PC2133: A Resident-led Quality Improvement Project on Firearm Safety in a Pediatric Continuity Clinic

Purpose/Objectives: Gun violence is the leading cause of injury-related death for children in the United States, and children account for 26% of unintentional firearm deaths. However, many pediatricians do not feel comfortable inquiring about firearms in the home and are not familiar with existing firearm safety campaigns. To address this gap, we implemented a quality improvement (QI) project and examined its effect on physician attitudes, knowledge, and practices surrounding firearm safety counseling.

Design/Methods: From Feb 2020-Apr 2021, a resident-led QI project on firearm safety was implemented in a pediatric clinic. Following the Institute for Healthcare Improvement’s Model for Improvement, residents set the primary outcome measure as the percentage of well visits and mental health visits in which firearm safety was addressed, with a goal of documented counseling in 75% of encounters. A key process measure was the percentage of visits in which safe firearm storage was documented. Residents designed and implemented tests of change using iterative Plan-Do-Study-Act (PDSA) cycles. Physicians completed both a pre- and post-survey to gauge their effects on attitudes, knowledge, and practices.

Results: We implemented six iterative PDSA Cycles, with tests of change including adding check-in firearm storage screening questions, creating visual counseling reminders in clinic workspaces, gathering resources for obtaining gun locks, creating educational handouts for staff and families, and education on safe storage and firearm safety counseling techniques in accordance with the American Academy of Pediatrics’ Ohio Chapter Store It Safe campaign. Documentation of firearm safety counseling during well visits and mental health visits increased from 0% at baseline to 17% (Figure 1). Documentation of safe firearm storage in the home increased from 2% to 48%. Thirty-seven of 47 residents (79%) and six of seven (85%) clinic attendings completed surveys. At project completion, respondents reported significantly increased comfort in counseling on firearm safety and asking about firearms in the home, as well as higher rates of actual firearm safety counseling during well visits and mental health visits (Figure 2). They also reported more familiarity with firearm safety campaigns such as Project ChildSafe and increased satisfaction with firearm safety education during residency.

Conclusion/Discussion: A QI project within a pediatric continuity clinic increased rates of firearm safety counseling and safe storage documentation, although not at the rate set for the initial outcome measure. The project improved physician knowledge and comfort regarding firearm safety counseling.

DISCLAIMER: The views reported in this abstract are those of the authors alone and do not reflect the views of the United States Air Force, Department of Defense, or United States Government.