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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

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system of healthcare management
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
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
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
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


    • 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
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
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


    • 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


    • 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
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
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
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
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


    • 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


    • 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

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
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
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
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
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
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
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
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
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
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
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
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