Breaking Barriers: How Lakeridge Health is Revolutionizing Sickle Cell Care Through Equity and Inclusion

Sickle cell disease (SCD) is a genetic condition that disproportionately affects racialized communities, particularly those of African, Caribbean, Mediterranean, and South Asian descent. For years, systemic inequities in health care have led to gaps in understanding, diagnosing, and treating SCD, resulting in preventable suffering and higher mortality rates. At Lakeridge Health, a transformative initiative is underway to address these disparities head-on, integrating the organization’s commitment to inclusion, diversity, equity, accessibility, and anti-racism (IDEAA) into every facet of SCD care.

A Pilot Project with Profound Impact

The journey began with a pilot project at Lakeridge Health’s Ajax Pickering Hospital in 2023, focused on improving emergency care for SCD patients. Spearheaded by the organization's IDEAA and ED teams, the initiative was born from a recognition of stark disparities: only 11 per cent of patients received pain medication within the target time of 30 minutes, and the use of physician order sets – decision support tools that aim to help physicians prescribe appropriate treatments – was at just 17 per cent.

Dr. Gemma Cox, an ED physician, and physician lead for the project, joined the effort in late 2023 and has since witnessed remarkable progress. "The data showed a critical gap in provider knowledge," she explains. "But through education, we’ve seen order set usage rise to 34 per cent, and the percentage of patients receiving timely pain medication has doubled to 20 per cent."

The educational component is comprehensive, addressing not only the clinical aspects of SCD but also the systemic racism embedded in healthcare. "We start with the basics – what SCD is, how it manifests – but we also confront the uncomfortable truths about bias and discrimination," says Dr. Cox. "Patients with SCD often modify their behavior – their tone, their clothing – just to be taken seriously. That realization has been transformative for our team."

Confronting Challenges with Courage

The work has not been without its challenges. Karen Fleming, Lakeridge Health’s Senior Clinical IDEAA Lead and nurse clinical lead for the SCD initiative, describes the resistance encountered during anti-racism training sessions. "Some staff dismiss the need for this education outright, saying things like, 'I didn’t come here to learn about racism,' or 'Show me the data.' It’s disheartening, but it underscores why this work is so urgent."

Despite these hurdles, the team remains steadfast. Karen emphasizes the importance of prioritizing patient voices. "We’re honoured to have lived experience advocates who share their stories directly with our clinical teams. Their courage in reliving traumatic experiences is what keeps us going. We’re here to change the way care is delivered, no matter how uncomfortable the process is.”

Expanding Care Across the Network

The success of the pilot project has paved the way for broader implementation. The initiative is now being scaled across Lakeridge Health’s three other EDs, with plans to extend to inpatient units later in 2025. Key advancements that have been introduced include:

• Vein viewers: Devices that improve visualization of veins on light and dark skin tones, improving successful IV attempts.

• Sublingual fentanyl: An oral pain management option that can help build trust and reduce patient anxiety because they feel heard.
• Incentive spirometers: Tools to prevent complications like acute chest syndrome.
• Nursing and Medical workflows and standards of work implemented.

• Order sets updated to align with best practices from the Ontario Health Quality Standards for Sickle Cell Disease

Education has also been embedded into clinical orientation and professional development programs, ensuring all staff are equipped to provide equitable care.

A Community-Centered Future

Beyond the hospital walls, Lakeridge Health is partnering with the Durham Community Health Centre and the Sickle Cell Awareness Group of Ontario (SCAGO) to launch the Durham Sickle Cell Wellness Service. Starting with mobile clinic services, these services will bring disease management, education, and psychosocial support directly to underserved communities, reducing the need for emergency visits.

"This is about meeting patients where they are," says Karen. "Many avoid local hospitals due to past trauma, traveling far for care, and prolonged wait times. We want to change that by offering compassionate, culturally relevant services closer to home."

A Vision for Equity

For Dr. Cox and Karen, success is measured not just in data but in cultural shifts. "We want staff to recognize their biases, to listen, and to prioritize equity in every interaction," says Dr. Cox. "When a provider tells me, 'This changed how I see my patients,' that’s progress."

As Lakeridge Health continues this vital work, the message is clear: equitable care for SCD is not just a goal – it’s a commitment to justice, dignity, and healing for all.

Learn more about how Lakeridge Health is advancing IDEAA across the organization in our Multi-Year Action Plan.