Collective efforts to better support patients, health care workers in Surrey

From June 1-6, 2023, Adrian Dix, Minister of Health; Stephen Brown, deputy minister of health; Jim Sinclair, board chair of Fraser Health; and Dr. Victoria Lee, CEO of Fraser Health, met with staff from various departments at Surrey Memorial Hospital to listen to concerns and work on solutions.

“I’m grateful for the many health care workers at Surrey Memorial Hospital who have raised their concerns to me, including the hard-working people who have taken time out of their day over the past week to speak with me,” said Dix. “Along with Fraser Health, we are all working together on real, meaningful solutions to improve hospital flow and ensure health care workers are fully supported in providing their patients with the best possible care. This includes a plan to expand the hospital to better meet the need of this growing community. We’re going to keep working with health care providers in Surrey and across the province to strengthen the care people need.”

B.C.’s population is growing and changing, especially in Surrey. As more people move to Surrey, health services need to keep up with the significantly growing demand. To bolster Surrey Memorial Hospital’s function as a tertiary hospital, the Province and Fraser Health are outlining specific actions, including planning work to expand the existing Surrey Memorial Hospital by improving and increasing capacity for more inpatient and outpatient care, surgeries and clinical programs, in addition to the new Surrey hospital being built in Cloverdale.

More details about this expansion at Surrey Memorial Hospital will be identified through the fall 2023 annual capital planning process, which will build upon a refreshed clinical service plan for the hospital and region.

While this work is being done, the Province and Fraser Health will implement other solutions to benefit health care workers and patients in the short and medium term.

Immediate actions include:

• working with hospitalists to stabilize their physician workforce and sufficient service levels to ensure continued access to inpatient medicine services, while also working to build out their capacity and establish a new contract;
• increasing funding available for additional physician coverage, nursing and allied health services, including opening a care and triage unit in the emergency department;
• utilizing nearby community health care services to relieve patient demand at the emergency department, including additional resources to expand hours of urgent and primary care centres;
• introducing an interdisciplinary team for child and youth mental health for emergency care and staffing for the pediatric emergency department;
• increasing the number of internal medicine positions to support admitted patients and build out an internal medicine clinical teaching unit to support recruitment;
• increasing capacity in outpatient and community services to discharge patients safely 24 hours, seven days a week;
• focusing on psychological and physical health and safety of staff by augmenting available counselling services on site and continuing to hire additional relational security officers;
• funding for additional workforce, such as clinical associates, associate physicians and nurse practitioners; and
• targeted international recruitment of medical and health care staff.

The Ministry of Health and Fraser Health are also actively engaging with medical staff and staff from the Family Birthing Unit at Surrey Memorial Hospital to ensure that it continues to serve as the highest tier of services for maternity and women’s health care at the hospital. This will involve adding more support for the care teams, expanding access to operating rooms and increasing the infrastructure for maternity, pediatrics and women’s health in the longer term.

In the medium term, the Ministry of Health will work closely with Fraser Health, including medical staff, nurses and allied health professionals, to refresh clinical service planning. The plan will determine how and where services should be delivered in Surrey and the broader region. The plan for Surrey Memorial Hospital will include:

• expanding renal services within 18 months;
• building a second interventional radiology suite at Surrey Memorial Hospital, which will enable stroke and cardiac specialty expansion;
• adding two cardiac catheterization labs at Surrey Memorial Hospital;
• adding new MRI and CT and replacing existing CT with cardiac capabilities to increase access to diagnostic services;
• completing renovations of existing operating rooms to expand capacity;
• expanding critical health care services such as outpatient, home health and home support services, clinical social work, physiotherapy, rehabilitation and respiratory therapy;
• expanding the Urgent Care Response Centre and Gateway Mental Health services to 12 hours, seven days a week;
• renovation to the pediatric emergency waiting areas;
• increased access to transitional beds for vulnerable patient populations by purchasing new care spaces;
• building out innovative and digital services such as Hospital at Home, Digital Front Door and virtual specialty consultation services;
• significantly increasing resident physician allocation at Fraser Health and including Surrey Memorial Hospital as their home residency sites; and
• enhancing Fraser Health’s successful in-house learning institute to close critical gaps in allied staff and nursing.

The Province and Fraser Health will continue working with Surrey Memorial Hospital and staff to find solutions that will support providing quality care to patients in Surrey.

Four backgrounders follow.

Backgrounders

Quick facts about Surrey

The population of B.C. is overall getting larger, but there has been a significant growth in the population of Surrey:

• Growth in population:
  
  • Surrey has been growing at a rate of 9.7 per cent annually.
  • It is estimated that approximately 1,000 new residents are moving to Surrey each month.
  • Based on recent growth rates, the estimated population of Surrey is thought to be more than 600,000.
• With growth, Surrey also faces other challenges linked to growth in the number of homeless people and the drug toxicity crisis.

Fraser Health services are having to meet the demands of this growth in Surrey across its regional hospitals and specifically at Surrey Memorial Hospital which has seen:

• increased growth in volume;
• increased complexity of disease in the patients they serve;
• increased social and financial issues for more vulnerable patient populations, which are complex to address at the same time as addressing health concerns and appropriate referral services (including living/housing options); and
• increased care for newcomers and providing additional health and social supports.

Summary of issues raised by health care workers at Surrey Memorial Hospital

During the meetings between June 1 and 6, 2023, health care providers raised several key concerns while also expressing a strong professional and personal commitment to the community and patients, especially throughout the COVID-19 pandemic. They are also dealing with a significant increase in demand for services, staffing challenges and hospital space.

1. Patients and staff are dealing with chronic congestion and very high daily volumes across key areas of the hospital:

• Waits have become longer than desirable in the emergency room, while waiting for a bed and to be discharged either home or to other sites or services. Staff are reporting growing levels of aggression, increased levels of stress and concerns about staff’s ability to meet demand.
• The hospitalist team is feeling stress faced with significant demands, capacity issues and challenges in recruitment.
• Maternity care has experienced significant periods of demand exceeding physical capacity and creating high levels of stress for patients and providers.
• Other areas of hospital services are also facing high demand and stress with the need for more capacity.

2. Increased complexity through the changing demographics and growing population in Surrey:

• While there are very strong existing specialties services providing care, there is a need for increased capacity and additional specialty service including:
  
  • renal and renal dialysis;
  • maternity care is operating at the highest accessed level, but there is a need for increased capacity;
  • neurology (stroke care);
  • surgeries from the existing operating room infrastructure edits; and
  • new speciality services are needed, including: interventional radiology, on-site catheterization lab capacity for cardiac care, cardiac MRI and CT to improve patient flow.
• Discharging patients when they no longer need hospital care. This is caused by challenges with:
  community based mental health and substance use services;
  
  • long-term care spaces;
  • services for patients with an acquired brain injury and cognitive challenges combined with behavioural and addiction challenges; and
  • services for individuals in vulnerable living situations or experiencing homelessness.

3. Specific health and human resources challenges for Surrey include:

• need for additional residency program slots in Fraser Health;
• nurse recruitment has been successful in many ways, but additional clinical support available to newer nurses is required;
• allied health staff dealing with a significant volume increase that are outstretching capacity; and
• volumes, demand and capacity are making retention more challenging.

Summary of short-term actions

The Province and Fraser Health will work with medical and health-care staff to increase flow through hospital from emergency department (ED) to in-patient to discharge through:

• Building and enhancing current Emergency Operations Centre (EOC) structure and existing bed management strategies to support flow.
• Adjusting clinical services provided by hospitalists in line with their current service capacity while we work with them on recruitment challenges.
  • Fraser Health is working with the hospitalists at Surrey Memorial Hospital and across the region to establish their current clinical capacity to meet patient needs and their recruitment and retention challenges. Where there is a gap between hospitalist capacity and patient demand, short-term stabilization plans are being developed in early June 2023 focused on using general internal medicine specialists, clinical associates and/or family physicians providing in-patient care, to supports the work done by hospitalists.
  • The stabilization plans are intended to be short-term supports while the Ministry of Health, Fraser Health and the hospitalists work collaboratively to develop a refreshed provincial contract framework over the next six months.
• Providing funding available for additional physician coverage and services to better support patients, including opening an in-patient transition unit in the ED.
• Utilizing nearby health care services to relieve patient demand at the ED.
  • Increase the capacity of nearby urgent and primary care centres (UPCC) to meet lower acuity patients to take release pressure from ED.
  • Work has already been undertaken to add capacity at Surrey UPCC allowing more physicians to work at the UPCC full-time.
  • This could potentially provide care for up to 100 patients daily away from ED to alleviate hospital pressure.
  • Effective and immediate triage for more frail older patients and mental health and substance use patients with immediate collaboration with home-health services and mental health and addictions community services.
• Increasing additional clinical capacity to support patient care and flow by building out critical health-care supports, including, diagnostics, occupational therapy, physiotherapy, respiratory therapy and clinical social work, along with more effective and timely referrals to community services.

Building out capacity of the Surrey Memorial Family Birth Unit, through several specific actions including:

• introducing a centralized registration system for patients throughout Fraser Health to gain a comprehensive understanding of patient demographics within the system;
• providing immediate funding for beds and staffing in the Neonatal Intensive Care Unit to accommodate maternity and pediatric patients;
• implementing a midwifery-led early patient discharge program to create bed space and improve longitudinal patient care upon hospital discharge;
• expand maternity resources, including specialty nursing roles such as clinical nurse educators (CNEs), clinical nurse specialists (CNSs) and charge nurses for maternity to enhance nurse
• support, recruitment and retention;
• regional and provincial planning in partnership with Perinatal Services BC (PSBC) to better position the Family Birthing Unit to meet current and future demand;
• finish renovations of operating rooms to expand surgical capacity;
• enhance patient care supports to provide physical, emotional and cultural care in the context of high volume and wait-times.
• increase the number of personal support workers and clinical social workers to better support patients and reduce pressure on existing health-care workers; and
• focus on psychological and physical safety of staff by:
  
  • implementing the relational security staffing plan to enhance the safety of staff and adequate perimeter security;
  • continuing focus on building out violence prevention training;
  • implementing on-site access to counselling (same-day in-person and virtual drop-in); and
  • increasing debriefing service for Fraser Health staff after a traumatic incident.

Summary of medium-term actions

Clinical service planning

Fraser Health board and senior executive will be engaging fully with the Surrey Fraser Health team, including doctors, nurses and allied-health professionals, to create a refreshed plan that looks at the growth and specialty needs of the population, as well as how and where services should be located at SMH and across the region.

This will be done over the coming five months and be brought to the Ministry of Health for review and action through the annual fall 2023 capital and operating planning process.

In the meantime, the Ministry of Health directs immediate planning to start for:

• Renal services: Increasing capacity to meet patient demand with more physical space through additional modular units for completion within 18 months.
• Interventional Radiology (IR): Increasing capacity at Surrey Memorial Hospital, while increasing access through other sites.
• Catheterization lab and cardiology services: The Province will be creating a plan for a cardiac catheterization lab (two suites and ancillary space) for completion within 18 months.
• Adding net new MRI and CT and replacing existing CT with cardiac capabilities to increase access to diagnostic services.
• Expand critical health care services and resources (occupational therapy, physiotherapy, respiratory therapy, mental health and substance use services, and clinical social worker services).
• Developing additional transition beds for hard to serve populations.
• Building out Hospital at Home services.

Maternity care

In partnership with provincial and regional colleagues, Fraser Health will be working to add providers to the teams for maternity care and determine the right size for the current and future unit. This will involve:

• expanding maternity resources, including specialty nursing clinical pharmacy, quality improvement initiatives, and data collection at Surrey Memorial Hospital;
• improving utilization and, where necessary, expand available operating room time for gynecology by optimizing existing operating room time at Surrey Memorial Hospital, Jim Pattison
• Outpatient Care and Surgery Centre, and other Fraser South acute care sites to meet provincial wait-time benchmarks; and
• expanding infrastructure for maternity, pediatric and women's health at Surrey Memorial Hospital.