Improving the Frequency and Documentation of Gun Safety Counseling in a Resident Primary Care Clinic

Updates in Firearms Access Screening

“…Since our initial study, research teams demonstrated that pediatric residents’ rates of screening for access to firearms was low in other settings, including inpatient wards 5 and primary care clinics. 6 However, similar to our follow-up study, 2 quality improvement methodology successfully increased the rate of screening. 6 These quality improvement projects delineated multiple perceived barriers that had to be addressed to improve screening rates, including perceived stigma, time to complete screening, discomfort with responding to a positive screen, and failure to consider screening at the time of the patient interaction.…”

“… 6 However, similar to our follow-up study, 2 quality improvement methodology successfully increased the rate of screening. 6 These quality improvement projects delineated multiple perceived barriers that had to be addressed to improve screening rates, including perceived stigma, time to complete screening, discomfort with responding to a positive screen, and failure to consider screening at the time of the patient interaction. In our own institution, training around firearms screening and counseling has been added to intern orientation for all trainees to help address these barriers, to call attention to the central importance of this issue as a basic tenet of routine care, and to help with sustainability of our quality improvement initiatives.…”

Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death

“…Other clinical team members can incorporate screening into the tertiary survey. Given what is known about low comfort levels and efficacy of clinician screening for depression and lethal means, it is important to provide guidance to trainees and there should be prompts in the EMR to both improve efficacy, adherence to the instrument, and documentation [ 88 , 91 ]. Any positive screen should prompt referral to the appropriate mental health provider for further evaluation, safety planning, treatment, and follow-up, and the detection of a firearm in the home should be accompanied by education to the caregiver on lethal means access, counseling for secure storage and if available, provision of a firearm lock, or information on options for temporary relinquishment or safe storage.…”

Our power to reduce gun violence

“…Inpatient encounters represent a unique opportunity for firearm safety screening and counseling because of the additional opportunity for family and provider interactions, potential periods of available unstructured time compared to outpatient or emergency department visits, and a population who may have a gap in consistent primary care. Several outpatient initiatives have demonstrated success in increasing provider screening rates and producing safer storage practices 13,14 . It is vital that we expand this approach to other phases of care, including during hospitalization, where screening rates have been estimated to be as low as 3% 15 .…”

“…Several outpatient initiatives have demonstrated success in increasing provider screening rates and producing safer storage practices. 13,14 It is vital that we expand this approach to other phases of care, including during hospitalization, where screening rates have been estimated to be as low as 3%. 15…”