RESUMEN
Despite vast long-standing healthcare industry support for a public health approach to firearm injury and mortality prevention - still -- the minority of physicians, surgeons, nurses, and social workers ask patients questions about firearm access or gun violence risk, let alone counsel about firearm safety.1,2 For most of us, screening and counselling related to firearm injury prevention, though demonstrated to be beneficial,3 continues to fall outside the umbrella of 'usual care' and is often reserved for patients deemed 'high risk' such as those presenting with suicidality, assault-related injuries or perceived risk.1,2,3 But for us to practice what we preach, a complete re-think using a novel, unconventional and non-discriminatory universal firearm injury risk screening approach across trauma, emergency, and primary care settings - for all patients regardless of reason for visit -- may be the transformative change needed to shift the paradigm. By asking each and every patient questions about firearm injury risk as part of routine surgical or medical care, we may finally be able to break down barriers and get comfortable talking to patients about firearm safety. After all, for any public health issue, it all starts with surveillance and screening. If we can't get comfortable asking the necessary questions in the first place, holistic progress from the healthcare lane on our nation's public health crisis of firearm injury and violence will continue to prove elusive.
RESUMEN
Application of Quality Improvement methodology to nuanced clinical scenarios may be useful to ensure consistent delivery of equitable and comprehensive care. The purpose of this article is to inform the pediatric surgical readership of opportunities where quality improvement methodology may aid in navigating ethical nuances of complex surgical care. We present three case scenarios and discuss how quality improvement methodology could be utilized to address issues of provider autonomy, patient autonomy, and justice.