Jan 29, 2015A SMART Idea
At Illinois State University, the opening of the SMART Clinic has provided more hands-on opportunities for athletic training students and a place for recreational athletes to receive treatment.
By Dr. Justin Stanek
Justin Stanek, EdD, ATC, is an Instructional Assistant Professor and the Clinical Education Coordinator for the CAATE Athletic Training Program in the School of Kinesiology and Recreation at Illinois State University. He can be reached at: [email protected].
It’s a Thursday afternoon and the Sports Medicine and Rehabilitation Therapy (SMART) Clinic at Illinois State University is humming. In one corner, an ultimate player is receiving rehab for a shoulder injury. In another, a dancer with a big performance over the upcoming weekend has a stim machine working on her lower leg. And just outside the door, members of an intramural basketball team are lined up to get their ankles taped in preparation for their title game that night. You won’t find any intercollegiate athletes in our space, but our patients are athletes who need the services of athletic training professionals. We have been able to meet their needs through a unique new program.
Opened one year ago, the SMART Clinic is a result of collaboration among many entities at Illinois State to provide advanced care for ISU students in the areas of prevention, evaluation, and rehabilitation of athletic-related orthopedic injuries. It also allows clinical experience for our athletic training students, as well as a research resource for professors in our School of Kinesiology and Recreation.
While it took a few years to get the project up and running, it has proven to be hugely successful. The SMART Clinic recently won the 2013 ISU Student Affairs Outstanding New Program award and received Honorable Mention for the Team Excellence Award at ISU’s 2013 Founder’s Day Convocation.
STARTING UP
The seeds for the SMART clinic were planted about seven years ago. At that time, two staff athletic trainers from the university’s athletic department began providing services to the general student population through Student Health Services as part of a pilot program. The collected data and patient feedback showed positive results. The patients treated by the athletic trainers regained their function and returned to activity, while Student Health appreciated the ability to closely monitor progress. However, limited space and resources within Student Health made the program difficult to continue. In addition, the athletic trainers were finding it hard to work for two different entities in multiple places. As a result, the program was terminated after only two semesters of operation.
In the fall of 2008, the idea for a therapeutic rehabilitation clinic for students was revisited thanks to new construction on campus. McCormick Hall, which serves as home to our athletic training program, was being expanded to include a fitness center and additional classrooms. Administrators and professors from the School of Kinesiology and Recreation proposed including a fully functioning athletic training room/laboratory in the design.
The thinking was that this space could serve many needs. To start, it could expand the services of Student Health by offering students an on-campus location for treatment and rehab of athletic injuries. Second, it could provide an additional clinical education site for athletic training students. Third, professors could use the space for both teaching and research. Our proposal was approved, but there were hurdles to clear before the clinic could be up and running. One was to secure startup funding, which was needed to cover staffing, purchase a credit card machine, and pay for some minimal advertising and supplies, including collared shirts for staff. This money came from Student Health Services, the College of Applied Science and Technology, and the School of Kinesiology and Recreation. Fortunately, the majority of the necessary equipment was already owned for didactic instruction in the University’s athletic training program.
We also needed to consider the interests of local rehabilitation clinics. These clinics have a direct relationship with the ISU undergraduate and graduate athletic training programs, as well as university intercollegiate athletics. We wanted to reassure them that the aim of the SMART Clinic was not to serve as a competitor to their operations–Student Health and our clinic would still be referring patients to them regularly. These communications were important in getting two prominent orthopedists in the area to agree to continue working with both our educational and athletic programs. The result of our efforts is a 3,500 square foot, state-of-the-art facility with an attached classroom. It is equipped with numerous treatment tables, a private examination room, an office, therapeutic modalities, and rehabilitation equipment commonly found in an athletic training facility. In the morning, it is used by professors as an instructional or research area, and in the afternoon it becomes a functioning clinic.
As you might expect, the daily operations of the clinic require the combined efforts of numerous stakeholders from across the university. The clinic works closely with Student Health Services through the Division of Student Affairs. Additionally, the clinic shares resources with the College of Applied Science and Technology and School of Kinesiology and Recreation. Lastly, Campus Recreation handles all of the building maintenance, and maintains the schedules for the space.
DAILY OPERATIONS
The current hours of operation are from 2:00 to 6:00 p.m. Monday through Thursday, and 1:00 to 5:00 p.m. on Friday. We sometimes adjust our regular hours to accommodate patients and allow weekend appointments as necessary. As the Clinical Education Coordinator of ISU’s Undergraduate Athletic Training Program, I serve as Director of the SMART Clinic and spend my afternoons there. The other certified athletic trainer on staff is a graduate student. She receives a graduate assistantship for this work as well as the opportunity to further her clinical skills and develop her leadership and mentoring abilities by overseeing the work of undergraduate students in our athletic training program.
The two of us practice under the direction of the physicians at Student Health Services, as required by the Illinois State Practice Act, and are responsible for overseeing the day-to-day operations of the clinic. Some of our duties include patient care, scheduling, record keeping, communicating with Student Health, inventory and ordering of supplies, and tracking patient satisfaction and outcomes. However, a big part of our responsibility is overseeing the work of our undergraduate athletic training students. As the students progress through the program, they take on greater responsibilities with patient care. These experiences allow the students to transfer their classroom knowledge to a real-world context under the direction of preceptors who know and understand their current skill level. An added bonus for our students is that working at the SMART Clinic gives them athletic training experience in a unique setting with a relaxed atmosphere. A typical day begins around 1:30. The patient files for the day are pulled, and paperwork for new patients is assembled. Patients are greeted at the door upon arrival, payment is secured, and the plan of care is started. Each visit is documented via the daily SOAP note and rehab log. The graduate assistant and I work with the students to adjust rehab exercises and care based on the patient’s progress. After the last client has been treated, folders are filed and necessary records are faxed to Student Health.
This schedule has worked well for patients and our students. The biggest challenge is that my time is often stretched too thin. During a typical week, I spend approximately 20 hours in the clinic on patient care, which can take away from my teaching and department duties. We are working on remedying this by shifting some responsibilities to our graduate assistant and students.
CLIENTS & SERVICES
To get the word out about the new clinic, we partnered with Campus Recreation to advertise on the television monitors placed throughout McCormick Hall. Additional publicity included flyers placed at Student Health Services and ads in the student newspaper. A ribbon-cutting event was held shortly after opening, allowing local media the chance to tour and ask questions about the facility, resulting in some indirect advertising.
We also provide a lot of information on our Web site (kinrec.ilstu.edu/smart), which serves as an advertising tool. The site details the services we provide, who we are, how to make an appointment, and costs. It also explains what an athletic trainer is and how we collaborate with other groups on campus.
Most of our patients are referred to us by Student Health, which faxes the student’s diagnosis and any specific instructions for care directly to us. A crucial part of our client services is to take patient privacy very seriously. Student Health only shares necessary information related to the patient’s current athletic-related condition and SMART Clinic patient records are kept in a locked file cabinet, housed within the clinic office. Only the athletic training graduate assistant and I have immediate access to these records. Additionally, undergraduate students fulfilling their clinical education rotation with us sign verification forms indicating they understand the confidentiality and protected health information policies and procedures prior to any exposure to patient care. Also, all patients sign a student authorization/consent form for disclosure of protected health information. During the patient’s first visit, a thorough evaluation is performed and a plan of care is developed. Patient education of the diagnosis and treatment is emphasized during this initial visit and, if applicable, a home exercise program is developed. This information is sent back to Student Health to ensure they are aware of all rehabilitation procedures.
If a student sustains an orthopedic-related injury during regular SMART Clinic hours, but outside of Student Health Services hours (weekdays from 9 a.m. to 5 p.m.), an agreement is in place to allow myself or the athletic training graduate student to perform an initial evaluation and any necessary immediate care. However, if we determine care beyond basic first aid is needed, the student is referred to the emergency room for further evaluation by a physician. The student may be referred back to the SMART Clinic after this visit for follow-up care. We have been pleasantly surprised by the variety of students utilizing the clinic. Prior to opening, we thought the majority of our patients would be club sport and intramural participants. While we see a fair number from this population, it is certainly not the majority. We have learned a lot about the types of injuries that can occur in quidditch, ultimate, boxing, team handball, ROTC, rugby, and equestrian. We also have treated a number of runners training for half or full marathons and students from the College of Fine Arts who have suffered an injury during classes or rehearsing for an upcoming performance. A wide variety of both acute and chronic orthopedic conditions have walked (or hobbled) through our doors. Examples include post-operative rehabilitation procedures for ACL reconstruction, patellofemoral pain syndrome, ankle sprains, muscle strains, medial tibial stress syndrome, and low back pain. We utilize many different treatment approaches to address these conditions, such as myofascial release, muscle energy technique, Graston Technique, joint mobilization and traction, therapeutic ultrasound, electrical stimulation, balance training, stretching protocols, and strengthening exercises.
The clinic also offers students preventative joint taping (ankles, wrist, etc.) for a nominal fee. No appointment is necessary for this service. If the patient wishes to bring his or her own supplies, we offer the taping for free. In addition, sport clubs on campus may hire an athletic trainer for event coverage and are charged on an hourly basis.
In terms of billing, the clinic charges $10 per visit, the same fee used by Student Health, and students can pay using a major credit card, cash, or check. Due to feedback from patients, this fall we’ve begun allowing patients to charge the fee to their student account. One challenge we have faced is patients not showing up for scheduled appointments. Unlike a traditional athletic training facility where you typically see the athlete daily, the clinic usually schedules patients for two to three visits per week. This seems to make it harder for them to remember their appointment. Additionally, we find that despite being referred from Student Health Services, some patients never show up for their initial treatments. This leads to loss of revenue for the clinic, as it results in an open time slot. In response, we have instituted a no-show policy. Modeling this after Student Health Services, we now charge the student’s account $10 for the missed appointment if the student fails to notify us in advance. Our overall goal is to fund all athletic trainer stipends and salaries, clinic equipment, and resource expenditures from patient fees, and thus have a self-sustaining operation. After our first year, the clinic is on target for being self-sufficient, and all remaining profit will be put towards paying back our startup funding.
WIN-WIN-WIN
The SMART Clinic has proven to be a successful endeavor at ISU. Along with providing a unique and cost-effective service to our student body, it has provided many other benefits. First, the clinical opportunity for our students has been tremendous. The students assigned to the SMART Clinic say that the atmosphere allows them more independence than an intercollegiate athletic setting and they feel more confident in the low-risk environment. Second, the SMART Clinic has promoted the profession of athletic training and the athletic training major on campus. Not only do injured students receive education about their injuries, they also receive excellent care and some education about the knowledge and abilities of athletic trainers. Finally, the collaboration among groups on campus has been a very rewarding experience. The clinic has garnered the attention of administrators from across the campus and opened up doors for research partnerships between faculty and the physicians at Student Health. We have also joined with Health Promotion and Wellness to put together information on injury prevention.
If the idea of starting a clinic like ours is something you are interested in starting at your school, the importance of garnering support from many different constituents cannot be overstated. In our first year of operation, we have found these relationships to be extremely important and supportive in our efforts. Overall, the response we have received from both patients and the campus community has been very positive.
Sidebar: TWO STUDENTS
One of the most rewarding aspects of overseeing the SMART Clinic is watching an athletic training student thrive through hands-on experience. This was the case for one of our students (whom I’ll call Alvin) and a recent patient (Tim).
Tim came to us two-weeks post-op ACL reconstruction. This was the second time he had torn his ACL, so he was not looking forward to the rehab process. He had a fairly significant amount of edema and was completely non-weight bearing when he arrived for his first visit. Alvin was a junior athletic training student and was taking our therapeutic rehabilitation class at the time. He had seen many acute injuries but had not been able to work with a post-op patient through an entire injury rehabilitation. He was excited by the opportunity.
Knowing Tim’s history, Alvin was determined to not allow him to become bored with rehab. After carefully studying the protocol, Alvin worked diligently to create a variety of exercises that would keep Tim motivated but also on track to progress quickly. As Tim warmed up each day, Alvin was busy tweaking exercises based on Tim’s previous visit.
Slowly, both began to see results. Hobbling along on crutches soon became pain-free for Tim, and his normal gait returned. Wall slides for mobility were replaced with stool scoot races and balancing contests between Alvin and Tim. Rehab games that Alvin had easily won were soon being won by Tim. As Tim continued to progress, Alvin began modifying portions of the treatment and searching for new exercises. By the end of the semester, Tim was running again and was able to begin more sport-specific training. As a result of their time together, both Tim and Alvin had gained confidence from the experience–along with a genuine mutual respect.
