Development of a hospital-affiliated warming centre to reduce emergency department pressures among patients experiencing homelessness.

OBJECTIVES: Emergency departments (EDs) face severe capacity challenges exacerbated by shelter bed shortages, delaying discharges for people experiencing homelessness during the winter months. In response, a Toronto-based hospital-affiliated warming centre was launched to enable EDs to discharge people experiencing homelessness to a supportive location. METHODS: This exploratory study examined the relationship between ED visits by people experiencing homelessness and hospital-affiliated warming centre operation. Administrative data on ED and hospital-affiliated warming centre utilization were obtained for the winter seasons between Nov 2022 and April 2025. Publicly available data on shelter system volumes and temperature were also obtained. Multiple regression models were fitted to predict how hospital-affiliated warming centre operation affected ED volume and flow. RESULTS: The hospital-affiliated warming centre supported 1,196 visits during its first year and 638 visits during the second year. There was a nonsignificant association between ED visits by people experiencing homelessness and operation of the hospital-affiliated warming centre in both years. Operation in year one was associated with significantly longer daily mean ED visits (44.6 min longer) among people experiencing homelessness; the opposite effect was found in the second year (86.1 min shorter). Mean ED lengths of stay in 2024-5 were significantly higher on days when there were more people staying in the Toronto shelter system. CONCLUSIONS: The hospital-affiliated warming centre, operated in collaboration with a community partner agency with expertise in delivering person-centred supports to homeless and marginalized populations, has the potential to reduce ED length of stay among people experiencing homelessness by providing a safe, alternative space for overnight sheltering. Ongoing monitoring of this type of intervention is necessary to mitigate unintended service model outcomes, such as ED return visits related to warming centre access.