Exploring Safer Hospital Discharges

People experiencing homelessness often visit emergency departments (EDs) as a source of shelter, particularly during the colder months. Researchers at UHN found that hospital-affiliated warming centres, operated in collaboration with community partners, have the potential to reduce ED length of stay for people experiencing homelessness.

In Toronto, rates of non-urgent ED visits by people experiencing homelessness during winter months have been increasing. This is often due to limited sheltering options, as people experiencing homelessness may seek care in the ED for a range of concerns, including access to shelter.

Following an ED visit, people experiencing unsheltered homelessness may face barriers to accessing shelter beds and other safe discharge locations. Due to the medical risks associated with discharge to an unsafe environment, this can result in patients remaining in the ED even after their medical needs have been addressed. This delay contributes to ED overcrowding, which causes reduced service quality, increased risk of mortality, and greater staff distress.

As the number of people experiencing homelessness continues to rise, identifying safe discharge options is becoming increasingly important to help reduce ED overcrowding while ensuring patients receive appropriate support after leaving the hospital. To address this need, UHN’s Social Medicine program worked with community partners to establish a hospital-affiliated warming centre in Toronto in 2023 to provide a safe location for discharges during the winter months.

To examine the impact of this warming centre, the researchers looked at the relationship between ED visits by people experiencing homelessness and the operation of the Toronto-based hospital-affiliated warming centre. This warming centre were operated in collaboration with a community partner with expertise in supporting people experiencing homelessness. The team analyzed administrative data on ED and hospital-affiliated warming centre utilization from the winter seasons between November 2022 and April 2025.

The research team found that the hospital-affiliated warming centre supported 1,196 visits during its first year and 638 visits during the second year. In the second year, when a referral pathway from the ED to the warming centre was open, it was associated with decreased ED lengths of stay. This suggests that the referral pathway may have helped facilitate faster discharges.

The study also found that in the second year, municipal shelter system volumes correlated with ED length of stay, suggesting that shelter capacity may influence patient flow in the ED.

Overall, the researchers say that hospital-affiliated warming centres have the potential to reduce ED burden. More research and monitoring of these interventions are needed to ensure optimal outcomes.  The researchers note that improved access to emergency shelter beds and affordable and supportive housing is necessary to improve the health of people experiencing homelessness.

Dr. Nick Kerman, Research Associate with the Gattuso Centre for Social Medicine at UHN, and Clinical Psychologist at UHN, is the first author of the study.

Dr. Kate Hayman, Clinician Investigator and emergency physician at UHN, is the corresponding author of the study. She is an Assistant Professor in the Department of Medicine at the University of Toronto.

This work was supported by UHN’s STAR-EM (Summer Training and Research in Emergency Medicine) program and UHN Foundation. The warming centre was developed and delivered through collaboration among UHN Emergency Medicine, the Gattuso Centre for Social Medicine at UHN, and a community partner with expertise supporting people experiencing homelessness.

Kerman N, Yanikomeroglu S, Ragusila A, Vitkin N, Coyle S, Steer L, Boozary A, Hayman K. Development of a hospital-affiliated warming centre to reduce emergency department pressures among patients experiencing homelessness. CJEM. 2026 Aug 10. doi: 10.1007/s43678-026-01250-y. Epub ahead of print.