purpose is to determine if athlete is
engaged in a healthy lifestyle
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6. Baseline Concussion Testing
IMPACT (Immediate Post-Concussion Assessment and Cognitive Testing)
• the first, most-widely used, and most scientifically validated
computerized concussion evaluation system.
• Measures player symptoms
• Measures verbal and visual memory, processing speed and
reaction time
• Reaction time measured to 1/100th of second
• Assists clinicians and athletic trainers in making difficult return-toplay decisions
• Provides reliable baseline test information
• Produces comprehensive report of test results
• Results can be e-mailed or faxed for fast consultation by a
neuropsychologist
• Automatically stores data from repeat testing
• Testing is administered online for individuals or groups
What are the 6 parts of a preparticipation exam?
Medical History
Physical Examination
Cardiovascular Screening
Orthopaedic Screening
Wellness Screening
Baseline Concussion Testing (IMPACT)
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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
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Personal Information Card
• Contains contact information for family, personal
physician, and insurance information
Injury Reports and Injury Disposition
• Injury reports serve as future references, Necessary
in case of litigation
• 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)
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Supplies and Equipment
Inventory
• Managing budget and
equipment/supplies is critically
important
• Inventory must be taken yearly in order
to effectively replenish supplies
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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
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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
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