SREMI Clinician Scientist Profile

Patients with cancer frequently rely on the emergency department (ED) at every stage of their cancer journey, from diagnosis to treatment and survivorship. Yet, very little is known about how these ED visits impact outcomes for patients with cancer. SREMI Clinician Scientist, Dr. Keerat Grewal, is addressing this critical knowledge gap through her research which focuses on the relationship between ED visits and patient outcomes throughout the cancer continuum, with the ultimate goal of improving the care of patients with cancer in the ED.

One of Dr. Grewal’s current projects is examining the care of patients in Ontario who are diagnosed with cancer through the ED. Working with population-level data from ICES, Dr. Grewal and her team recently published a study in CMAJ reveling that over one-third of patients diagnosed with cancer in Ontario used the ED in the 90 days prior to their cancer diagnosis. Several key patient- and system-level factors were identified as being associated with receiving a suspected cancer diagnosis through the ED, highlighting critical gaps in care. Building on this, this year, Dr. Grewal and colleagues published a study in JAMA Network Open that found patients with ED use prior to cancer diagnosis have significantly higher mortality.

Complementing these findings, qualitative research published in BMJ Open from Dr. Grewal’s team highlighted that emergency physicians find current processes for managing patients with new cancer challenging and inequitable, underscoring the urgent need for system-wide improvements. Together, the findings from Dr. Grewal’s research highlight a tremendous opportunity and need to enhance care for the many patients who receive a suspected cancer diagnosis in the ED. In this last year alone, Dr. Grewal’s research in this area has received national media attention, including features in The Toronto Star, National Post, Global News, CTV, CP24, CBC News and Radio, among others.

Locally, at Mount Sinai Hospital, Dr. Grewal aims to translate her research into action. Collaborating with physicians across the hospital, she is working on identifying and implementing innovative ways to improve outpatient access to cancer diagnostics in order to reduce avoidable hospital admissions. The results of Dr. Grewal’s research program are laying the foundation to improve access to cancer care from the ED and will help improve patient care for the many Canadians who will use the ED during the diagnostic phase of their cancer journey.

Beyond cancer care, Dr. Grewal continues to study venous thromboembolism and anticoagulation in the ED. This year, she was appointed as a co-lead of the CanVECTOR Population Health Services Platform. Dr. Grewal is also collaborating with the EARTH group, an international network of emergency researchers interested in venous thromboembolism. As a part of this collaboration, she is working with an international group of physicians to examine the use of preemptive anticoagulation for suspected pulmonary embolism by emergency physicians around the world. This research was presented at the International Society of Thrombosis and Hemostasis Annual Conference earlier this year. This year, Dr. Grewal was invited to present on pulmonary embolism at the International Conference on Emergency Medicine and cancer-associated thrombosis at the European Society of Emergency Medicine Conference.

Dr. Grewal continues to be engaged with various local and national emergency medicine and research initiatives. She continues in her role as Research Lead for the Division of Emergency Medicine, Department of Medicine at the University of Toronto. She has been working with the tri-divisions to host emergency medicine resident research rounds for the university. Dr. Grewal continues to mentor medical students, residents and graduate students for their research projects.