TOP 31 - Assessing Implementation Climate for Firearm Safety Screening in the Pediatric Emergency Department

Publication Number: 4734.TOP 31

Julia Klein, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States; Amanda Nickel, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States; Rachel Weigert, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States

Background: Firearm injuries are the leading cause of pediatric mortality since 2020. Firearm sales surged during the COVID-19 pandemic, increasing access for children. Over 400 million firearms exist nationwide, and an estimated 4.6 million American children live in homes with unsecured firearms. Secure storage reduces the risk of accidental injury by younger children and prevents access in teens considering suicide. Firearm safety counseling aligns with routine pediatric anticipatory guidance, yet implementation remains inconsistent. Quality improvement (QI) initiatives demonstrate that firearm safety screening and gun lock distribution are feasible within pediatric emergency departments (PEDs), but standardized processes are lacking. This growing body of research supports the acceptability and potential impact of firearm safety interventions in pediatric clinical settings while underscoring the need to identify and address persistent implementation barriers.

Objective: We aimed to assess the clinical climate surrounding firearm safety counseling in the PED. We sought to identify providers' practice patterns and experiences as well as perceived barriers and facilitators to implementation, to inform future QI efforts integrating firearm safety screening into routine care.

Design/Methods: Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted a mixed-methods, pre-implementation assessment of two urban PEDs in the upper Midwest, one of which is a level I pediatric trauma center, and with a collective annual census of 90,000. Children's Minnesota Internal Review Board deemed this study exempt. We developed and distributed a survey to staff to assess perspectives and experiences related to firearm safety counseling. The survey included Likert-scale and open-ended questions, as well as demographic items to explore variation across roles and sites. We subsequently held World-Café style focus groups to further explore how to integrate firearm safety screening and education into PED workflows. In this model, participants engaged in small group discussions guided by structured questions. Detailed de-identified notes were compiled. Qualitative data, including direct quotes, will be analyzed via inductive thematic coding to identify salient themes and implementation considerations. Two researchers will independently review transcripts to identify preliminary codes, which will be iteratively refined through team consensus. Codes will then be grouped into higher-order categories aligned with CFIR constructs to highlight multilevel barriers and facilitators to implementation.

Figure 1. Recognized Importance but Limited Practice of Firearm Safety Counseling
Likert-scale staff survey responses to A. "I currently discuss firearm ownership and storage with families in the Children's emergency department." and B. "I see firearm safety discussions as an important part of pediatric injury prevention." Responses demonstrate high perceived importance but limited implementation of firearm safety counseling.

Figure 2. Perceived Confidence and Knowledge in Discussing Firearm Safety with Caregivers
Likert-scale staff survey responses to A. "I feel confident initiating discussions about firearm safety with caregivers." and B. "I feel knowledgeable about firearm safety and firearm injury prevention strategies." Mixed responses indicate opportunities for additional training to strengthen staff confidence and knowledge surrounding firearm injury prevention discussions.