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{ "pk": 50852, "title": "Clinician-documented Firearm Access and Safety Interventions for Veterans Receiving Suicide Risk Evaluation in VA Emergency Care Settings", "subtitle": null, "abstract": "<p><strong>Background: </strong>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. </p>\n<p><strong>Methods:</strong> 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. </p>\n<p><strong>Results:</strong> 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.</p>\n<p><strong>Conclusion: </strong>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.</p>", "language": "eng", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Firearm injury" }, { "word": "Suicide" }, { "word": "veteran" }, { "word": "emergency care" } ], "section": "Injury Prevention and Population Health", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/9nc1d1tm", "frozenauthors": [ { "first_name": "Joseph", "middle_name": "", "last_name": "Simonetti", "name_suffix": "", "institution": "Veterans Health Administration, Rocky Mountain Regional VA Medical Center, Department of Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado; University of Colorado Anschutz School of Medicine, Firearm Injury Prevention Initiative, Aurora, Colorado", "department": "" }, { "first_name": "Samuel", "middle_name": "E.", "last_name": "King", "name_suffix": "", "institution": "Veterans Health Administration, Rocky Mountain Regional VA Medical Center, Department of Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado", "department": "" }, { "first_name": "Ryan", "middle_name": "", "last_name": "Holliday", "name_suffix": "", "institution": "Veterans Health Administration, Rocky Mountain Regional VA Medical Center, Department of Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado; University of Colorado Anschutz School of Medicine, Department of Physical Medicine and Rehabilitation, Aurora, Colorado; University of Colorado Anschutz School of Medicine, Department of Psychiatry, Aurora, Colorado", "department": "" }, { "first_name": "Gabriela", "middle_name": "K", "last_name": "Khazanov", "name_suffix": "", "institution": "Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York", "department": "" }, { "first_name": "Alexandra", "middle_name": "", "last_name": "Smith", "name_suffix": "", "institution": "Veterans Health Administration, Rocky Mountain Regional VA Medical Center, Department of Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado; University of Colorado Anschutz School of Medicine, Department of Physical Medicine and Rehabilitation, Aurora, Colorado", "department": "" }, { "first_name": "Nazanin", "middle_name": "", "last_name": "Bahraini", "name_suffix": "", "institution": "Veterans Health Administration, Rocky Mountain Regional VA Medical Center, Department of Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado; University of Colorado Anschutz School of Medicine, Department of Physical Medicine and Rehabilitation, Aurora, Colorado; University of Colorado Anschutz School of Medicine, Department of Psychiatry, Aurora, Colorado", "department": "" }, { "first_name": "Lisa", "middle_name": "", "last_name": "Brenner", "name_suffix": "", "institution": "University of Colorado Anschutz School of Medicine, Department of Physical Medicine and Rehabilitation, Aurora, Colorado; niversity of Colorado Anschutz School of Medicine, Department of Neurology, Aurora, Colorado;University of Colorado Anschutz School of Medicine, Department of Psychiatry, Aurora, Colorado; Veterans Health Administration, Rocky Mountain Regional VA Medical Center, Brain Health Coordinating Center, Aurora, Colorado", "department": "" }, { "first_name": "Bridget", "middle_name": "B.", "last_name": "Matarazzo", "name_suffix": "", "institution": "Veterans Health Administration, Rocky Mountain Regional VA Medical Center, Department of Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado; University of Colorado Anschutz School of Medicine, Department of Psychiatry, Aurora, Colorado", "department": "" } ], "date_submitted": "2025-09-10T00:30:45.686000+03:00", "date_accepted": "2026-01-15T03:49:53.973000+03:00", "date_published": "2026-05-19T17:26:00+03:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/50852/galley/50440/download/" } ] }