Download Chapter 2: Health Care Administration in Athletic Training

Chapter 2: Health Care
Administration in Athletic
Training
System of Healthcare Management
• Strategic Plan Development
– Determine why there is need for such a
program
– Determine function of program within scope of
athletic program
– Decision of administrators will determine
extent of health care program
– Develop written mission statement to focus
direction of program
• Strategic Plan Development (cont.)
– Strategic plan development must include
administrators, student-athletes, coaches,
physicians, athletic trainers, parents and
community health leaders
– Ongoing process that reviews strengths and
weaknesses of program
• Policy and Procedure Development
– Creation of policies and procedures for all
involved in health care of athletes necessary
– To be covered throughout presentation
– Abbreviated version of policies and procedures
should be provided to athletes and parents (if
financially feasible)
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 sloping
floor to drain, equipped with 2-3 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 & Orthotic 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, refrigerator
– 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
– Training rooms often lack ample storage space
– Storage in 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
• Athletic Trainer’s Office
– Space at least 10x12 feet is ample
– All areas of training room should be supervised
without leaving office space (glass partitions)
– Equipment should include, desk, chair, tack
board, telephone, computer (if necessary) 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
– X-Ray Room: separate room with lead
shielding in walls, large enough to house
necessary equipment
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
– Clinical and Industrial Settings: patient care
outside high school and collegiate athletes, with
a broader scope of practice that could include:
• Pediatric work
• Work hardening
• Orthopedic and neurological patients
– Athletic trainers should be sure to work within
their scope (physically active)
– Fitness programming may also become an
ATC’s responsibility in this setting
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 or at least a student
should attend all practices and games (home
and away)
– Different institutions (including high schools)
have different levels of coverage based on
personnel and risks involved with sports
Hygiene and Sanitation
• Athletic Training Facility
– Rules concerning room cleanliness and
sanitation must be set and made known to
population using facility
– Examples
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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
– Cleaning responsibilities are divided between
athletic training staff and maintenance
personnel
– 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
• Matted service cleaning (wrestling)
– Equipment and clothing
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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
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Athlete clearance to participate
Athlete insurance
Prompt injury and illness reporting
Follow good living habits
Avoid sharing clothes and towels
Exhibit good hygiene practices
Avoid common drinking sources
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. high
school)
• Continuous planning and prioritizing is
necessary to effectively manage monetary
allocations to meet programmatic goals
• Supplies
– Expendable (supplies that cannot be reusedfirst 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
– Fixed (remain in the training room- ice
machine, tables)
– Non-fixed (crutches, coolers, training kits)
• Purchasing Systems
– Direct buy vs. competitive bidding
– Lease alternative
• Additional Budget Considerations
– Telephone and postage expenses
– Contracts for outside services
– Purchases relative to liability insurance and
professional development
Developing a Risk Management
Plan
• Security Issues
– Accessibility to training room (staff,
physicians, student athletic trainers)
– Supervision issues
• 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 Injury Management
– 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
• The sports medicine team is only as good as
the individuals in the group
• 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 principals
• 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
Record Keeping
• Major responsibility
• Rule not the exception - accurate and up-todate
• Medical records, injury reports, insurance
information, injury evaluations, progress
notes, equipment inventories, annual reports
Administering Preparticipation
Examinations
• Initial pre-participation exam prior to start
of practice is critical
• Purpose it 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 physicianpatient 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 preparticipation exam
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
• Can be used as legal documentation in
instances of litigation
Personal Information Card
• Contains contact information for family,
personal physician, and insurance
information
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 eval)
– A: Assessment (opinion of injury based on
information gained during evaluation)
– P: Plan (short and long term goals of
rehabilitation)
Supplies and Equipment
Inventory
• Managing budget and equipment/supplies is
critically important
• Inventory must be taken yearly in order to
effectively replenish supplies
Annual Report
• Summary of athletic training room
functioning
• Can be used to evaluate recommend
potential changes for program
• Includes number and types of injuries
seen/treated
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)
Computer as Tool for Athletic
Trainer
• Indispensable tool
• Can make the job
more efficient with
appropriate software
• Must maintain
security
• Can also be used for
other administrative
tasks
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
• Injury study falls under numerous categories
– Age, gender, body part, occurrence in different
sports
– Contact vs. non-contact 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
• Epidemiological approach that studies relationship
of various factors that influence frequency and
distribution of injury in sport
• Extrinsic factors (activity, exposure, equipement)
• 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 catastrophic injuries in all
levels of sports)
– NCAA Injury Surveillance System (data
collected on most major sports- ATC data
collection)
– National Electronic Injury Surveillance System
(Monitor injuries relative to different products -consumer safety, determine if products are
hazardous or defective)
– National High School Sports Injury Registry
(tracks injuries in specific sports at 150-200
high schools)