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Reducing access to lethal means (especially firearms) might prevent suicide, but counseling of at-risk individuals about this strategy may not be routine. Among emergency department (ED) patients with suicidal ideation or attempts (SI/SA), we sought to describe home firearm access and examine ED provider assessment of access to lethal means.This secondary analysis used data from the Emergency Department Safety Assessment and Follow-up Evaluation, a three-phase, eight-center study of adult ED patients with SI/SA (2010–2013). Research staff surveyed participants about suicide-related factors (including home firearms) and later reviewed the ED chart (including documented assessment of lethal means access).Among 1,358 patients with SI/SA, 11% (95% CI: 10–13%) reported ≥1 firearm at home; rates varied across sites (range: 6–26%) but not over time. On chart review, 50% (95% CI: 47–52%) of patients had documentation of lethal means access assessment. Frequency of documented assessment increased over study phases (40–60%, P < .001) but was not associated with state firearm ownership rates. Among the 337 (25%, 95% CI: 23–27%) patients discharged to home, 55% (95% CI: 49–60%) had no documentation of lethal means assessment; of these, 13% (95% CI: 8–19%; n = 24) actually had ≥1 firearm at home. Among all those reporting ≥1 home firearm to study staff, only half (50%, 95% CI: 42–59%) had provider documentation of assessment of lethal means access.Among these ED patients with SI/SA, many did not have documented assessment of home access to lethal means, including patients who were discharged home and had ≥1 firearm at home.