Northwell Health’s gun safety screening goes national

Northwell Health has been using a screening tool for gun violence for years, and now it’s becoming more widely available to other hospital systems.

The New York health system has partnered with Epic, the nation’s largest electronic health record provider. Northwell’s gun violence screening tool is now part of Epic’s electronic medical record system.

Dr. Chethan Sathya, director of Northwell's Center for Gun Violence Prevention, tells Chief Healthcare Executive® that he’s excited about the prospect of helping more hospitals screen patients at risk for injuries from firearms.

“One of the big friction points for getting screening questions into clinical workflows in hospitals is EMR integration,” Sathya says.

“Everyone's time is tight and people don't want to ask another question that's cumbersome, unless it's really integrated,” he says. “If you can't get that done, it's very hard, and that can be a barrier in most places to even starting this process of screening. And so we partnered with Epic to get this in their foundational system.”

Northwell began using its gun violence screening tool in 2020, and the health system has screened more than 300,000 patients. Northwell’s tool is also being utilized by other trauma centers in the state of New York.

With Epic’s health records being used by more than 300 million patients, Sathya says there is the potential for much greater impact.

“It's a big step forward for getting hospitals to screen, of course,” Sathya says. “They now have to do the heavy lift of educating providers to be able to screen and intervene and have the resources behind it. But taking away this big barrier is very important and really will help every hospital in the country that's on Epic be able to easily access these questions, which is a big starting point.”

Sathya says he’s hoping the screening tool can be added to other electronic health record systems as well.

“We're hoping this is just the start, and that the other EHRs will also consider moving on it, because we certainly need everybody involved,” he says.

Not part of routine care

For years, Northwell has asked patients if they own firearms and if they are stored safely, and offers resources to patients who want them. Northwell also assesses if patients are at risk of interpersonal gun violence.

“We ask every single patient who comes to Northwell questions about gun violence risk,” Sathya says. “We ask them if they have access to a firearm within or outside of the household, but then we also ask them, how many times in the last six months have you heard gunshots or had a gun pulled on you?”

Those questions can make a difference in saving lives, but Sathya says most doctors aren’t doing such inquiries in their patient assessments.

“We've known that evidence has shown that those interventions save lives, but only a minority of doctors ever ask those questions to patients,” he says. “It's not part of our usual care. It's not part of routine medical care. We screen for things like mental health issues, substance use, drowning avoidance, helmet wearing, but we don't really screen for gun violence risk.”

Even with the screening questions now being available in hospitals using Epic’s system, Sathya says it will likely take some time to get physicians in the habit of asking such questions.

When Northwell first developed its screening tool, adoption wasn’t immediate.

“It took a while to educate folks to get buy-in, but we really use a team-based model,” Sathya says.

The team-based approach includes doctors, but nurses and social workers also ask patients questions. “That team-based model really helps make it more feasible,” he says. “Otherwise, it falls on one group, it is very difficult.”

Being non-judgmental

Conversations about gun violence and firearm safety need to be non-judgmental. Sathya says the discussions aren’t based on whether or not patients should own firearms. But discussions are centered on safety, including making sure children don’t have access to guns.

“You're talking about violence prevention,” Sathya says. “As long as you have the conversation in light of the safety of the kids in the home, in the same vein as you talk about drowning avoidance, seat belt wearing, it tends to be very well received. People are looking for these resources.”

“We’re finding a lot of families don't even know the risks until we talk to them about it, so they're quite surprised, and they go home and kind of reflect on that,” he says.

Sathya also says that gun owners are some of the best allies and educators.

“Our biggest supporters are gun owners who do safely store a firearm. They're a big part of this education that is developed,” he says. “They're proud to demonstrate that, and you know, there are many gun owners in America that do responsibly start their firearms, and so they become big proponents of this. And so because you're having that conversation in a very non-judgmental way, and with the right amount of humility, it does become a productive part of the conversation.”

Momentum grows

Northwell established its Center for Gun Violence Prevention in 2019, and the health system operates an annual conference for healthcare leaders on reducing deaths and injuries related to firearms.

In addition, Northwell has also spurred other hospitals and health systems to tackle gun violence as a public health issue. Northwell helped establish the National Health Care CEO Council on Gun Violence Prevention and Safety, which includes leaders from more than 60 major health systems.

Michael Dowling, the longtime Northwell CEO who stepped down last fall, urged hospital executives to get more involved and vocal on addressing gun violence. John D’Angelo, who took over as Northwell’s CEO in October, told Chief Healthcare Executive last fall that Northwell would continue to remain engaged on working to reduce gun violence.

Northwell has also developed a digital guide for health systems on preventing gun violence and firearm injuries.

Sathya points to the success of efforts to reduce firearm deaths, with significant declines in the homicide rates in a host of U.S. cities. He says he’s encouraged that other healthcare leaders are putting more time and resources into curbing gun violence.

“That momentum has certainly continued, and if anything, grown, despite cuts in funding for programs,” Sathya says. “Folks are banding together, they're finding ways to engage in philanthropy, finding ways to engage state governments that are supporting this work, and we're also seeing results.”