Integrating Equity Into Sickle Cell Disease Care

A new pilot project to improve care for individuals with Sickle Cell Disease (SCD) who visit the Emergency Department (ED) is an example of how Lakeridge Health is applying the commitments in its Inclusion, Diversity, Equity, Accessibility, and Anti-Racism (IDEAA) Multi-Year Action Plan to clinical care.

SCD is a group of inherited red blood cell disorders that affect hemoglobin, the protein that carries oxygen through the body. Normally, red blood cells are disc-shaped and flexible enough to move easily through the blood vessels. In SCD, red blood cells become crescent – or “sickle” – shaped due to a genetic mutation. These sickled red blood cells do not bend or move easily and can block blood flow to the rest of the body. The blocked blood flow through the body can lead to serious problems, including stroke, eye problems, infections, and episodes of pain called pain crises.

“People living with Sickle Cell Disease, who are predominantly of African, Caribbean, Middle Eastern, Mediterranean, and Indian descent, often face discrimination, in addition to the challenges of living with this debilitating disease,” explains Umwali Sauter, Director, IDEAA, Organizational Development, Wellness, Health Science Library, Volunteer Resources, and Spiritual Care.

Lakeridge Health serves a region where two thirds of the growth stems from immigrant communities. What’s more, the Town of Ajax has the highest Black population percentage among major Canadian cities.

With these demographics in mind and the IDEAA Multi-Year Action Plan as their guide, Lakeridge Health’s IDEAA team led a successful application to partner with the Institute for Healthcare Improvement to introduce a SCD quality standard in the ED at the Ajax Pickering Hospital.  The pilot project includes a three-part data review, an SCD education plan for staff and physicians, and a robust evaluation framework.

“The SCD quality standard is designed to provide staff and physicians with improved guidance on the management and treatment of sickle cell complications, so that all SCD patients receive timely care in an environment that is free from racism, discrimination, and stigma,” shares Dr. Placide Rubabaza, Obstetrician and Gynecologist and Interim Chief and Medical Director, IDEAA, Lakeridge Health.

“Many staff and physicians in the ED may not understand the urgency with regards to pain management for SCD patients,” notes Kerry Duggan, a Registered Nurse in the ED at the Ajax Pickering Hospital. “I feel this quality standard is a tool to assist us in learning to advocate for this group.”

Dr. Jaclyn Herman, Chief and Medical Director for Emergency Medicine, Lakeridge Health, adds that “the SCD quality standard is an important partnership between the ED and IDEAA teams designed to both improve the quality of care and instill a greater sense of trust among patients and families in their care team.”

Once the pilot project is complete, Dr. Rubabaza explains that the next steps include “spreading this important work to the three other EDs at Lakeridge Health, as well as applying it to other areas of the organization, including the Paediatrics and Medicine programs.”

“Together, we will ensure that the excellent care we provide is aligned with the principles of equity and racial justice,” adds Umwali.