Jan 29, 2015No Appointment Necessary
More and more sports medicine practices are hosting walk-in clinics specifically for high school athletes. The one profiled here has found success by carefully considering all logistics.
By Bobbie Hirsch
Bobbie Hirsch, MEd, ATC, LAT, is the Associate Athletic Trainer at the Tulane Institute of Sports Medicine, a satellite clinic of the Tulane University Medical Center. She also serves on the Louisiana High School Athletic Association’s Sports Medicine Advisory Committee and can be reached at: [email protected].
When we talk about life here in New Orleans, things are often described as either pre-Katrina or post-Katrina. As devastating as the storm was, there has been a lot of positive change since, and the recovery can be seen throughout the city. One of the things that bounced back and remains true to its pre-storm mission is the walk-in clinic at the Tulane Institute of Sports Medicine (TISM).
When TISM decided to rebuild after the storm, continuing the walk-in clinic was a top priority. The goal of the clinic has always been simple: to provide local high school athletes with timely access to sports medicine professionals. Since the clinic is available to all athletes, regardless of their ability to pay, this service became even more important after Katrina.
From the beginning, the clinic has always been about providing much-needed services, not turning a profit. Our success is measured by the number of athletes we’re able to return to the field safely, not by billable services. In the eight years since the storm, the effort and resources that went into rebuilding TISM continues to pay off, and with continued investment, we hope to see even greater success.
TISM was founded by longtime Tulane University Team Physician, Michael Brunet, MD, in 1998 and soon added an outreach program. When it began, the outreach program consisted of three athletic trainers providing coverage to a handful of local athletic programs. Today, we have a staff of 15 athletic trainers servicing more than 20 area organizations, including high schools, colleges, professional teams, and dance programs.
Shortly after opening TISM, we realized high school athletes here had no access to immediate sports medicine-based care for non-emergency injuries. Plus, because of the demand for the care provided at TISM, there was often a significant wait time for an appointment. We wanted to reduce that wait and provide athletes with timely, high-quality care. To us, a walk-in clinic seemed like the perfect solution, and we began ours in 1999.
The key to our success has been the personal relationships we’ve developed with schools and organizations, coaches, administrators, parents, and athletes. By establishing and nurturing relationships, we have opened avenues of trust and communication that engage the community and facilitate the care of as many student-athletes as possible.
WHERE & WHEN
Our walk-in clinic is run at TISM, which is situated in uptown New Orleans on the edge of the Tulane University campus. The high-profile and convenient location is easy to access, has ample parking, and is only a block away from a major city bus line.
In addition to logistics, TISM has many features that make it an ideal setting for a walk-in clinic. During the clinic’s planning stages, we determined that an outpatient facility designed exclusively for the care of athletes would be more comfortable and efficient than an emergency room environment, which is where many walk-in clinics are situated. Because of our setup, TISM is able to dedicate its full resources to the clinic, which means athletes can quickly see top sports-medicine professionals.
Operating out of TISM also gives us access to an array of invaluable equipment, including X-ray, MRI, and diagnostic ultrasound machines, as well as orthopedic bracing supplies. This allows us to promptly complete our evaluation and design injury-management strategies.
Our next concern as we developed the walk-in clinic was timing. This clinic was intended to be used by all high school athletes, but it seemed logical to host it in conjunction with the football season, so it runs from August to November. We made this decision in part because of the sport’s high injury rates and its popularity in and around New Orleans, and also because there are many other sports competing and practicing in the fall.
Choosing the best day of the week to operate the clinic was a more complex decision. Many of our schools share football stadiums, so varsity games take place on Thursday, Friday, and Saturday evenings. Since our goal was to see as many athletes as possible, we decided the traditional Friday night clinic model wasn’t the best option for us.
In addition, staffing an evening clinic would be difficult. As part of TISM’s outreach program, our orthopedic physicians and residents share the sidelines at high school football games with our athletic trainers, allowing us to provide more comprehensive medical coverage. Our personnel cover games all over the city, thus it would be difficult for them to staff a walk-in clinic on a game night. Transportation was another factor we considered. A large number of our student-athletes rely on public transportation. This would make it tough for many to get to a late-night clinic and even harder for them to return home.
Finally, while our clinic would run parallel to the high school football season, and we expected the majority of its users to be football players, we didn’t want to exclude athletes from other sports. Since many of these sports don’t play night games, we thought the inconvenience of a late-night clinic would deter many athletes from utilizing our services.
Based on all of these criteria, a Saturday morning walk-in clinic seemed the most reasonable option. TISM’s normal days of operation are Monday through Friday, so hosting the clinic on Saturday would allow us to devote the entire facility to young athletes. And since the majority of the city’s high school contests would be played before Saturday morning, we would be able to see a large percentage of the players who were injured that week. In addition, athletic trainers, coaches, and parents would have time to assess an injury situation from previous nights to determine whether or not a visit with a physician would be necessary.
HOW IT WORKS
We open the doors to our Saturday clinic at 9 a.m. and registration runs until 11 a.m. On average, we have seven employees on hand: two customer service coordinators to check patients in and out, one radiology technician, two athletic trainers, and two physicians, one of whom is an orthopedic surgeon. This is a skeleton crew compared to our regular staff, but is perfect for our walk-in clinic, which averages about 20 athletes each Saturday.
When athletes visit the clinic, they’re first registered at the front desk. The majority of the athletes we see have either private insurance or Medicaid and both are accepted. It’s rare for an athlete to come in with no insurance coverage, but when this does happen they are treated at no cost to them.
Once registration is complete, an athletic trainer documents the athlete’s medical history and gets a subjective account of the injury. X-rays are taken for all new injuries, then the athlete is examined by a physician. At this point, a plan of action is determined: An MRI may be ordered, diagnostic ultrasound performed, surgery scheduled, physical therapy or home exercise prescribed, and/or bracing or casting applied. An athletic trainer handles the bracing and casting duties and prescribes the home-exercise routines.
The Saturday clinic has been a complete success. Coaches and parents have been pleased to have convenient access to sports-medicine professionals, along with prompt and accurate diagnoses and action plans. As a result, athletes are returning to the field safely and more quickly.
Not long after opening, however, we began getting requests from coaches, parents, and school administrators to open an additional walk-in clinic during the week. We were also seeing the need for more clinic hours. Athletic trainers working at the schools or at TISM were scheduling more and more weekday appointments for players who were injured in practice during the week or required a follow-up exam after a visit to the Saturday clinic. We were also seeing an increase in the number of appointments being made for athletes in sports other than football. It didn’t take long to decide that hosting a walk-in clinic on Wednesday afternoons would be a good idea.
In 2009, we opened our first weekday walk-in clinic, allowing us to follow up on any lingering injuries from the prior week’s games and practices. Wednesdays are also ideal because TISM is always fully staffed that day. This allows us to smoothly run the walk-in clinic concurrently with the regular sports medicine practice that TISM conducts each weekday. We chose afternoon hours–registration runs from 1 p.m. to 4 p.m.–because it is most convenient for the kids, coaches, and parents.
There’s very little difference between the walk-in clinic and the regular practice. Processes and procedures are the same for both, yet they largely operate independently of each another.
We set up the TISM building so that it’s divided into three distinct hallways with six exam rooms in each. One hallway is used exclusively for the walk-in clinic and the other two are used for the patients from the regular practice. Separating operations simplifies things for our staff and enables us to operate in a much more efficient manner. By having separate check-in areas for the walk-in clinic and regular practice, we’re able to cut wait times for the walk-in athletes.
During a typical Wednesday walk-in clinic, we see approximately 15 to 20 patients for either first-time visits or follow-ups. We have a designated customer service coordinator who registers the athletes, and there are three athletic trainers who work solely with the walk-ins. A sports medicine-trained physiatrist serves as the primary doctor for the walk-in clinic. In addition, two orthopedic surgeons who work the regular practice are available to the walk-in clinic should the physiatrist need a consult regarding a patient.
Due to the success of our walk-in clinics and the increase in demand from athletes playing sports other than football, we’ve decided to expand the scope of our Wednesday clinic. Starting next year, the clinic will run throughout the full school year, not just during the fall. We hope to see the same success the rest of the year that we do during the football season.
Sidebar: WORD OF MOUTH
Marketing and promotion of the Tulane Institute of Sports Medicine (TISM) walk-in clinics are minimal. We have no newspaper ads or television and radio commercials. Our primary advertising method is networking, which is mainly done through our outreach program.
Within the high school setting, our athletic trainers are responsible for establishing and nurturing relationships with the schools that they work with. They also promote the clinics’ services to coaches, athletic trainers, and school officials who operate outside of our outreach program.
We also market the walk-in clinics through our annual mass physical examinations for area high school students. The Louisiana High School Athletic Association requires all athletes at member schools to have a physical examination each year prior to participation in a sport. As a community service, TISM hosts a mass physical day where these exams are provided free of charge.
During this event, our athletic trainers and doctors speak to the athletes’ parents and/or coaches about TISM’s services, including our walk-in clinics. It’s an excellent opportunity to establish new relationships and expand on existing ones.