Athletic Trainers' Perceptions of and Barriers to Patient Care Documentation: A Report From the Athletic Training Practice-Based Research Network

Organizational Expectations Regarding Documentation Practices in Athletic Training

CONTEXT

Although guidance is available, no nationally recognized standard exists for medical documentation in athletic training, leaving individual organizations responsible for setting expectations and enforcing policies. Previous research has examined clinician documentation behaviors; however, the supervisor's role in creating policy and procedures, communicating expectations, and ensuring accountability has not been investigated.

OBJECTIVE

To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level.

DESIGN

Mixed-methods study.

SETTING

Online surveys and follow-up interviews.

PATIENTS OR OTHER PARTICIPANTS

We criterion sampled supervising athletic trainers (n = 1107) in National Collegiate Athletic Association member schools. The survey collected responses from 64 participants (age = 43 ± 11 years; years of experience as a supervisor = 12 ± 10; access rate = 9.6%; completion rate = 66.7%), and 12 (age = 35 ± 6 years; years of experience as a supervisor = 8 ± 5) participated in a follow-up interview.

DATA COLLECTION AND ANALYSIS

We used measures of central tendency to summarize survey data and the consensual qualitative research approach with a 3-person data analysis team and multiphase process to create a consensus codebook. We established trustworthiness using multiple-analyst triangulation, member checking, and internal and external auditing.

RESULTS

Fewer than half of supervisors reported having formal written organization-level documentation policies (n = 45/93, 48%) and procedures (n = 32/93, 34%) and an expected timeline for completing documentation (n = 24/84, 29%). Participants described a framework relative to orienting new and existing employees, communicating policies and procedures, strategies for holding employees accountable, and identifying purpose. Limitations included lack of time, prioritization of other roles and responsibilities, and assumptions of prior training and record quality.

CONCLUSION

Despite a lack of clear policies, procedures, expectations, prioritization, and accountability strategies, supervisors still felt confident in their employees' abilities to create complete and accurate records. This highlights a gap between supervisor and employee perceptions, as practicing athletic trainers have reported uncertainty regarding documentation practices in previous studies. Although supervisors perceive high confidence in their employees, clear organization standards, employer prioritization, and mechanisms for accountability surrounding documentation will result in improved patient care delivery, system outcomes, and legal compliance.

Athletic Trainer's Varying Levels of Awareness and Use of Disablement Model Frameworks: A Qualitative Study

In healthcare, disablement model frameworks aim to improve the delivery of patient-centered care through the recognition of patient factors beyond impairments, restrictions, and limitations, which include personal, environmental, and societal factors. Such benefits translate directly to athletic healthcare providing a mechanism for athletic trainers (ATs), as well as other healthcare professionals, to ensure that all aspects of the patient are managed prior to returning to work or sport. The purpose of this study was to investigate ATs recognition and use of disablement frameworks in current clinical practice. We used criterion sampling to identify ATs who were currently practicing from a random sample of ATs that participated in a related cross-sectional survey. A total of 13 participants engaged in an online, audio-only, semi-structured interview that was audio-recorded and transcribed verbatim. A consensual qualitative research (CQR) approach was used to analyze the data. A coding team of three individuals used a multi-phase process to construct a consensus codebook that identified common domains and categories among the participants' responses. Four domains emerged regarding ATs' experiences and recognition of disablement model frameworks. The first three domains were related to the application of disablement model frameworks: (1) patient-centered care, (2) limitations and impairments, and (3) environment and support. Participants described varying degrees of competence and consciousness regarding these domains. The fourth domain related to participants' exposure to disablement model frameworks through formal or informal experiences. Findings suggest that ATs largely demonstrate unconscious incompetence regarding the use of disablement frameworks in clinical practice.

Validation of a Script to Facilitate Social Determinant of Health Conversations with Adolescent Patients

Current social determinants of health (SDOH) tools exist to assess patient exposure; however, healthcare providers for the adolescent population are unsure of how to integrate SDOH knowledge into clinical practice. The purpose of this study was to validate a focused history script designed to facilitate SDOH conversations between clinicians and adolescents through the use of the Delphi method. Six individuals (1 clinician, 5 educators/researchers) participated as expert panelists. Panelists provided critical feedback on the script for rounds 1 and 2. For rounds 3-7, panelists received an electronic questionnaire asking them to indicate agreement on a 6-point Likert scale (1 = strongly disagree, 6 = strongly agree). We defined consensus as mean item agreement ≥ 5.0 and percent agreement ≥ 80%. In round 7, panelists rated overall script level of agreement. After seven rounds of feedback, the focused history script achieved content validity with 100% of panelists agreeing on the final 40-item script. A focused history script for the SDOH was content validated to aid conversations between healthcare providers and adolescent patients on factors that affect their life, school, and play. Addressing social determinants of health with adolescent patients will improve cultural proficiency and family-centered care delivered by school healthcare professionals.

Characterizing athletic healthcare: A perspective on methodological challenges, lessons learned, and paths forward

Recently, there has been an emphasis on collecting large datasets in the field of sports medicine. While there have been great advances in areas of sport performance and sport epidemiology, there have been fewer efforts dedicated to understanding the effectiveness and impact of athletic healthcare, including injury prevention programs and rehabilitation interventions provided at the point-of-care. In 2009, the Athletic Training Practice-Based Research Network (AT-PBRN) was launched to address this need, with the mission of improving the quality of care provided by athletic trainers. Unlike other research efforts in sports and medicine, such as sport epidemiology, there are fewer methodological best practices specifically related to clinical data in athletic healthcare. As a result, the AT-PBRN has encountered several methodological challenges during its tenure and has established guidelines based on various sources within the fields of sports and medicine to address these challenges. Therefore, the purpose of this perspective is to identify the challenges and describe strategies to address these challenges related to characterizing athletic healthcare using a large database. Specifically, challenges related to data entry (data quality and reliability) and data extraction and processing (data variability and missing data) will be discussed. Sharing challenges and perspectives on solutions for collecting and reporting on athletic healthcare data may facilitate a greater consistency in the approach used to collect, analyze, and report on clinical data in athletic healthcare, with the goal of improving patient outcomes and the quality of care provided by athletic trainers.

Core Competency-Related Professional Behaviors During Patient Encounters: A Report From the Association for Athletic Training Education Research Network

CONTEXT

To enhance the quality of patient care, it is important that athletic trainers integrate the components of the core competencies (CCs; evidence-based practice [EBP], patient-centered care [PCC], health information technology [HIT], interprofessional education and collaborative practice [IPECP], quality improvement [QI], professionalism) as a part of routine clinical practice. In what ways, if any, athletic training students (ATSs) are currently integrating CCs into patient encounters (PEs) during clinical experiences is unclear.

OBJECTIVE

To describe which professional behaviors associated with the CCs were implemented by ATSs during PEs that occurred during clinical experiences.

DESIGN

Multisite panel design.

SETTING

A total of 12 professional athletic training programs (5 bachelor's, 7 master's level).

PATIENTS OR OTHER PARTICIPANTS

A total of 363 ATSs from the athletic training programs that used E*Value software to document PEs during clinical experiences participated.

MAIN OUTCOME MEASURE(S)

During each PE, ATSs were asked to report whether professional behaviors reflecting 5 of the CCs occurred (the professionalism CC was excluded). Summary statistics, including means ± SDs, counts, and percentages were tabulated for the professional behaviors of each CC.

RESULTS

Data from 30 630 PEs were collected during the study period. Professional behaviors related to EBP were the most frequently incorporated during PEs (74.3%, n = 22 773), followed by QI (72.3%, n = 22 147), PCC (56.6%, n = 17 326), HIT (35.4%, n = 10 857), and IPECP (18.4%, n = 5627).

CONCLUSIONS

It is unsurprising that EBP and PCC behaviors were 2 of the most frequently incorporated CCs during PEs due to the emphasis on these competencies during the past several years. However, it is surprising that ATSs did not incorporate behaviors related to either HIT (in 65% of PEs) or IPECP (in 82% of PEs). These findings suggest that directed efforts are needed to ensure that ATSs are provided opportunities to incorporate professional behaviors related to the CCs during clinical experiences.

The critical need for advanced training of electronic records use: implications for clinical practice, education, and the advancement of athletic training

CONTEXT

The effective use of electronic records (ie, electronic health/medical records) is essential to professional initiatives and the overall advancement of the athletic training profession. However, evidence suggests comprehensive patient care documentation and wide-spread use of electronic records is still limited in athletic training. The lack of formal training and education for clinicians and students are often cited as primary barriers to electronic records use. Other healthcare disciplines have used academic electronic health records (AEHR) systems to address these barriers with promising results.

OBJECTIVES

To identify common challenges associated with the effective use of electronic records in clinical practice, discuss how an AEHR can address these challenges and encourage more effective use of electronic records, and describe strategies for deploying AEHRs within the athletic training profession.

DESCRIPTION

The AEHR is an electronic records system specifically designed for educational use to support simulation learning among all types of learners (eg, practicing clinicians, students). Mimicking the form and function of an EHR, the AEHR offers various educational tasks including patient care documentation projects, critical reviews of standardized patient cases, and assessments of patient care data for quality improvement efforts. Clinical and Research Advantages: Recent evidence suggests the use of an AEHR can improve knowledge and enhance skills. Specifically, AEHR use has been associated with enhanced attitudes toward EHR technology, enhanced informatics competencies, and improved documentation skills. Also, the use of an AEHR has been associated with improved critical thinking and decision-making skills. AEHRs appear to be valuable tools for health professions education and athletic training stands to benefit from AEHR use to better train and upskill clinicians and students alike for clinical practice. Although the implementation of an AEHR will require much time and large-scale coordinated efforts, it will be a worthy investment to address current challenges and advance the athletic training profession.

Cost and Treatment Characteristics of Sport-Related Knee Injuries Managed by Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network

CONTEXT

Knee injuries are common during sport participation. However, little is known about the overall management and estimated direct costs of care associated with these injuries when under the care of athletic trainers.

OBJECTIVE

To describe the treatment characteristics and direct costs of care for athletic training services provided for patients with knee injuries.

DESIGN

Descriptive study.

SETTING

Ninety-five athletic training facilities across 24 states.

PATIENTS OR OTHER PARTICIPANTS

A total of 117 athletic trainers (females = 56.4%, age = 29.4 ± 8.7 years, years certified = 4.7 ± 6.0, years employed at site = 1.6 ± 4.1).

MAIN OUTCOME MEASURE(S)

Complete patient cases were identified using International Classification of Disease-10 diagnostic codes between 2009 and 2020. Summary statistics were calculated for patient demographics, treatment characteristics, and direct costs of care. Treatment characteristics included the type of athletic training service, duration, amount (eg, number of visits), and direct costs of care.

RESULTS

A total of 441 patient cases were included. The most common injuries reported were cruciate ligament sprain (18.1%, n = 80), medial collateral ligament sprain (15.4%, n = 68), and knee pain (14.1%, n = 62). Injuries occurred most frequently during football (35.4%, n = 156), basketball (14.7%, n = 65), and soccer (12.7%, n = 56). A total of 8484 athletic training services were recorded over 4254 visits, with therapeutic exercise (29.8%, n = 2530), hot or cold pack (25.8%, n = 2189), and therapeutic activities (11.2%, n = 954) being the most frequently reported services. The median duration of care was 23 days and number of visits was 8. The median total cost of care was $564 per injury and $73 per visit.

CONCLUSIONS

Patients with knee injuries demonstrated greater time loss than those with other lower extremity injuries. Thus, it is unsurprising that knee injuries were associated with a longer duration and higher cost of care than other lower extremity injuries such as ankle sprains. Future researchers should examine the effectiveness of common treatment strategies and aim to identify treatments that can reduce costs and improve patient outcomes.

Documentation Practices of Athletic Trainers Employed in the Clinic, Physician Practice, and Emerging Clinical Settings

CONTEXT

The documentation practices of athletic trainers (ATs) employed in the secondary school setting, including their strategies for, barriers to, and perceptions of documentation, have been characterized in previous research. The documentation practices of ATs employed in other settings have yet to be studied in depth.

OBJECTIVE

To examine the documentation practices of ATs employed in the clinic, physician practice, and emerging clinical settings.

DESIGN

Qualitative study.

SETTING

Web-based interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 22 ATs 11 employed in the clinic or physician practice setting and 11 employed in an emerging clinical setting.

DATA COLLECTION AND ANALYSIS

The ATs employed in the settings of interest were recruited with purposeful, convenience, and snowball sampling. Participants were interviewed using a Web-based platform so that we could learn about their behaviors and perceptions of documentation. Data were analyzed using the consensual qualitative research approach, followed by a thematic analysis. Trustworthiness was addressed using data source triangulation, multiple-analyst triangulation, and an established interview guide and codebook.

RESULTS

Participants described following clear guidelines for documentation established by regulatory agencies, employers, and electronic medical record templates. They were motivated to document for patient safety and to demonstrate value. Participants typically documented in real time and continuously, which was facilitated by employer requirements. The ATs described experiencing a learning curve for documentation due to the unique requirements of their settings, but learning was facilitated by employer guidance and mentorship.

CONCLUSIONS

Employer guidelines, training, and ongoing support facilitated effective and thorough documentation in these clinical settings. Athletic trainers and employers in a variety of settings should consider establishing clear guidelines to promote thorough and effective documentation.

Knowledge Translation in Athletic Training: Considerations for Bridging the Knowledge-to-Practice Gap

As the athletic training profession continues to embrace evidence-based practice, athletic trainers should not only critically appraise the best available evidence, but also effectively translate it into clinical practice to optimize patient outcomes. While previous research has investigated the effectiveness of educational interventions on increasing knowledge of critical appraisal of evidence, little attention has been given to strategies for both researchers and clinicians to effectively translate evidence into clinical practice. The use of knowledge translation strategies has potential to bridge the knowledge-to-practice gap, which could lead to reduced health costs, improved patient outcomes, and enhanced quality of care. The purpose of this paper is to 1) highlight current challenges prohibiting successful translation of evidence into practice, 2) discuss knowledge translation and describe conceptual frameworks behind effectively translating evidence into practice, and 3) identify considerations for athletic trainers as they continue to provide high quality patient care in an evidence-based manner.

Patient Care Documentation in the Secondary School Setting: Unique Challenges and Needs

CONTEXT

Athletic trainers (ATs) recognize patient care documentation as an important part of clinical practice. However, ATs using 1 electronic medical record (EMR) platform reported low accountability and lack of time as barriers to documentation. Whether ATs using paper, other EMRs, or a combined paper-electronic system exhibit similar behaviors or experience similar challenges is unclear.

OBJECTIVE

To explore ATs' documentation behaviors and perceived challenges while using various systems to document patient care in the secondary school setting.

DESIGN

Qualitative study.

SETTING

Individual telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Twenty ATs (12 women, 8 men; age = 38 ± 14 years; clinical experience = 15 ± 13 years; from National Athletic Trainers' Association Districts 2, 3, 6, 7, 8, 9, and 10) were recruited via purposeful and snowball-sampling techniques.

DATA COLLECTION AND ANALYSIS

Two investigators conducted semistructured interviews, which were audio recorded and transcribed verbatim. Following the consensual qualitative research tradition, 3 researchers independently coded transcripts in 4 rounds using a codebook to confirm codes, themes, and data saturation. Multiple researchers, member checking, and peer reviewing were the methods used to triangulate data and enhance trustworthiness.

RESULTS

The secondary school setting was central to 3 themes. The ATs identified challenges to documentation, including lack of time due to high patient volume and multiple providers or locations where care was provided. Oftentimes, these challenges affected their documentation behaviors, including the process of and criteria for whether to document or not, content documented, and location and timing of documentation. To enhance patient care documentation, ATs described the need for more professional development, including resources or specific guidelines and viewing how documentation has been used to improve clinical practice.

CONCLUSIONS

Challenges particular to the secondary school setting affected ATs' documentation behaviors, regardless of the system used to document care. Targeted professional development is needed to promote best practices in patient care documentation.

Does the Method of Administration Affect Reliability of the Foot and Ankle Ability Measure?

BACKGROUND

Region-specific patient-reported outcomes (PROs) are commonly used in rehabilitation medicine. Digital versions of PROs may be implemented into electronic medical records and are also commonly used in research, but the validity of this method of administration (MOA) must be established.

PURPOSE

To determine the agreement between and compare the test-retest reliability of a paper version (FAAM-P) and digital version (FAAM-D) of the Foot and Ankle Ability Measure (FAAM).

STUDY DESIGN

Randomized, nonblinded, crossover observational study.

METHODS

A total of 90 adults were randomized to complete the FAAM-P or FAAM-D first, and then completed the second MOA (first day [D1]). The FAAM-D was a digital adaptation of both FAAM-P subscales on Qualtrics. Identical test procedures were completed 1 week later (D2). Data were removed if a participant scored 100% on both MOA, reported injury between D1 and D2, or did not complete both MOA. Agreement was assessed on 46 participants between the 2 MOA using intraclass correlation coefficients (ICC) at D1. There was good-to-excellent test-retest reliability for the FAAM activities of daily living.

RESULTS

The authors observed good agreement between the FAAM-P and FAAM-D for the activities of daily living (ICC = .88) and sport scales (ICC = .87). Test-retest reliability was good-to-excellent for the FAAM activities of daily living (FAAM-P: ICC = .87; FAAM-D: ICC = .89) and sport (FAAM-P: ICC = .71; FAAM-D: ICC = .91).

CONCLUSIONS

The MOA does not appear to affect the responses on the FAAM; however, the authors observed slightly higher reliability on the FAAM-D. The FAAM-D is sufficient to be used for generating practice-based evidence in rehabilitation medicine.

Aspects of Technology That Influence Athletic Trainers' Current Patient Care Documentation Strategies in the Secondary School

CONTEXT

Previous research on athletic trainers' (ATs) documentation practices in the secondary school setting has focused on users of 1 electronic medical record (EMR) platform. These studies have identified that ATs use multiple platforms for documentation, including paper, even when an EMR is available.

OBJECTIVE

To examine the documentation practices of ATs who use various forms of patient care documentation, including paper, EMRs, or both.

DESIGN

Qualitative study.

SETTING

Individual telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Twenty ATs participated in this study: 12 women and 8 men who averaged 38 ± 14 years of age, 15 ± 13 years of clinical experience, and 11 ± 11 years of employment at their current secondary school.

DATA COLLECTION AND ANALYSIS

Semistructured telephone interviews were conducted to gain insight into ATs' documentation practices. Three researchers and 2 auditors inductively coded the transcripts using a consensual qualitative research process that consisted of 4 rounds of consensus coding and determination of data saturation. Trustworthiness was addressed with member checking, multiple-analyst triangulation, and peer review.

RESULTS

The ATs' documentation practices were largely influenced by technology, organized in 3 themes. Participants' current documentation strategies included the use of both paper and EMRs, as they found different benefits to using each platform. Oftentimes documentation practices were shaped by technological challenges, including unreliable networks, software design problems, and the lack of a streamlined approach. Lastly, participants identified future strategies for improving documentation, including the need for better EMR options and streamlining their individual documentation behaviors.

CONCLUSIONS

Many ATs wanted to incorporate EMRs in their clinical practice but faced challenges when attempting to do so. In turn, clinicians often duplicated documentation or used 2 platforms. Athletic trainers should communicate with administrators to select an EMR that fits their documentation needs and seek resources, such as network access and educational opportunities, to learn how to use EMRs.

Research at the Point of Care: Using Electronic Medical Record Systems to Generate Clinically Meaningful Evidence

CONTEXT

Health care leaders have recommended the use of health information technology to improve the quality of patient care. In athletic training, using informatics, such as electronic medical records (EMRs), would support practice-based decisions about patient care. However, athletic trainers (ATs) may lack the knowledge to effectively participate in point-of-care clinical research using EMRs.

OBJECTIVES

To discuss the role of EMRs in athletic training and identify methodologic approaches to conducting clinical research at the point of care.

DESCRIPTION

The 2020 Commission on Accreditation of Athletic Training Education curricular content standards included the use of an electronic patient record to document care, mitigate error, and support decision making through the collection and use of patient data (Standard 64). Patient data are collected by ATs at the point of care via routine documentation, and these data can be used to answer clinical questions about their practice. Observational or descriptive study designs are ideal for this type of data. Observational research (ie, case-control, cross-sectional, cohort studies) evaluates factors that influence patients' lives in the "real world," whereas descriptive research (ie, case study or series, descriptive epidemiology studies) identifies characteristics of individuals and groups. If ATs are comprehensively documenting patient care using an EMR, they have the means to participate in observational and descriptive research.

CLINICAL AND RESEARCH ADVANTAGES

Using an EMR to its full capacity allows ATs to collect meaningful data at the point of care, conduct practice-based research, and improve health care for the patient and clinician. However, to ensure data quality, these approaches must include routine and comprehensive documentation habits.

Point-of-Care Clinical Trials in Sports Medicine Research: Identifying Effective Treatment Interventions Through Comparative Effectiveness Research

CONTEXT

Recently, calls to conduct comparative effectiveness research (CER) in athletic training to better support patient care decisions have been circulated. Traditional research methods (eg, randomized controlled trials [RCTs], observational studies) may be ill suited for CER. Thus, innovative research methods are needed to support CER efforts.

OBJECTIVES

To discuss the limitations of traditional research designs in CER studies, describe a novel methodologic approach called the point-of-care clinical trial (POC-CT), and highlight components of the POC-CT (eg, incorporation of an electronic medical record [EMR], Bayesian adaptive feature) that allow investigators to conduct scientifically rigorous studies at the point of care.

DESCRIPTION

Practical concerns (eg, high costs and limited generalizability of RCTs, the inability to control for bias in observational studies) may stall CER efforts in athletic training. In short, the aim of the POC-CT is to embed a randomized pragmatic trial into routine care; thus, patients are randomized to minimize potential bias, but the study is conducted at the point of care to limit cost and improve the generalizability of the findings. Furthermore, the POC-CT uses an EMR to replace much of the infrastructure associated with a traditional RCT (eg, research team, patient and clinician reminders) and a Bayesian adaptive feature to help limit the number of patients needed for the study. Together, the EMR and Bayesian adaptive feature can improve the overall feasibility of the study and preserve the typical clinical experiences of the patient and clinician.

CLINICAL ADVANTAGES

The POC-CT includes the basic tenets of practice-based research because studies are conducted at the point of care, in real-life settings, and during routine clinical practice. If implemented effectively, the POC-CT can be seamlessly integrated into daily clinical practice, allowing investigators to establish patient-reported evidence that may be quickly applied to patient care decisions. This design appears to be a promising approach for CER investigations and may help establish a "learning health care system" in the sports medicine community.

Athletic Trainers' Practice Patterns Regarding Medical Documentation

CONTEXT

Medical documentation is a required component of patient care in all health care professions.

OBJECTIVE

To evaluate athletic trainers' perceived behaviors toward, barriers to, and confidence in their medical documentation.

DESIGN

Cross-sectional study.

SETTING

Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

We purchased a list of randomly selected e-mails from the National Athletic Trainers' Association. Of the 9578 participants, 1150 accessed our questionnaire (12.0% access rate), 1053 completed at least 1 portion, and 904 completed the questionnaire in its entirety (85.8% completion rate). Of the participants, 60.1% (n = 569/947) were female, 66.6% (n = 632/949) held a master's degree, 39.3% (n = 414/1053) worked in a collegiate or university setting, and 36.1% (n = 381/1053) worked in a secondary school setting.

MAIN OUTCOME MEASURE(S)

We used a 31-item questionnaire with demographics (12 items), medical documentation behaviors (16 items), barriers (2 items), and perceptions (1 multipart item) sections. The questionnaire explored athletic trainers' behaviors as well as confidence in, comfort with, and concerns about their documentation practices (Cronbach α = 0.887). We used descriptive statistics to identify characteristics of central tendency (mean, standard deviation, mode, frequency).

RESULTS

Participants always (45.7%, n = 478/1046) or very frequently (39.0%, n = 408/1046) used a double documentation system consisting of electronic and paper records (50.4%, n = 523/1038). They most often documented to provide legal protection (86.8%, n = 914/1053), because it is a legal obligation (79.1%, n = 833/1053), or to track patient progress (83.9%, n = 883/1053). The most frequently cited barriers to medical documentation were time (76.5%, n = 806/1053), managing too many patients (51.9%, n = 547/1053), technological concerns (17.2%, n = 181/1053), and software limitations (17.2%, n = 181/1053). Respondents believed they were competent, comfortable, and confident in their documentation practices.

CONCLUSIONS

We were able to evaluate the generalizability of previous research while adding to the understanding of the behaviors toward, barriers to, and perceptions about medical documentation. We confirmed that time and patient load affected the ability to perform high-quality medical documentation.

A technology-enabled electronic incident report to document and facilitate management of sport concussion: A cohort study of youth and young adults

Despite the widespread awareness of concussion across all levels of sport, the management of concussion from youth to college is inconsistent and fragmented. A fundamental gap contributing to inconsistent care is the lack of a scalable, systematic approach to document initial injury characteristics following concussion. The purpose of this study was to determine differences in injury profiles and management of youth, high school, and college athletes using a mobile application for incident report documentation.A cohort study was conducted in which concussion electronic incident report data from 46 high schools and colleges, and Cleveland Clinic ambulatory concussion clinics were gathered and analyzed.In sum, 1421 (N = 88 youth, N = 1171 high school and N = 162 college) athletes with sport-related concussions were included.Despite the relative absence of red flags, youth athletes had a greater probability of being sent to the emergency department than high school and collegiate athletes. Over 60% of athletes were removed from play immediately post-injury. Injury recognition was delayed in 25% of athletes due to delayed symptom reporting (20% of males, 16% of females) or delayed symptom onset (5% of males, 9% of females). A significantly greater incidence of red flags was evident in males, and in high school and collegiate athletes compared to youth athletes.The high frequency of youth athletes sent to the emergency department, despite the absence of red flags, may be a reflection of inadequate medical coverage at youth events, ultimately resulting in unnecessary utilization of emergency medicine services. The relatively high incidence of delayed injury reporting implies that additional educational efforts targeting student-athletes and the utilization of resources to improve injury detection are warranted. The systematic collection of injury-related demographics through the electronic mobile application facilitated interdisciplinary communication and improved the efficiency of managing athletes with concussion.

Future Strategies to Enhance Patient Care Documentation Among Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network

CONTEXT

  High-quality patient care documentation is an essential component of any health care professional's daily practice. Whereas athletic trainers (ATs) recognize the importance of patient care documentation, several barriers may prevent them from producing high-quality patient care documentation.

OBJECTIVE

  To explore beneficial strategies and techniques that ATs perceived would enhance the quality of patient care documentation in the secondary school setting.

DESIGN

  Qualitative study.

SETTING

  Individual telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

  Ten ATs who were members of the Athletic Training Practice-Based Research Network and employed in the secondary school setting were interviewed (4 men, 6 women with 7.1 ± 7.8 years of athletic training experience).

DATA COLLECTION AND ANALYSIS

  An individual telephone interview was conducted with each participant. Once transcribed, data were analyzed into common themes and categories per the consensual qualitative research tradition. Trustworthiness of the data was achieved through triangulation strategies: (1) the inclusion of multiple researchers to ensure accuracy and representativeness of the data and (2) participant member checking.

RESULTS

  Participants identified several documentation strategies they perceived would be helpful to improve the quality of patient care documentation, including mode and consistency of documentation and the need for a standardized process as well as the need for system standardization. In addition, participants discussed the need for more education on patient care documentation. Specifically, they identified ways of learning and strategies for future education to enhance patient care documentation across the profession.

CONCLUSIONS

  As athletic training continues to evolve, it is crucial that ATs are well educated on how to produce high-quality patient care documentation as a part of routine practice. Continuing professional development opportunities are needed to promote lifelong learning in the area of patient care documentation.

Athletic Trainers' Reasons for and Mechanics of Documenting Patient Care: A Report From the Athletic Training Practice-Based Research Network

CONTEXT

  Documenting patient care is an important responsibility of athletic trainers (ATs). However, little is known about ATs' reasons for documenting patient care and the mechanics of completing documentation tasks.

OBJECTIVE

  To understand ATs' perceptions about reasons for and the mechanics of patient care documentation.

DESIGN

  Qualitative study.

SETTING

  Individual telephone interviews with Athletic Training Practice-Based Research Network members.

PATIENTS OR OTHER PARTICIPANTS

  Ten ATs employed in the secondary school setting (age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) were recruited using a criterion-based sampling technique. Participants were Athletic Training Practice-Based Research Network members who used the Clinical Outcomes Research Education for Athletic Trainers electronic medical record system and practiced in 6 states.

DATA COLLECTION AND ANALYSIS

  We used the consensual qualitative research tradition. One investigator conducted individual telephone interviews with each participant. Data collection was considered complete after the research team determined that data saturation was reached. Interviews were transcribed verbatim and independently analyzed by 4 research team members following the process of open, axial, and selective coding. After independently categorizing interview responses into categories and themes, the members of the research team developed a consensus codebook, reanalyzed all interviews, and came to a final agreement on the findings. Trustworthiness was established through multiple-analyst triangulation and member checking.

RESULTS

  Participants identified 3 reasons for documenting patient care: communication, monitoring patient care, and legal implications. Four subcategories emerged from the mechanics-of-documentation theme: location, time of day, length of time, and criteria for documenting. The ATs described different criteria for documenting patient care, ranging from documenting every injury in the same manner to documenting time-loss and follow-up injuries differently.

CONCLUSIONS

  Whereas ATs recognized individual mechanisms that enabled them to document patient care, they may need more guidance on the appropriate criteria for documenting various patient care encounters and strategies to help them document more effectively.