A new firearm injury risk screening tool developed by Northwell is now available to health systems nationwide through Epic.
Electronic health record screening tools combine access to firearms and community violence risk assessments. From there, it is up to each organization to decide whether to intervene to refer patients if they screen positive.
“We have known for decades that there are evidence-based strategies that health care workers can use to save lives,” Dr. Chesan Sathya, director of the Northwell Gun Violence Prevention Center, told Fierce Healthcare. These include counseling patients and teaching youth about safe firearm storage.
However, as of 2019, less than 8% of adults living in a home with a firearm reported having discussed firearm safety with a health care provider. “This is far from normal and it is not routine,” Satya said. Asking questions should become the standard of care, he said.
The screening protocol, the first of its kind for emergency clinicians, was developed by the health system through research funded by the National Institutes of Health, according to the New York-based system. At Northwell, we have screened more than 250,000 emergency department patients with this approach since 2020. Of those, approximately 15% of patients screened positive and were referred to resources such as hospital-based violence intervention programs.
Screening can be narrowed down to two main questions: That is, whether the patient can use a firearm within or outside the home. Has the patient heard gunshots or been held at gunpoint within the past 6 months? According to Satya, the latter question predicts community violence 95% of the time.
There are important reasons for both questions. One assesses access to firearms and the other assesses community violence risk. According to Sathya, there is a big difference between the two. Gun suicide and accidental injuries are related to safe storage. Firearm homicide, the most common form of interpersonal community violence in the United States, is associated with risk factors such as social isolation and unemployment. “We have a responsibility to talk about this nuance and how important it is,” Satya said.
Epic’s integration has two benefits. One is to streamline processes for clinicians and increase adoption. “One of the biggest barriers to clinician workflow questions is (EHR) integration,” Satya said.
The other is to standardize data collection and support research and prevention efforts. “You need data to investigate anything, and right now there is very little data on what questions are being asked,” Satya said. “This is the beginning.”
Sathya said hospitals with screening devices in place need to have pathways in place to support patients who screen positive. As explained in Northwell’s toolkit for doing this work, hospitals should be aware of community resources, such as gunlock options and community-based organizations that support additional social determinants of health. Prior to screening, hospitals should communicate with key departments and staff to ensure all parties are aware of the screening program and protocols.
“I would never advise anyone to get tested and not intervene,” Satya said. “We encourage everyone to start somewhere.”
Northwell will soon publish outcome data for patients who screen positive and are followed up at three and six months. The goal is to see if positive behavior change actually occurs. So far, Northwell has had good results, Satya said.
Additionally, New York Governor Kathy Hochul recently announced a state-funded pilot to integrate Northwell testing into emergency departments across the state. Northwell’s Gun Violence Prevention Center will provide training, technical assistance, coordination and support to the three participating providers.
