Athletic Training Management

Athletic Training Management Chapter 18 Athletic Training Facilities Management

Facilities Management • Facility managers control the resources at their disposal, both people and things • Establishing policies and procedures, personnel scheduling, budgeting and communications are all involved

Policies and Procedures • Policies are the basic framework of principles and rules used to govern and expedite decision making (what and why) • Procedures describe the process by which something is done (how) • Policies and procedures manuals will vary according to setting • It is possible to overwrite this document in an attempt to micromanage a facility

Policies and Procedures • In college or high school settings the policies and procedures should address the following: • population served • appropriate use of facilities • job descriptions for staff • chain of command • supervision

Policies and Procedures • In clinic settings the policies and procedures should address the following: • Administrative issues • Personnel • Medical records • Billing issues • Patient and staff safety • Facility-wide issues

Policies and Procedures • Scheduling • Medical records • Referral • Documentation • Departmental issues • Job descriptions • Safety considerations • Personnel appraisal • Position requirements • Equipment

Policies and Procedures • Population served in colleges • Athletes • Then who? • Athletic trainers, coaches, managers • Cheerleaders? • Band? • Athletic department staff (secretaries, AD)? • Media? • Faculty?

Policies and Procedures • Club sports? • Intramurals? • Is it conference policy that host school ATC covers visiting teams traveling without an ATC? • Population served in high schools • Consent to treat a minor is a problem • Most schools have parents complete a form allowing EMERGENCY care due to injury

Policies and Procedures • Parents are also free to refuse to allow treatment until they have been notified. If this is the case, only first aid necessary to stabilize life is allowed until a parental OK. • Athletic trainers need a copy of the schools’ form or have their own permission form signed and kept on-file in the ATR before treatment can take place. • Usually only athletes are treated, others to the school nurse

Policies and Procedures • In industrial settings the company physician refers the patient to the athletic trainer in the rehabilitation site, often established at the workplace • In many states worker’s compensation laws govern where a patient may be sent and what rehab setting must be used for a specified number of visits

Policies and Procedures • The legal responsibility to the population served must not be abrogated • If you treat someone outside the defined population, you may be personally responsible for anything that goes wrong, the site could say you acted outside your allowed job roles

Policies and Procedures • Facility usage in colleges • The following principles must be observed: • Strict confidentiality is a must. • Sterile procedures must be carried out. • Respect is required for the patients served. • No problem is to be ignored or mishandled due to the personal feelings of the staff toward the patient. • The same standards as a doctor’s office apply

Policies and Procedures • Patients must respect the nature of the facility and the professionals who staff it. • Vulgarity, sexism, harassment, theft, and the use of tobacco, drugs, or alcohol must not be tolerated. • The ATR is the main site in which athletic training is practiced in colleges or high schools.

Policies and Procedures • The domains of practice for athletic trainers include Prevention; Clinical Evaluation and Diagnosis; Immediate Care; Treatment, Rehabilitation and Reconditioning; Organization and Administration; and Professional Responsibility.

Policies and Procedures • At some places, only varsity athletes may be treated • At others, the ATR may also be a teaching lab, used by the ATS club, or rented to outside groups that may teach medically related skills like partner massage or first aid

Policies and Procedures • Most college or university athletic training facilities will post some general rules of conduct within the athletic training room. Examples include: • The athletic training room is not a student union, please don't use it as one! (We want to encourage only those who are in the athletic training room for healthcare reasons to be there.) • The athletic training room is not an appropriate place to study. (Studying during treatments is one thing, but using the athletic training room as a study lounge is inappropriate.)

Policies and Procedures • Persons who are not patients or athletic training room personnel are not permitted in the athletic training room without permission from the head athletic trainer. (Please wait for your friends outside, as your presence is disruptive to good traffic flow and takes up space.) • Please leave cleated shoes at the door. (They cut up the carpet and track in dirt.) • No form of tobacco is allowed in the athletic training room at any time. (This is unsanitary.) • Ice is to be used for therapy and not for consumption. (If too many people eat the ice there may not be enough at the end of the day.)

Policies and Procedures • In high schools facilities may not be your own • Coaches may have access at times you are not present • If coaches, etc., are banned, then they need kits that need to be restocked as needed • Not really a problem in industrial settings the clinic is isolated to the health care unit or plant

Sports Medicine Clinic P&P • Administrative issues include orienting both employees and patients to the clinic • Standard operating procedures should govern most patient interactions including: • Document the evaluation of the patient • Establishing a treatment plan • Document the results of the plan

Sports Medicine Clinic P&P • Follow-up evaluation of the patient • How modifications in the plan are implemented as the patient’s condition changes • Patient billing procedures should be covered so the patient, therapist and administration all understand who is responsible for paying for the services rendered the patient • Maintenance of medical records should be discussed including patient confidentiality, release of medical records for insurance purposes including HIPPA, and for communication between medical professionals dealing with the patient’s care

Sports Medicine Clinic P&P • Employment policies including: • Salaries • Benefits • Vacations • Hiring practices • Termination policies • Safety policies including OSHA training and area access • Emergency procedures • Sexual harassment policies

Sports Medicine Clinic P&P • Facility-Wide issues • Patient scheduling • Referral • Transfer of patients among clinicians • Documentation of patient progress and therapy procedures • These are global policies

Sports Medicine Clinic P&P • Departmental Policies • Job description • Job responsibilities • Education and credentialing requirements • Performance appraisal • Patient scheduling • Safety concerns • OSHA guidelines and training • Purchasing usually begins here

Policies and Procedures • Job descriptions in any setting – see Chapter 4 on The Sports Medicine Team • Chain of command in college settings • Chain of command is best when the athletic trainers are hired by the school health center or university hospital • Chain of command is worst when the athletic department hires the athletic trainers

Policies and Procedures • This is because hiring, retention, and budgets are determined by people with a conflict of interest in the conduct of your job which is to give the best health care possible to the athletes, often at the expense of early return to play • In high school settings the chain is much more open • ATs report to athletic directors, team physicians, family physicians, principals, and even superintendents

Policies and Procedures • In industrial settings the plant physician is the final stop • In professional sports with minor leagues (baseball and ice-hockey) there may be heavy reliance on the local team physician • Career ending injuries or injuries to big-money athletes may be referred to the parent club

Policies and Procedures • In sports medicine clinics the administrative structure is varied with the setting housing the clinic (hospital, chain, individual clinic) • At the root level there is always a medical director in control of implementing medical policy which is made by the director or a board of directors

Athletic Training Student Supervision • Athletic training student supervision • We are governed by three agencies • JRC-AT • Standards and Guideline • BOC • Mandate completion of competencies and proficiencies • NATA Education Council • Created competencies and proficiencies

Athletic Training Student Supervision • The interaction between the student and supervisor involves daily personal contact at the site of supervision • In addition, the supervisor must be in close enough contact that they may intervene if necessary to protect the patient from the student • State practice acts have final legal say in the local practice of athletic training • What a student may practice and the type of supervision must be consistent with state law

Athletic Training Student Supervision • A concept called “learning over time” governs how things must be sequenced in ATEPs • Material must first be introduced in a didactic (lecture) type class, evaluated in a lab setting, then further evaluated the following semester in a seminar type setting before you are allowed to practice that skill on patients in a clinical setting

Athletic Training Student Supervision • Before 2001 there were 192 competency statements that had to be included in an education plan • After 2001 there were 675 competencies and 1270 proficiencies, hence the changes in how educational outcomes are evaluated

Athletic Training Student Supervision • Required subject matter in an ATEP • Risk management and injury prevention • Pathology of injuries and illnesses • Assessment and evaluation • Acute care of injury and illness • Pharmacology • Therapeutic modalities • Therapeutic exercise • General medical conditions and disabilities • Nutritional aspects of injury and illness • Psychosocial intervention and referral • Health care administration • Professional development and responsibilities

Personnel Scheduling • Scheduling includes the purpose of the facility; hours of operation; FT, PT, or graduate assistant status • Purpose of the facility • Is this a clinic/outreach, clinic, high school/teacher, high school, college/university, professional, industrial, outreach/industrial, outreach professional, or per diem position?

Personnel Scheduling • Hours of operation • Setting often dictates hours • Must be open enough hours to handle the expected patient load • Clinics may be open 8-5, 7-7 to take advantage of patients using the facility during pre work and post work times, or only part days • Colleges may be open 7-7 at all sites, open only when a practice/competition uses the site, or may have a central morning site and satellite afternoon sites

Personnel Scheduling • High schools are often open until 5:30 PM or later during Fall and Winter sports, yet close before 4 on days with no scheduled competitions • Professional settings are dictated by management, open any time athletes will need the services • Possibly 14-18 hours a day during competitive season • Industrial settings are usually on shifts the same as the employees

Personnel Scheduling • Full-time employment is the norm in college/university settings and is supplemented by graduate assistants • FT or part-time is seen in high schools. PT are most often outreach employees from clinics or graduate assistants • FT employees is almost a certainty in professional sports, but often for a fixed number of weeks or months

Personnel Scheduling • Per diem scheduling is newer in athletic training, but has been around in physical therapy for a long time • Work day to day much like a substitute teacher • Scheduled week to week only • No benefits • Can set your schedule to accommodate personal/family considerations

Personnel Scheduling • Graduate assistant athletic trainers are mostly certified and take positions in colleges, high schools, clinics, and clinic/outreach settings • This gives additional experience as a certified and is virtually required for FT employment in the college/university setting • Taking a GA position in a setting you do not wish long-term employment can be limiting

Personnel Scheduling • Team versus ATR coverage • Some programs assign a group of ATCs to a specific ATR and whatever athletic teams use the room are shared • Advantage is being able to adjust travel and coverage to personal need (e.g. new mom) • Disadvantage is losing continuity of care for an individual

Communications • Multisite communications is often critical in colleges and high schools • A university may use the stadium, FB practice site, varsity tennis courts, track, student rec center, basketball facility, other sport complex/locker rooms, baseball field, soccer field, and softball field ON campus • Additionally it may use a country club for golf, the same or another for cross country, tennis club(s), fitness centers, all OFF campus

Communications • Telephone • Limited by locations unless portable • Portable phone communications is not confidential so care must be utilized when discussing patient information • Cell telephones • Go anywhere there is a cell in operation and the batteries are charged

Communications • The only way to get secure line is to pay for encryption technology used by the military and it is VERY expensive • Anyone with a scanner can listen in • Law says this is not privileged communication so no warrant is needed to listen in • Two-way radios • Again, anyone with a scanner can listen in • At UT we share a channel with the bus garage and have to break in to use the line

Communications • Beepers or pagers • Can reach someone to request a call be returned or leave a voice mail or text mail message • Can send coded information about an injury situation

Athletic Training Management