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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

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Chapter 2: Health Care Administration in Athletic Training

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Chapter 2 health care administration in athletic training l.jpg

Chapter 2: Health Care Administration in Athletic Training

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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

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  • 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

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  • 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)

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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

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  • 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

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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

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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

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  • 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

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  • 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

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  • 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

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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

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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

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  • 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

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  • 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)

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  • 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

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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

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  • 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

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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

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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

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  • 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

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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

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  • 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

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  • Illumination

    • Well lighted throughout

    • Reflective ceilings and walls will aid in process

    • Natural lighting is a plus

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  • 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

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  • 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

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  • 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

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  • 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

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  • 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

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  • 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

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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

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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

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  • 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

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  • 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

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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

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  • 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)

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  • 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

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  • 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

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  • 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

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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

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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

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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)

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Supplies and Equipment Inventory

  • Managing budget and equipment/supplies is critically important

  • Inventory must be taken yearly in order to effectively replenish supplies

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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

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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)

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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

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  • 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

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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

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  • Epidemiologic studies may assess various areas

    • Age or gender

    • Body part

    • Occurrence in different sports

    • Contact, non-contact, limited contact, collision sports

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  • 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

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  • 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, equipment)

      • Intrinsic factors (age, gender, neuromuscular aspects, structural aspects….etc)

    • Number of different surveillance systems in place

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  • 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

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  • 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

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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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