Improving delivery of firearm safety resources for behavioral health patients in the pediatric ED: A quality improvement initiative

OBJECTIVE: Addressing unsafe firearm storage is essential to preventing suicide and unintentional firearm injury. For patients presenting to our pediatric emergency department (ED) with behavioral health (BH) needs, we implemented a standardized approach to screening for exposure to unsafely stored firearms and offering firearm storage devices and educational resources to the families of patients presenting with BH concerns. 

METHODS: Using quality improvement methodology, we identified electronic medical record (EMR) documentation and availability of firearm safety resources (gun locks and firearm safety handouts) as areas for improvement. PDSA cycles were: 1) integrating standardized, templated firearm safety questions within an existing social work BH assessment template in the EMR; and 2) improving access to/restocking of firearm safety resources. We tracked screening documentation rates and safety resource offering rates as process and outcome measures. 

RESULTS: Screening documentation rates increased from 0% pre-intervention to an initial 89% post introduction of standardized EMR firearm safety questions. Firearm safety screening documentation rates increased to and were sustained at >90% without special cause variation following our two PDSA cycles. Two sporadic and expected fluctuations occurred, both attributed to changes in screening documentation formatting in EMR. Over the course of the study, our offering rate increased from 0% pre-study to 85% for patients with unsafely stored guns following chart review. 

CONCLUSION: Incorporating firearm safety questions into the EMR and maintaining a supply of firearm safety resources in the ED is an effective and sustainable approach to enhancing firearm safety for high-risk BH patients.