SREMI Clinician Scientist Profile

Patients with cancer use the ED frequently throughout their cancer journey, from diagnosis to treatment and survivorship. However, very little is known about how these ED visits impact outcomes for patients with cancer. SREMI Clinician Scientist, Dr. Keerat Grewal, is studying the relationship between ED visits and patient outcomes throughout the cancer continuum. Her research aims to improve the care of patients with cancer in the ED.

Dr. Grewal is leading a Canadian Institutes of Health Research (CIHR) funded multidisciplinary, mixed-methods study examining the care of patients in Ontario who are diagnosed with cancer through the ED. Working with administrative data from ICES, Dr. Grewal’s team recently reported that over one-third of patients diagnosed with cancer in Ontario used the ED in the 90 days prior to diagnosis. This highlights a tremendous opportunity to improve care for the many patients who receive a suspected cancer diagnosis in the ED, an often neglected route to cancer diagnosis. Drs. Grewal and Varner recently co-wrote an editorial in the Canadian Medical Association Journal discussing the need for better access to care from EDs for patients with a suspected cancer diagnosis. This work was featured on the front page of the Toronto Star and multiple Canadian news outlets and is shedding light on this troubling trend. Locally, at Mount Sinai Hospital, Dr. Grewal is collaborating with physicians across the hospital to identify innovative ways to improve outpatient access to cancer diagnostics in order to avoid admission to hospital. The results of Dr. Grewal’s research program will lay 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.

Dr. Grewal continues to study venous thromboembolism and anticoagulation in the ED. She has partnered with investigators and clinicians from Thrombosis Canada, CanVECTOR, and ICES on a grant submission to examine real-world data on anticoagulation for cancer-associated thrombosis by comparing newer anticoagulants to older anticoagulants. Given Dr. Grewal’s experience with venous thromboembolism research in the ED and administrative databases, this year she was invited to collaborate with the EARTH group, an international network of emergency researchers interested in venous thromboembolism. She is also working with an international group of physicians to examine the use of preemptive anticoagulation for suspected pulmonary embolism by emergency physicians around the world. Dr. Grewal was a co-investigator on a successful CIHR planning and dissemination grant to create Pulmonary Embolism Canada (PECAN), a Canadian consortium focusing on recognizing and managing intermediate and high risk pulmonary embolism, which left untreated has very high morbidity and mortality. She was invited to co-lead a talk at the PECAN inaugural meeting about how to leverage existing administrative databases in Ontario to study pulmonary embolism.

Dr. Grewal is active with various local and national emergency medicine and research initiatives. This year she was selected as the 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 research rounds for the university. Dr. Grewal continues to sit on the Emergency Medicine Resident Academic Project committee at the University of Toronto and the CAEP Scientific Planning Committee for continuing medical education webinars. Dr. Grewal has been a mentor for multiple medical students, residents and graduate students. Pranav Tandon, a medical student supervised by Dr. Grewal, won the CAEP-CanVECTOR award at this year’s CAEP conference for a study conducted through SREMI that examined hospitalization for pulmonary embolism.