A new firearm injury risk screening tool, developed by Northwell, is now available to health systems nationwide through Epic.
The screening tool in the electronic health record combines assessments of firearm access and community violence risk. From there, it will be up to each organization to have interventions to which to refer patients if they screen positive.
“We’ve known for decades that there are evidence-based strategies that healthcare workers can use to save lives,” Chethan Sathya, M.D., director of Northwell’s Center for Gun Violence Prevention, told Fierce Healthcare. These include counseling patients about safe storage of firearms and mentorship for youth.
Yet as of 2019, fewer than 8% of adults living in homes with firearms reported having ever discussed firearm safety with a provider. “It’s far from normal and far from routine,” Sathya noted. Asking the questions should become a standard of care, he said.
The screening protocol, which the New York-based system says is the first of its kind for emergency clinicians, was developed by the health system through a National Institutes of Health-funded study. Northwell has screened over 250,000 emergency department patients with this approach since 2020. Of those, about 15% of patients screened positive and were referred to resources, including hospital-based violence intervention programs.
The screening can be distilled down to two primary questions: does the patient have access to a firearm within or outside their household; and in the last six months, has the patient heard gunshots or had a gun pulled on them. The latter question is 95% predictive of community violence, per Sathya.
There is an important reason for both questions. One assesses firearm access, while the other assesses community violence risk. There is a drastic difference between the two, per Sathya. Firearm suicides and accidental injuries have to do with safe storage. Firearm homicides—most commonly interpersonal community violence in the U.S.—are related to risk factors like social isolation and joblessness. “We have a responsibility to talk about this nuance and how important it is,” Sathya said.
There are two benefits to the Epic integration. One is streamlining the process for clinicians and encouraging uptake. “One of the biggest barriers to questions when it comes to clinician workflows is [EHR] integration,” Sathya noted.
The other is to standardize data collection and support research and prevention efforts. “You need data to research anything, and right now we have very little data on what questions are being asked,” Sathya said. “This is the start.”
Hospitals deploying the screener should have pathways in place to support those who screen positive, Sathya said. As described in Northwell’s toolkit for doing the work, hospitals should be aware of local resources, including options for gun locks and community-based organizations that support additional social determinants of health. Before screening, hospitals should communicate with key departments and staff to ensure all parties are aware of the screening program and protocol.
“I would never recommend anyone screen and not intervene,” Sathya said. “We encourage folks to start somewhere.”
Northwell will soon publish outcomes data on patients who screened positive and were followed up with after three and six months. The goal is to see that positive behavior change actually took place. So far, Northwell has seen good outcomes, per Sathya.
Additionally, New York Governor Kathy Hochul recently announced a state-funded pilot to integrate Northwell’s screening into emergency departments across the state. Northwell’s Center for Gun Violence Prevention will offer training, technical assistance, coordination and support to three participating providers.