Update on progress to implement 30 promised health care actions in Surrey

“Along with Fraser Health, the Ministry of Health committed to implementing 30 short-, medium- and long-term health care actions to improve the delivery of health care services in Surrey for patients and health care workers, and the partnerships we have forged with staff and medical staff at Surrey Memorial Hospital are doing just that,” said Adrian Dix, minister of health. “Since our renewed commitment in June, we’ve already made significant progress and are continuing the work to further support patients and the people delivering care at the hospital. We’re continuing to work with hospital staff and medical staff to ensure that the solutions we are implementing now will strengthen our public health care system in Surrey and throughout the province.”

In June following comprehensive engagement with health care workers in Surrey, two cardiac catheterization labs, a second interventional radiology suite and expanded renal services were approved by the Ministry of Health for the community. Fraser Health has selected sites for these additions and planning work is actively underway to provide Surrey patients with faster access to care.

In addition, immediate actions announced in June are already benefitting patients, families, staff and medical staff, including:

• To expedite access to non-urgent health services, Fraser Health, in partnership with Surrey Memorial Hospital Emergency Department physicians, has almost doubled capacity at the hospital’s satellite Emergency Department within the Surrey Urgent and Primary Care Centre by expanding hours and adding physician availability.
• Since June 2023, Fraser Health has filled more than 216 staff positions at Surrey Memorial Hospital. These include 133 registered nurses, 20 licensed practical nurses, 41 allied health professionals, 15 care aides and seven unit clerks. Additionally, 64 brand new positions have been posted for Surrey Memorial Hospital to bolster staffing resources.
• Since January 2023, 146 internationally educated nurses have been hired throughout Fraser Health to enhance staffing levels, including 39 at Surrey Memorial Hospital.
• Since January 2023, Fraser Health has also hired 55 physicians at Surrey Memorial Hospital.
• A new, on-site clinical counsellor is now at Surrey Memorial Hospital to support the well-being of staff and medical staff.
• In addition, Fraser Health has recruited 10 patient ambassadors to greet patients and families and provide support with wayfinding and general information.
• To support the safety and well-being of patients, families and staff, Fraser Health has recruited nine relational security officers at Surrey Memorial Hospital and is recruiting six additional officers.
• To expand access to care within the hospital, Fraser Health has expanded Internal Medicine bed capacity at Surrey Memorial Hospital from 30 to 60 beds and has hired two new nurse practitioners.

“As the Surrey community continues to grow and change, so too must Fraser Health expand and change the way we deliver care. These and other strategic, sustainable investments in our health system support our patients and clients in staying and getting well, and equip our staff and medical staff with the tools they need to continue to deliver excellent care,” said Dr. Victoria Lee, Fraser Health president and CEO. “The contributions of our staff and medical staff during the early stages of implementation have produced rapid achievement in a short period of time. I know they will continue to make this essential difference as we work together to advance the care we provide in Surrey.”

In the medium-term, Fraser Health is also making progress towards a number of important initiatives, including:

• Expanding the waiting area in the Pediatric Emergency Department to better support pediatric patients and their families.
• Planning to enhance the Surrey Memorial Hospital’s Family Birthing Unit to ensure adequate maternity resources are in place to support the community now and in the years to come.
• Expanding the clinical teaching unit with additional Fraser Health dedicated residents that will play a crucial role in supporting ongoing efforts to train and recruit medical graduates within our hospitals.

Underpinning the investments in Surrey is an investment in quality of life for both those receiving care and those providing it, from services for our littlest patients in our maternity unit and pediatric emergency department to actions supporting the safety and well-being of staff. Assigning highly experienced leaders, staff and medical staff to move these initiatives forward is ensuring actions produce benefits now, and in the weeks and months ahead.

“Staff from clinical programs across Surrey Memorial Hospital and Fraser Health have been working non-stop this summer to build a roadmap for services for Surrey and Fraser South communities. We are working together with the Ministry to create a plan to meet the needs of people who come to us when they need care,” said Dr. Greg Haljan, site medical director for Surrey Memorial Hospital.

“When time is of the essence, it is critical that a patient experiencing a cardiac event is able to access the care they need as quickly as possible. The enhancement of Surrey Memorial Hospital’s cardiac services will help ensure people in Surrey receive the care they need here in the community and I am encouraged by the progress that has been made in moving this work forward,” said Dr. Courtney Young, local department head for Cardiology at Surrey Memorial Hospital.

“Going into the fall and winter seasons, we will be able to provide expanded hours in our satellite Emergency Department at the Surrey Urgent and Primary Care Centre to ensure faster access for patients in our community to in-person medical care for lower acuity problems. Overall, this will contribute to a better care experience for all our patients and their families seeking care in the Surrey Memorial Hospital Emergency Department,” said Dr. Craig Murray, regional medical director, Emergency Medicine.

Over the long-term, additional expansion opportunities at Surrey Memorial Hospital are being identified through the fall 2023 annual capital planning process, which will build upon a refreshed clinical service plan for the hospital and region.

“Since June we’ve been working hard to plan long-term solutions that benefit people south of the Fraser. While short- and medium-term solutions are rapidly brought into place, our focus will remain on expanding existing clinical services, and increasing capacity for inpatient care, surgeries and clinical programs that transform health services in the community," added Dix.

Learn more:

To learn more about the short-, medium- and long-term efforts underway to support patients and health care workers in Surrey, visit: https://news.gov.bc.ca/releases/2023HLTH0081-000894

One backgrounder follows.

Update on progress to implement 30 promised health care actions in Surrey

The following is a three-month update on short-, medium-, and long-term actions underway to support health care in Surrey:

Completed actions

1. Increase funding available for additional physician coverage, nursing and allied-health services, including opening a care and triage unit in the emergency department.
   • Fraser Health established a Care and Triage team in July 2023. The team consists of Emergency physicians and Internal Medicine physicians who assume oversight and care for patients who are admitted in Emergency.
   • Sixty-four net new positions have been posted for all of Surrey Memorial Hospital, including positions in the Pediatric Emergency Department and Emergency Department as well as clinical and support services.
2. Focus on psychological and physical health and safety of staff by augmenting available counselling services on site and continuing to hire additional relational security officers.
   • Fraser Health hired an on-site clinical counsellor at Surrey Memorial Hospital in July 2023. Nearly 350 staff and medical staff have connected with the counsellor to date. Sessions include huddle debriefs, team education, individual support, daily team huddles on all units.
   • Fraser Health has hired additional relational security officers for Surrey Memorial Hospital and across the region. Regionally, 68 out of 95 positions have been hired. Nine out of 15 positions have been hired at Surrey Memorial Hospital.
3. Build and enhance current Emergency Operations Centre (EOC) structure and existing bed management strategies to support flow.
   • Surrey Memorial Hospital has established a detailed overcapacity plan including implementation of an Emergency Operations Centre when required.
   • An administrator on-call status meeting is held seven days per week with site leadership, including physicians, to discuss site status and any bed management planning required for overnight.
4. Enhance patient care supports to provide physical, emotional and cultural care in the context of high volume and wait-times.
   • In May 2023, Fraser Health made Emergency Department wait times available online to the public to enhance patients’ understanding of what they can expect when they visit the Emergency Department.
   • In partnership with Surrey Memorial Hospital Emergency Department physicians, Fraser Health has expanded the Surrey satellite Emergency Department at the Surrey Urgent and Primary Care Centre effective September 5, 2023. Currently, the satellite Emergency Department is averaging 60 patients per day.
   • Fraser Health has hired patient ambassadors at Surrey Memorial Hospital and throughout Fraser Health. This position serves as a patient navigator, ambassador and comfort provider to patients waiting in Fraser Health emergency departments. At Surrey Memorial, 10 positions have been filled.
     

     Actions in progress

5. 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.
   • Surrey Memorial hospitalists have agreed to a formal interim stabilization agreement effective July 12, 2023. It has helped to support a stable environment for the hospitalists. Long-term hospitalist contract discussions will commence in September 2023.
   • Surrey has expanded internal medicine bed capacity from 30 to 80 beds effective September 2023, with the intention to expand to 100 beds. This will reduce reliance on the Hospitalist service for majority of acute inpatient care.
6. Introduce an interdisciplinary team for child and youth mental health for emergency care and staffing for the pediatric emergency department.
   • Hiring in process for 12.9 FTE nursing and 4.3 FTE care-aide to expand pediatric emergency nursing staffing by November 2023.
   • An interdisciplinary child and youth mental health team at Surrey Memorial Hospital and Fraser South will be implemented October 2023. All hires have been completed with a launch date of October 2.
7. Increase the number of internal medicine positions to support admitted patients and build out an internal medicine clinical teaching unit to support recruitment.
   • Surrey Memorial Hospital Internal Medicine capacity increased from 30 to approximately 80 beds effective August 2023. Plan is to continue to expand Internal Medicine bed capacity to 100 beds.
   • Two nurse practitioners have been hired and have commenced their roles as part of the expanded care team.
   • Fraser Health posted an associate program director position in August 2023. This position will manage the implementation of the Internal Medicine residency program inclusive of the Clinical Teaching Unit.
   • The University of British Columbia has confirmed five Internal Medicine resident positions starting July 2024.
8. Funding for additional workforce, such as clinical associates, associate physicians and nurse practitioners.
   • 21 new resident clinical associates have been hired to date to support hospitalist and Internal Medicine groups.
   • Five clinical associate positions have been posted for Surrey Internal Medicine group.
   • Nine associate physician positions have been posted.
9. Targeted international recruitment of medical and health care staff.
   • Regionally, 128 internationally educated nurses have been hired to date. Of these, 39 have been hired at Surrey Memorial Hospital.
   • Since January 2023, a total of 55 physicians including some serving as locums have been recruited to Surrey Memorial Hospital. Of the total 55 hires, three are international recruits.
10. Refresh the Clinical Service Plan for Surrey to look at the growth and specialty needs of the population, as well as how and where services should be located at Surrey Memorial and across the region.
    • Fraser Health initiated the Clinical Service Planning process in August 2023.
    • Meetings with clinical stakeholders are underway.
    • Target completion date for final clinical services plan report is September/October 2023.
11. Increase the number of personal support workers and clinical social workers to better support patients and reduce pressure on existing health care workers.
    • 3.8 FTE Social work and 17.2 FTE care aide positions were posted in September.
12. Build out innovative and digital services such as Hospital at Home, Digital Front Door and virtual specialty consultation services.
    • Planning is on track to implement virtual transition unit at Surrey Memorial Hospital by 2024/25.
    • Planning to expand virtual specialist consult services by 2024/2025 is underway.
13. Enhance Fraser Health’s successful in-house learning institute to close critical gaps in allied staff and nursing.
    • Work underway to increase nurse practitioner residency program seats by 50 per cent by December 2023. To date, residency placements completed as follows:
      • One for UPCC nurse practitioner (locum – Metrotown)
      • Two for Surrey UPCC
      • Two for Surrey Memorial Hospital Internal Medicine
      • One for Abbotsford Regional Hospital Cardiology Clinic
    • Work is underway to expand in-house allied and nursing programs by 50 seats by December 2023 with successful enrollment occurring.
    • HCAP acute program expansion has gone from 50 to 60 seats. Currently, there have been 36 hired to date regionally.
    • Active planning with academic partners to expand respiratory therapy education.
      

      Actions with active planning underway

14. Use nearby community health care services to relieve patient demand at the emergency department, including additional resources to expand hours of urgent care response centre and primary care centres.
    • Fraser Health is on track to expand Surrey-Whalley UPCC hours of operation by September 30, 2023.
    • Planning is underway for expansion of Surrey-Newton UPCC by 2024.
    • Planning is underway for expansion of Abbotsford UPCC by September 2024.
15. Effective and immediate triage for more frail older patients and Mental Health and Substance Use (MHSU) patients with immediate collaboration with home health services and mental health and addictions community services.
    • Staffing model is being developed to enhance supports within our Emergency Department for clients with substance use concerns.
    • Planning is on track to implement an enhanced regional MHSU access and flow model through consistent 12 hours per day, seven days per week. Implementation planned for January 2024.
16. Increase additional clinical capacity to support patient care and flow by building out critical health care supports, along with more effective and timely referrals to community services.
    • As of July 2023, social prescribing was expanded to Chilliwack, Langley, Tri-Cities and South Surrey. Social prescribing referral form has been built within the PARIS electronic system.
    • Plan to be implemented by December 2023. Social prescribing is a means of enabling health professionals to refer people to a range of local, non-clinical services. It complements clinical treatments and seeks to address people’s needs in a holistic manner. This asset-based approach goes beyond treating illnesses. It recognizes people as not just patients with needs, but as community members with gifts to share, while supporting them to engage with and contribute back to their communities.
17. Increase capacity in outpatient and community services to discharge patients safely 24 hours, seven days a week.
    • Plans are underway to augment hours of operation in the community outpatient clinics at the Jim Pattison Outpatient Care and Surgery Centre including clinics such as: outpatient antibiotic therapy, medical daycare, breast health, neurology, chronic pain and internal medicine clinics.
18. Ensure Family Birthing Unit at Surrey Memorial Hospital continues to serve as the highest tier of services for maternity and women’s health care.
    • Active planning has commenced with Fraser Health and Perinatal Services BC to outline requirements for Tier six maternity program at Surrey Memorial Hospital.
19. Build out capacity of the Surrey Memorial Family Birth Unit, through several specific actions.
    • Modelling and patient journey map analysis underway to validate the requirements for new models of care and additional investment to help determine what additional capacity is required.
20. Expand renal services within 18 months.
    • Space identified for a stand-alone renal in center service on the Surrey Memorial Hospital campus.
    • Ministry approved moving forward with design and planning work. Prime consultant Request for Proposal (RFP) issued August 1 and construction Management RFP issued August 8.
21. Build a second interventional radiology suite at Surrey Memorial Hospital, which will enable stroke and cardiac specialty expansion.
    • Site has identified location in which newly announced second Interventional Radiology suite can be situated with the newly announced two cardiac catheterization labs. The RFP process is underway.
22. Adding two cardiac catheterization labs at Surrey Memorial Hospital.
    • Active planning underway for two Cath labs to be developed with the second Interventional Radiology suite in the same location.
23. Add new MRI and CT and replacing existing CT with cardiac capabilities to increase access to diagnostic services.
    • MRI phasing options being considered as an initial step in MRI planning.
    • Planning underway with clinical teams on location and space requirements for replacement CT.
    • Business plan for replacement CT nearing completion.
24. Complete renovations of existing operating rooms (OR) to expand capacity.
    • Four ORs confirmed to require updating with an estimated completion date of September 2025.
25. Expand critical health care services such as outpatient, home health and home support services, clinical social work, physiotherapy, rehabilitation and respiratory therapy.
    • Modelling underway to enhance home health and home support services to determine FTE requirements, target completion October/November 2023.
    • Virtual rehab model of care development commenced August 2023 with the goal to expand services.
    • Planning to expand the community wound care clinic underway.
26. Expand the Urgent Care Response Centre and Gateway Mental Health services to 12 hours, seven days a week.
    • Targeting expansion of Urgent Care Response Centre by January 2024.
    • Planning underway to expand Gateway Mental Health.
27. Renovate the pediatric emergency waiting areas.
    • Physician and leadership teams are in process of identifying a preferred option for pediatric waiting room expansion with a September fit test.
28. Increase access to transitional beds for vulnerable patient populations by purchasing new care spaces.
    • Three potential hotels identified for transitional housing capacity.
    • Facilities team is reviewing lease options with BC Housing and landlord.
    • Clinical teams working on patient population, model of care and resource requirements.
29. Significantly increase resident physician allocation at Fraser Health and including Surrey Memorial Hospital as their home residency sites.
    • UBC announced five internal medicine residents starting July 2024.
    • Three net new Emergency Medicine residents for a total of five have been allocated to Surrey Memorial Hospital effective July 2024.
    • Two pediatric residents starting July 2024.
    • Ongoing planning is occurring with academic partners.
30. Improve 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.
    • Waitlist review of Surrey Memorial Hospital gynecology surgeons was initiated in August.
    • One additional OR slate per week has been allocated to gynecology cases and one gynecology surgeon has started utilizing additional capacity.
    • Updated OR modeling for Surrey Memorial Hospital was completed August 12, 2023 to inform clinical services planning.
    • OR modeling update underway for Fraser South with a target completion date of early October.

To learn more about how we are transforming health care in Surrey, visit the webpage here.