Improving delivery of firearm safety resources for behavioral health patients in the pediatric emergency department: 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. Plan-Do-Study-Act (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% preintervention to an initial 89% postintroduction of standardized EMR firearm safety questions. Firearm safety screening documentation rates increased to and were sustained at >90% without special cause variation following our 2 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% prestudy to 85% for patients with unsafely stored guns following chart review. CONCLUSIONS: 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.