Clinician-documented Firearm Access and Safety Interventions for Veterans Receiving Suicide Risk Evaluation in VA...

The success of clinical programs aimed at preventing suicide risk depends in part on whether they can be used to identify and act upon risk factors for suicide. Our aim in this study was to describe frequency of clinician documentation of firearm access and the delivery of safety interventions among patients who received a suicide risk evaluation in Veterans Health Administration (VHA) emergency departments (ED) or urgent care (UC) settings.

We used electronic health record data of patients who received care in VHA ED/UC settings January 2021-October 2022 and underwent suicide risk evaluation by clinicians using the Veterans Affairs (VA) Comprehensive Suicide Risk Evaluation (CSRE) prior to discharging home. The proportion of patients with self-reported firearm access was identified from clinician-documented CSRE templates. Among those who reported firearm access, we identified the proportion who received any safety intervention (delivery of lethal means safety counseling and/or distribution of firearm cable locks per CSRE documentation, or update/creation/review of a VA Safety Plan) within 24 hours of the ED/UC encounter. We compared differences using chi-square or Fisher exact tests for categorical outcomes and analysis of variance or independent sample t-tests for continuous outcomes.

Of 17,194 patients who were discharged home, 15.2% were documented as having firearm access (8.5% access to "other" lethal means, 68.8% no lethal means access, 7.4% unknown access). Of 2,624 patients with documented firearm access, 80.6% were documented as having received a safety intervention. Of those, 56.8% received lethal means safety counseling, 13.2% received a firearm cable lock, and 88.6% reviewed or completed a new or updated VA Safety Plan.

Among patients who underwent suicide risk evaluation prior to discharging home from a Veterans Health Administration ED/UC setting, a low percentage were documented as having firearm access. Of those with firearm access, a large majority received at least one safety intervention. System-wide strategies to encourage delivery of safety interventions can reach a large proportion of at-risk patients. Additional efforts are needed to increase reporting and documentation of firearm access.