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A firearm safety program for families of pediatric ED patients with behavioral health concerns increased firearm storage screenings and resource distribution.

A quality improvement (QI) initiative in pediatric emergency departments (EDs) that screened for exposure to unsafely stored firearms and offered firearm storage devices and educational resources to the families of patients presenting with behavioral health (BH) concerns significantly increased screening documentation and prevention resource distribution, according to a study published in Academic Pediatrics.

The Escalating Threat

“Addressing unsafe firearm storage is essential to preventing suicide and unintentional firearm injury,” wrote study author Katherine Donches, MD, Children’s Hospital of Philadelphia (CHOP), and colleagues.

According to a CHOP press release, firearms have eclipsed motor‑vehicle collisions as the foremost cause of mortality among US children and adolescents. Roughly 30 million minors reside in homes with guns, and nearly 5 million live where weapons are both loaded and unsecured. Concomitantly, the prevalence of pediatric mental‑health disorders—particularly mood dysregulation and suicidality—has surged, magnifying the danger of unintentional shootings and self‑harm.

In response to this syndemic, and in alignment with the American Academy of Pediatrics’ recommendation that healthcare providers discuss gun safety with families, CHOP researchers initiated a QI program within their Philadelphia and King of Prussia EDs.

A Systematic Intervention

The team sought to normalize firearm‑safety counseling for youths presenting with behavioral health concerns. Two Plan‑Do‑Study‑Act (PDSA) cycles anchored the project. First, standardized firearm-access queries were embedded into the electronic medical record (EMR) social-work assessment, obligating clinicians to document the presence and storage status of household firearms. Second, the EDs established a continuously restocked cache of cable locks and evidence‑based educational handouts, ensuring immediate availability of tangible prevention tools.

Quantifiable Gains

According to the authors, baseline documentation of firearm‑safety discussions was nonexistent. Within weeks of the EMR modification, screening rates increased to 89% and subsequently stabilized above 90%, with only transient dips attributable to formatting updates. Notably, the proportion of families receiving resources after disclosing unsafe storage increased from 0% to 85%.

Taking Steps to Prevent Tragedies

The study findings suggest that integrating concise, mandatory EMR prompts and maintaining an on‑site inventory of safety devices constitute a scalable, durable strategy for mitigating pediatric firearm injury.

According to CHOP, the program has already expanded beyond the ED to multiple CHOP primary care sites, where complimentary cable locks—procured through philanthropic support—are dispensed.

“As healthcare professionals, we experience firsthand the devastating impact of gun violence,” said senior study author Joel Fein, MD, MPH, CHOP. “Just as we intervene to prevent disease, our findings show we can take steps to help put an end to unnecessary tragedies.”