© 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 2: Health Care Organization and...

© 2011 McGraw-Hill Higher Education. All rights reserved.

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 of Policy & Procedures Manual– 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 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 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


– 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

© 2011 McGraw-Hill Higher Education. All rights reserved. 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– 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 in-

patient, 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 health-related

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 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


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 non-

physicians 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 study- looks at specific incident of injury


• Epidemiologic studies may assess various areas– 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 catastrophic injuries in all levels of sports


– 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

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