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 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 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 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 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 –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-to- date 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 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 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 high schools)