Citation

Stegall CL, Allen KW, Andrews AL, Kwon SJ, Oddo ER. Acad. Pediatr. 2023; S1876-2859(23)00219-X.

Copyright

(Copyright © 2023, Academic Pediatric Association, Publisher Elsevier Publishing)

DOI

10.1016/j.acap.2023.06.009

PMID

37302700

Abstract

OBJECTIVE: Increase provider screening rates for firearm access among patients presenting to the pediatric emergency department (PED) for a psychiatric chief complaint. STUDY DESIGN: In this resident-driven quality improvement (QI) project, a retrospective chart review examined firearm access screening rates among patients presenting to the PED with the chief complaint of "psychiatric evaluation." After establishing our baseline screening rate, the first phase of our Plan, Do, Study, Act (PDSA) cycle included implementing Be SMART education for pediatric residents. We made Be SMART handouts available in the PED, created electronic medical record (EMR) templates to facilitate documentation, and emailed routine reminders to residents during their PED block. In the second PDSA cycle, the pediatric emergency medicine (PEM) fellows expanded our efforts to increase project awareness from a supervisory role.

RESULTS: The baseline screening rate was 14.7% (50/340). After PDSA 1, a center line shift occurred, and screening rates increased to 34.3% (297/867). After PDSA 2, screening rates increased to 35.7% (226/632). In the intervention phase, providers who received training screened 39.5% (238/603) of encounters versus providers who did not receive training screened 30.8% (276/896) of encounters. Of all encounters screened, 39.2% (205/523) screened positive for in-home firearms.

CONCLUSIONS: We improved firearm access screening rates in the PED using provider education, EMR prompts, and PEM fellow participation. Opportunities remain to promote firearm access screening and secure storage counseling in the PED.

Language: en

Keywords

Firearms; Injury prevention; Mental health; Advocacy; Safe storage