Emergency Medicine Research Series: Integrating clinical practice, research and mentorship to advance patient care
“In this Emergency Medicine Research Series, the Department of Medicine will be highlighting the work of dedicated physicians and researchers who are shaping the future of patient care. These features will delve into the research and clinical advancements of leaders in the field of emergency medicine, focusing on how they address some of the most pressing challenges in healthcare today. From improving patient outcomes in high-pressure environments to incorporating cutting-edge technologies, these researchers are at the forefront of transforming emergency care.” – Dr. Erin O’Connor, Department Division Director for Emergency Medicine
Dr. Keerat Grewal is driving meaningful change in emergency medicine by bridging clinical practice with cutting-edge research.
As a clinician scientist and emergency medicine physician, she integrates clinical practice, research and mentorship to advance patient care and address knowledge gaps. Based at the Schwartz/Reisman Emergency Medicine Institute (SREMI) at Mount Sinai Hospital, Dr. Grewal is also an assistant professor at the University of Toronto (U of T) and an adjunct scientist at ICES.
“A career as a clinician scientist has been quite rewarding for me because I enjoy both clinical medicine and research, as well as how they complement each other,” she says.
Dr. Grewal credits her training at U of T for laying the groundwork for her current role. While completing her residency in emergency medicine, she completed a Master of Science in Clinical Epidemiology and Health Care Research at the Institute for Health Policy, Management & Evaluation (IHPME) and participated in the Eliot Philipson Clinician Scientist Training Program through the Department of Medicine and Clinician Investigator Program at U of T. These experiences, guided by mentorship from Dr. Clare Atzema, an emergency physician at Sunnybrook Health Sciences Centre, has shaped her approach to integrating health services research with clinical practice.
“I enjoy practicing medicine – the diagnostic workup, advocacy and communication that occur daily in the emergency department – but clinical practice also reveals knowledge gaps that can inspire meaningful research questions,” she says. “Research allows us to bridge those gaps and translate findings back into practice.”
Dr. Grewal’s research examines the relationship between emergency department (ED) visits and patient outcomes throughout the cancer continuum, aiming to improve care for cancer patients, many of whom frequently use the ED during their diagnosis and treatment.
“My research uses population-based data, mostly housed at ICES, to answer clinical questions relevant to emergency medicine,” she says. “There are few scientists, particularly in emergency medicine, who have made this data the focus of their work despite its tremendous potential.”
Dr. Grewal is currently leading a Canadian Institutes of Health Research (CIHR) supported study examining the care of cancer patients diagnosed through the ED in Ontario. Published in the Canadian Medical Association Journal, this study found that over one-third of cancer patients in Ontario visit the ED within 90 days of their diagnosis. These findings highlight the need to improve outpatient access to diagnostics and reduce reliance on emergency care.
Dr. Grewal’s work has been featured in news outlets like the Toronto Star, shedding light on this troubling trend. At Mount Sinai, she is collaborating with colleagues across specialties to identify ways to streamline cancer diagnostics and reduce hospital admissions.
“The results of this research lay the foundation to improve access to cancer care from the ED and enhance patient outcomes,” she explains.
In addition to cancer care, Dr. Grewal investigates venous thromboembolism (VTE), a condition where blood clots form in the veins, and anticoagulation in emergency settings. Her research has revealed that patients immobilized with an ankle fracture have more than five times the risk of VTE, sparking important conversations about thromboprophylaxis (a medical treatment that prevents blood clots from forming) for patients discharged from the ED with lower limb immobilization.
She was also awarded a Canadian Association of Emergency Physicians (CAEP) New Investigator Award for her population-based study examining the risk of intracranial bleeding among older anticoagulated patients with head injuries. Recently, Dr. Grewal started collaborating with the EARTH initiative, an international network of emergency researchers focused on VTE research, and Pulmonary Embolism CANada (PECAN), a multidisciplinary group focused on the recognition and management of high-risk pulmonary embolism in Canada.
As a member of SREMI, Dr. Grewal is part of a team of scientists, educators and staff dedicated to advancing research, education and health policy in emergency medicine. The institute has also helped her to collaborate with other U of T faculty within the Division of Emergency Medicine, as well as other departments and divisions.
“SREMI has been fundamental in supporting me as an early career investigator, allowing me to have protected time to conduct research, and has provided excellent mentorship and networking opportunities for me,” she says.
