Asking about firearm safety during ER admissions: positive results

Newswise — Philadelphia June 4, 2025 – Firearms are now the leading cause of death for children and teens in the United States, surpassing car crashes. About 30 million kids live in homes with guns and nearly 5 million live in homes where guns are loaded and unlocked. At the same time, youth mental health struggles have sharply increased, raising the risk of suicide and accidental shootings.  

Given this public health crisis and the American Academy of Pediatrics recommendation that healthcare providers engage families in discussions on gun safety, researchers in the Center for Violence Prevention (CVP) at Children’s Hospital of Philadelphia (CHOP) embarked on a quality improvement (QI) initiative with behavioral health patients at CHOP’s Philadelphia and King of Prussia emergency departments with the goal of improving firearm safety conversations. The findings, recently published in the journal Academic Pediatrics, demonstrated that their new approach was successful in advancing the delivery of firearm safety resources to vulnerable families.

“By promoting safe firearm storage, medical professionals can contribute to broader efforts in reducing injury and mortality rates,” said Joel Fein, MD, MPH, the study’s senior author and co-director of CVP at CHOP. “Our model serves as a valuable framework for other institutions seeking to implement similar prevention strategies.”

In the study, researchers introduced standardized firearm safety questions into the electronic medical record (EMR) system, ensuring that healthcare providers consistently inquired about firearm access during behavioral health assessments. Additionally, the EDs maintained a readily available supply of firearm safety resources, such as gun locks and educational handouts, to distribute to families as needed. 

Prior to the intervention, CHOP’s emergency departments did not have a standardized approach toward documenting firearm safety with behavioral health patients and their families. Following the implementation of the standardized EMR questions, screening documentation rates increased to and were sustained at more than 90 percent through the study.

The availability and distribution of firearm safety resources also saw a strong improvement. Before the study, safety resources were not offered to families seeking behavioral health support in the emergency departments. At the completion of the QI process, 85% of the patients who identified they had unsafely stored firearms at home received safety resources. The study authors include lead authors Katherine Donches, MD, and Ashlee Murray, MD, MPH, Maggy Carka from Digital and Technology Services, and Mushyra Wright, LCSW, from the Department of Social Work.

In addition to CHOP’s EDs, firearm safety device distribution is also underway at several primary care practices and a wide range of additional CHOP care locations. As part of the program, cable lock safe storage devices are provided to participants for free through donations to CVP. “As healthcare professionals, we experience firsthand the devastating impact of gun violence,” said Fein. “Just as we intervene to prevent disease, our findings show we can take steps to help put an end to unnecessary tragedies.”

Donches et al. “Improving Delivery of Firearm Safety Resources for Behavioral Health Patients in the Pediatric ED: A Quality Improvement Initiative.” Academic Pediatrics. Online April 22, 2025. DOI: 10.1016/j.acap.2025.102843.

About Children’s Hospital of Philadelphia:  A non-profit, charitable organization, Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey. CHOP also operates the Middleman Family Pavilion and its dedicated pediatric emergency department in King of Prussia, the Behavioral Health and Crisis Center (including a 24/7 Crisis Response Center) and the Center for Advanced Behavioral Healthcare, a mental health outpatient facility. Its unique family-centered care and public service programs have brought Children’s Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit https://www.chop.edu.