Emergency Medicine Research Series: Using emergency medicine research to strengthen healthcare system policy
“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
For Dr. Candace McNaughton, every shift in the emergency department (ED) is a chance to ask questions and uncover answers that can improve lives. A clinician-scientist at Sunnybrook Health Sciences Centre and associate professor at the University of Toronto, her research bridges emergency medicine (EM), patient safety and quality improvement.
After earning her MD from Washington University in St. Louis, Dr. McNaughton completed a residency in EM at Vanderbilt University Medical Center, where she discovered her passion for the specialty.
“I liked a little bit of everything and couldn’t choose one specialty to focus on, but I really loved emergencies,” she says.
She felt energized by the high-stakes nature of the work and the chance to make an immediate impact on patients.
“As I was going through emergency medicine, there were questions that kept coming up that we didn’t necessarily have answers to,” she says. “I wanted to figure out how we generate the data needed to develop evidence-based clinical practice.”
That curiosity led her to a fellowship in Patient Safety and Quality Improvement with the U.S. Veterans Health Administration, followed by a Master of Public Health and a PhD in Epidemiology at Vanderbilt. These experiences helped to launch her research career, which now focuses on cardiovascular outcomes, healthcare utilization and long COVID.
"At the end of the day, the goal for both research and quality improvement is to improve patient care and outcomes,” she says.
While randomized controlled trials are often considered the gold standard for research, Dr. McNaughton emphasizes letting the research question determine the method.
“Depending on the clinical question, the best design might be a case series or observational study,” she says.
During her PhD, she explored barriers to medication adherence in emergency versus clinic settings, integrating patient perspectives with biochemical data. One study involved interviewing patients to identify facilitators and barriers to adherence, then analyzing blood levels of cardiovascular medications to assess whether patients were taking them as prescribed. This work laid the foundation for a randomized trial of behavioural intervention.
Her interest in cardiovascular disease also stems from personal experience.
“My grandmother had a hemorrhagic stroke from hypertension and she ended up having what's called resistant hypertension,” she says.
Heart failure is a particularly challenging field due to its high cost, impact on quality of life and major treatment decisions. EM physicians must often decide when patients are safe to go home and how to initiate treatment.
“If I don’t start a medication in the ED, it often may not get started later or there may be a delay,” Dr. McNaughton explains. “If I start it in the ED, it’s easier for patients to continue it, as opposed to asking them to follow-up with their family doctor to monitor a symptom.”
In 2021, she moved to Toronto to join U of T and Sunnybrook, drawn by the opportunity to collaborate with clinicians whose work she had long followed.
“It’s really lovely to have colleagues, trainees and patients who I am learning from, and who push me every day to be a better clinician and researcher,” she says. “I feel lucky to be part of U of T and Sunnybrook, where I get to rub shoulders with people who are so hard working and engaged.”
The COVID-19 pandemic added a new dimension to her work. Dr. McNaughton began examining post-acute healthcare utilization and found that, unlike other viruses, COVID-19 appears to have a prolonged impact on patients’ need for healthcare services. Each successive infection may even compound long-term health risks. Her research has also found that women between the ages of 30 and 60 seem to be particularly at risk of needing home care post-infection.
“My overarching hypothesis that I'm working toward examining is that each successive COVID infection is probably a risk factor, on par with something like tobacco smoking, that increases your cardiovascular risk,” she says. “We don’t know yet if it goes down over time and it raises the question of what can we do to reduce the number of infections if they are a risk.”
Dr. McNaughton is also passionate about supporting Canada’s public healthcare system.
“Every healthcare system has its flaws but we have a really strong system in Canada and fantastic clinicians,” she says. “When I’m treating patients in the ED here, I’m not asking them to decide between keeping their home or getting medical care.”
She hopes to see ongoing improvements in access to physicians and reduced wait times – areas where she believes research can help shape better policy.
“50 years ago when this system was set up, we didn’t know how many ED visits to expect per capita or how many doctors would be enough,” she says. “But now we have decades of research to inform resource allocation.”
Ultimately, she hopes her work can empower Canadians to understand how health policy impacts their care and to advocate for a system that treats healthcare as a human right.
“People can tell their leadership what’s important to them when it comes to investing in public healthcare, and research can help to demonstrate what is working and how we can do better,” she says.
