Chapter 2: Health Care Administration in Athletic Training

1. Chapter 2: Health Care Administration in Athletic Training

2. 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

3. 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

4. Policy and Procedure Development • Creation of policies and procedures for all involved in health care of athletes necessary • Policies = clear written out statements of basic rules • Procedures = describe the process • To be covered throughout presentation • Abbreviated version of policies and procedures should be provided to athletes and parents (if financially feasible)

5. 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

6. Clinical, Corporate/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

7. 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 • Different institutions have different levels of coverage based on personnel and risks involved with sports

8. Hygiene and Sanitation • Athletic Training Facility • Rules concerning room cleanliness and sanitation must be set and made known to population using facility • Examples • No equipment/cleats in training room • Shoes off treatment tables • Shower prior to treatment • No roughhousing or profanity • No food or smokeless tobacco

9. 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

10. 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

11. Athlete • Promotion of good health and hygiene is critical • 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

12. 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

13. 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

14. Supplies • Expendable (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

15. Equipment • Items that can be used for a number of years • Capital (remain in the training room- ice machine, tables) • Non-consumable capital (crutches, coolers, training kits)

16. 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

17. 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

18. 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

19. 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

20. 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 principles

21. 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

22. 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

23. 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

24. Illumination • Well lighted throughout • Reflective ceilings and walls will aid in process • Natural lighting is a plus

25. 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

26. Hydrotherapy Area: area with centrally located 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 & Orthotics Area: 3-4 taping tables and storage cabinets to treat athletes with proximity to a sink

27. 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

28. 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

29. 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

30. 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

33. 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

34. Maintaining Confidentiality in Record Keeping • Health Insurance Portability and Accountability Act (HIPAA) • Regulates dissemination 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

35. 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

36. Family Educational Rights and Privacy Act • 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

37. Administering Pre-participation 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

38. 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 non-physicians and 5 managers/student athletic trainers)

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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)

45. Supplies and Equipment Inventory • Managing budget and equipment/supplies is critically important • Inventory must be taken yearly in order to effectively replenish supplies

46. Annual Report • Summary of athletic training room functions • Can be used to evaluate recommend potential changes for program • Includes number and types of injuries seen/treated

47. 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)

48. 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

49. 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

50. 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