SREMI Clinician Scientist Profile

Emergency departments (EDs) play a critical role in pregnancy care in Canada, which is SREMI’s Deputy Director Dr. Catherine Varner’s main focus of research. She is regarded as an international expert on the care of pregnant patients in the ED and has published foundational studies describing healthcare utilization and patient ED experiences during pregnancy.

She and co-authors have found that 4 in 5 people with threatened or spontaneous pregnancy loss visited an ED in Ontario. Although the ED is the safest and most expeditious place for a pregnant person to be treated for massive uterine hemorrhage or a suspected ruptured ectopic pregnancy, they have described that pregnant patients who are not critically ill often receive suboptimal care in emergency settings. Patients that experience early pregnancy loss have longer-than-average lengths of stay, sitting in chairs in non-private locations, and describe being made to feel as though they are “wasting the emergency department providers’ time,” given space constraints and relative stability compared with sicker patients. Continuity of care is also a concern, according to their studies, with many discharged without a follow-up plan or physician responsible for ongoing care, which contributes to high rates of return visits and puts patients at risk of preventable complications, such as ruptured ectopic pregnancy and massive hemorrhage.

Recognizing the care gap, Dr. Varner leads initiatives to improved care pathways for pregnant patients locally, provincially and nationally. In January 2023, Dr. Varner and the SREMI team launched a new care program to improve care for patients experiencing pregnancy loss in the Mount Sinai Hospital Emergency Department. Virtual Wraparound Care is a first-of-its-kind program that begins at the point of care in the ED and continues after discharge. Victoria Aziz, an advanced practice ED nurse, has supported nearly 1000 patients through their loss, has provided education and support as the loss progressed, and ensured timely follow-up care. The program has been an incredible addition to the ED, and more importantly, to the care of this vulnerable and frequent ED patient population. The research evaluation of the program has shown this program has been a win-win for all involved: the patients receive more attentive and comprehensive care, and the ED has established more efficient follow-up care pathways with our gynecology colleagues.

Dr. Varner is also an expert advisor for the Provincial Council for Maternal Child Health (PCMCH) and the Better Outcomes Registry and Network (BORN), which are both organizations funded by the Government of Ontario. In October 2024, Dr. Varner was the invited keynote speaker at the Early Pregnancy Complications and Loss Workshop, organized by PCMCH and BORN. Dr. Varner led discussions highlighting innovative solutions and implementing care pathways, like Virtual Wraparound Care, to improve care of patients with early pregnancy complications and loss in Ontario.

In the last year, Dr. Varner has published three editorials in the Canadian Medical Association Journal, advocating for improving streamlined access to pregnancy care in Canada for patients in early pregnancy and the postpartum period and for patients experiencing symptoms of early pregnancy loss. Informed by her research in these areas, these pregnancy editorials led to multiple media interviews by journalists for the CBC, CTV News, Toronto Star, Globe and Mail, and National Post. As Deputy Editor of CMAJ, her editorials on pregnancy and other vulnerable populations seeking care in the ED are regularly included in briefings for health policy makers on topics related to emergency care in Canada. She was welcomed by the University of Alberta and the University of Ottawa’s Departments of Emergency Medicine as their visiting professor in June and October, respectively, this year, where she spoke about the joy of building a research program in pregnancy care in the ED. Having met and heard from emergency medical trainees who shared their interest in pregnancy research, she was proud of SREMI’s lasting influence on this nascent field of study