Projects for transforming health care in Surrey

1. Work with hospitalists to stabilize their physician workforce and sufficient service levels to ensure continued access to inpatient medicine services by building their capacity and establishing a new contract.

• Surrey hospitalist contracts:
  
  • Long-term - all sites except for Abbotsford Regional Hospital have signed the finalized hospitalist contract, effective March 1, 2024.
• Access to inpatient medicine services:
  
  • Surrey Memorial Hospital expanded the Internal Medicine Department from 30 to 90 beds in 2023.

2. Increase funding for additional physician coverage, nursing and allied health services, including opening a care and triage unit in the emergency department.

• Increased funds to add more staff for the Surrey Memorial Hospital Emergency Department:
  
  • Since July 2023, a total of 414 new positions have been posted for Surrey Memorial Hospital and Surrey communities, including pediatric emergency, emergency clinical staff, support services and more.
  • As of May 30, 2024, 293 of the 414 new positions have been filled, including 23 out of 27 pediatric emergency positions. In September 2023, two nurse practitioners specializing in internal medicine were recruited. Refer to action numbers six, seven and 17 for physician recruitment updates.
• Care and Triage Team in emergency department:
  
  • The Care and Triage Team, formed in July 2023, oversees patients admitted to the emergency department waiting to see hospitalists. This team provides prompt and safe care, eliminating potential service delays.

3. 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 Substance Use community services.

• Increased capacity of the regional Mental Health and Substance Use Access and Flow Team to ensure care is consistently available for 12-hours-per-day, seven-days-per-week, as of November 6, 2023.
• Continuing to hire substance use patient assessment nurses and an additional psychiatric liaison nurse across multiple sites for increased support for substance use concerns in emergency departments:
  
  • All addiction assessment nurses hired for Surrey Memorial Hospital.

4. Introduce an interdisciplinary team for child and youth mental health for emergency care and staffing for the pediatric emergency department.

• Staffing at the Surrey Memorial Hospital Pediatric Emergency Department:
  
  • A total of 27 new positions have been posted since August 2023 to expand pediatric emergency nursing staffing (see action number two for a recruitment update).
• Child and Youth Mental Health Emergency Response Team to support timely assessment and collaborative care planning with families:
  
  • Surrey Memorial Hospital and Fraser South communities – the team started November 6, 2023.
  • Abbotsford Regional Hospital and Fraser East communities – the team started on March 11, 2024. As the remaining positions are filled, services will be provided to the wider Fraser East area.
  • Royal Columbian Hospital, Burnaby Hospital, Ridge Meadows Hospital and Fraser North communities – the teams started at Royal Columbian Hospital on February 19, 2024, and at Burnaby Hospital and Ridge Meadows Hospital in April 2024. As the remaining positions are filled, services will be provided to the wider Fraser North area.

5. Focusing on psychological and physical health and safety of staff and medical staff with onsite psycho-social support services and hiring of additional relational security officers.

• An onsite psychological and organizational wellness lead was hired at Surrey Memorial Hospital, effective July 2023, to support the mental health of staff and medical staff.
• All 15 relational security officer positions have been filled at Surrey Memorial Hospital and are now working to prevent and respond to workplace violence, emphasizing customer service, trauma-informed practices and cultural humility and safety.
• All 13 of the recommended actions from the Violence Risk Assessment done at Surrey Memorial Hospital in July 2023 are now complete.
• Close to 80 per cent of Surrey Memorial Hospital emergency department staff have completed annual violence prevention training.

6. Funding for additional workforce such as clinical associates, associate physicians and nurse practitioners.

• Twenty-one new resident clinical associates have been hired to date to support hospitalist and internal medicine groups. Five professional clinical associate positions have been posted for the Surrey Memorial Hospital internal medicine group.
• Twenty-three associate physician positions have been posted and four have been hired to date with four additional offers accepted as of April 2024. Regional position in medical affairs to oversee clinical associates and associate physicians is in place as of September 18, 2023.
• Seventeen new nurse practitioners have been recruited regionally since January 2023, including five for Surrey Memorial Hospital supporting internal medicine, and thoracic and general surgery.

7. Targeted international recruitment of medical and health care staff.

• Since January 2023, Fraser Health has hired 342 internationally educated nurses and 326 physicians, including locum physicians. Out of those, 88 nurses and 71 physicians have joined Surrey Memorial Hospital. Additionally, 122 new nursing graduates and 164 employed student nurses have been hired at Surrey Memorial Hospital, while 460 nursing graduates and 585 employed student nurses have been hired across Fraser Health from April 2023 to March 2024. Since April 1, 2024, 150 new employed student nurses and 23 new nursing grads have been hired at Surrey Memorial Hospital, a total of 472 employed student nurses and 78 nursing grads across Fraser Health.

8. 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 Hospital and across the region.

• The Clinical Services Plan and Surrey Memorial Hospital Site Master Plan is complete.
• The Ministry of Health announced on March 11, 2024, that a new acute care tower is coming to Surrey Memorial Hospital. Planning is underway to establish a Business Case Development Team.

9. Build and enhance the current emergency operations centre structure and existing bed management strategies to support flow through the health system.

• Surrey Memorial Hospital has a detailed over-capacity plan, which includes the use of an emergency operations centre to manage patient load when the hospital is beyond maximum capacity.

10. Enhance patient care supports that provide physical, emotional and cultural care in the context of high volume and wait times.

• Emergency department wait times across Fraser Health were made available to the public as of May 24, 2023.
• The Surrey satellite emergency department opened in December 2022 at the Surrey-Whalley Urgent and Primary Care Centre. Since November 2023, there have been approximately 500-600 patient visits to the department each week. Since opening, it has treated over 31,000 patients referred from Surrey Memorial Hospital emergency department and Urgent and Primary Care Centres.
• Surrey Memorial Hospital hired 10 patient ambassadors to comfort patients and help them find their way around the hospital and access onsite wheelchairs.

11. Increase the number of personal support workers and clinical social workers to better support patients and reduce pressure on existing health care workers.

• Social worker and care aide positions are being added over the next two years as part of the net new positions under action number two.

12. Renovate the pediatric emergency waiting areas.

• An expanded overflow waiting area for Surrey Memorial Hospital’s pediatric emergency has been in place since December 2023.

13. Increase access to transitional beds for vulnerable patient populations by purchasing new care spaces.

• A new transitional housing space opened on December 20, 2023, for patients needing short-term accommodation after discharge from Surrey Memorial Hospital. This facility provides onsite community support, including nursing, allied health and security. Permanent management and staff are in place.

14. Enhance Fraser Health’s successful in-house learning institute to close critical gaps in allied staff and nursing.

• Increase Nurse Practitioner Residency Program seats by 50 per cent:
  
  • As of October 2023, 10 nurse practitioners have completed the Nurse Practitioner Residency Program, and 10 are currently enrolled.
• Expand in-house allied and nursing programs by 50 seats:
  
  • Enrolled more than 50 additional nursing seats to date; allied health initiatives (social work, physiotherapy, mental health and substance use) are in progress.
• Expand Health Career Access Program in acute (emergency department cohort two) (August 2023):
  
  • Expanded to 66 program seats from 50.
  • Out of 66 positions, 64 have been hired.

15. Use nearby community health care services to relieve patient demand at the emergency department, including additional resources to expand hours of the Urgent Care Response Centre and Primary Care Centres.

• As of July 2023, hours have been extended at the Surrey-Whalley Urgent and Primary Care Centre to increase patient access to services.
• Working to expand Surrey-Newton Urgent and Primary Care Centre in 2024 to 12-hours-per-day, seven-days-per-week.
• As of November 13, 2023, the Abbotsford Urgent and Primary Care Centre extended its opening hours by three-hours-per-day on Mondays and Wednesdays. Beginning mid-January 2024, these extended hours expanded again to five-days-per-week.

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.

• Increased support for frail seniors through early intervention such as social prescribing and community connectors as of December 2023.

17. Increase the number of internal medicine positions to support admitted patients and build out an Internal Medicine Clinical Teaching Unit to support recruitment.

• Recruitment of internal medicine positions:
  
  • Since January 2023, a total of nine internists have been hired at Surrey Memorial Hospital.
  • There are 15 internal medicine positions available at Surrey Memorial Hospital, with an additional 21 positions available throughout the region.
  • Two nurse practitioners hired and started at Surrey Memorial Hospital to support internal medicine bed expansion, as of September 5, 2023.
• Building out the Internal Medicine Clinical Teaching Unit:
  
  • The University of British Columbia has confirmed the allocation of five internal medicine residents to Fraser Health. Candidate selection is complete; residency to begin July 2024.
  • The medical director position posting has closed, and the candidate selection process is in progress.

18. Increase capacity in outpatient and community services to discharge patients safely 24-hours-per-day, seven-days-per-week.

• Increased long-term care beds in select communities by adding 27 beds as of November 2023.
• As of March 22, 2024, the new medical services model was implemented to increase physician coverage in palliative care to seven-days-per-week.
  
  • Since its implementation, there have been 52 weekend hospice admissions.
• Planning is underway to develop a new seven-days-per-week medical services model for assisted living facilities. The model includes a dedicated onsite physician who acts as most responsible physician (MRP) for residents in assisted living who do not have a primary care provider, making proactive visits and liaising with onsite care staff.
  
  • Twenty-one out of 30 assisted living communities have recruited physicians and 230 assisted living residents have signed on since the program started.
• Increased enrolment of individuals with chronic obstructive pulmonary disease (COPD) into remote monitoring program upon discharge. The goal is to work with different clinical areas in the earlier identification of COPD patients, connecting them to community respiratory services for remote monitoring.
  
  • Four new community respiratory therapists (RTs) have started at Surrey Memorial Hospital as of December 2023.
  • From December 2023, :
    
    • Three-hundred-two net new patients had been referred to community respiratory services.
    • One-hundred-twenty-three net new patients had been referred to the Lung Health Clinic.

19. Ensure Family Birthing Unit at Surrey Memorial Hospital continues to serve as the highest tier of services for maternity and women’s health care.

• Twelve high-priority initiatives, including the expansion of the Surrey Memorial Hospital Neonatal Intensive Care Unit (NICU), have been approved to meet Tier 6 Neonatal service.

20. Build out capacity of the Surrey Memorial Hospital Family Birthing Unit through several specific actions.

• Implemented a midwifery-led Early Patient Discharge Program on October 12, 2023.
• Working to increase Midwifery Team support for Indigenous people and special populations (women escaping violence) through Maxxine Wright Centre.
• Short-term solution for centralized prenatal registration system implemented September 11, 2023.
• Expand tertiary Neonatal Intensive Care Unit bed capacity by four beds (an increase in funded beds from 32 to 36). The additional beds will help support the added double occupancy maternity capacity and improve access at the site Completion for this is November 2025.

21. Expand critical health care services such as outpatient, home health and home support services, clinical social work, physiotherapy, rehabilitation and respiratory therapy.

• Plans are underway to augment hours of operation in the community outpatient clinics at the Jim Pattison Outpatient Care and Surgery Centre.
  
  • In May 2024, operating hours at the Pain Clinic increased by 22.5-hours-per-week. Two new self-management cohorts started in April 2024 with a net new physiotherapist and occupational therapist in place. Recruitment of a psychologist is underway.
  • The Cystoscopy (a type of examination of the bladder and urethra) and Colposcopy services (a type of examination that looks at patients’ cervix) expanded by one-slate-per-week (eight hours) each, adding approximately 40-50 procedures-per-week.
  • As of May 1, 2024, hours at the Orthopedic Cast/Plastics Clinic increased by 24-hours-per-week, enabling an additional 120 patients to be seen per-week.
  • Hours in Medical Day Care and Outpatient Parenteral Antimicrobial Therapy are being expanded by 23.5-hours-per-week. Recruitment is underway.
  • Plans are in place to add 40 hours of electroencephalogram (EEG) appointment times-per-week to Neurology/Neuro Diagnostics. With this addition, the focus is on pediatric outpatients to reduce wait times by approximately 25 per cent. Net new nursing positions are in place to support rapid access and stroke services, and the target implementation is by September.2024?
  • Work is underway to expand endoscopy services by 16-hours-per-week. New rotations are in development.
  • Planning is underway to expand the Internal Medicine Clinic. Phase one is expected to be complete by the end of June.
• A phased approach is being taken to enhance home health and home support services.
  
  • Home Health enhancements are underway, starting with the Wound Care Clinic. New rotations implemented in April 2024 have resulted in an additional 36 net new appointments per week.
  • Recruitment of net new staff at the Gateway office is complete, reducing the average caseload per community health nurse by 26 per cent.
  • Recruitment of new staff at the Newton office is complete, reducing the average caseload per community health nurse by 25 per cent.
  • Recruitment of net new rehabilitation assistants is in progress to provide an additional 40 to 50 home-visits-per-week.
  • Home support: the new schedule developed for home support services is complete, adding about 75,000 hours of home support for Surrey clients.
• The virtual rehabilitation model of care development started in August 2023 with the goal to expand services. It will be part of the overall outpatient rehabilitation services expansion and redesign. Plans are in place, and the service model has been developed. Work is underway to identify a virtual platform and develop an implementation plan.

22. Expand the Urgent Care Response Centre and Gateway Mental Health services to 12-hours-per-day, seven-days-per-week.

• Urgent Care Response Centre:
  
  • Currently operating 12-hours-per-day, seven-days-per-week. Hours of operation increased by an additional 30-minutes-per-day, five-days-per-week (Monday to Friday), as of May 10, 2024.
  • Recruitment of net new positions is in progress.
• Gateway Mental Health:
  
  • The goal is to extend hours from eight-hours-per-day, five-days-per-week to 12-hours-per-day, seven-days-per-week.
  • Two peer-support workers contracted to support clients at Gateway Mental Health as of March 31, 2024.
  • Recruitment for allied health and nursing staff is in progress.

23. Build out innovative and digital services such as Hospital at Home, Digital Front Door and Virtual Specialty consultation services.

• Establish a virtual hospital to support the expansion of the virtual psychiatric unit, including plans to launch a second virtual medical unit.
  
  • A regional governance structure has been created and we are in the process of establishing a foundational virtual hospital service. Following this, we will proceed with the design and construction of the virtual hospital. Currently, we are in the planning phase for the technology needed to support virtual hospital care delivery.
• Expand virtual mental health services to increase access.
  
  • A plan has been developed to establish a Regional Virtual Psychiatry Consultation Clinic by November 2024. The implementation will be carried out in phases, with the development of the model of care underway.
  • In addition, a plan has been developed to establish a Regional Virtual Group Therapy service by September 2024. An environmental scan and data analysis have been completed to project service demand, and the staffing model has been finalized. A training plan and clinical workflow are being developed.
• Establish a regional surgical patient engagement platform to reduce in-hospital demand on pre-surgical supports. Target timeline for launch is late June 2024. Planning for regional expansion is underway.

24. 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.

• As of May 2024, one additional operating room slate-per-week has been allocated to gynecology cases. The Gynecology Out of Operating Room Procedural Sedation Program has expanded by one-slate-per-week, allowing for an additional eight to ten-procedures-per-week.
• Analysis for Fraser South communities is complete as of November 2023. Analysis helps show the demand and supply of operating rooms and lets us maximize the use of the operating rooms.

25. Expand renal services within 18 months.

• Project and operations plans are in development.
• Business plan is complete.
• Schematic design drawing, which includes things like a complete description of building systems (structural, mechanical, HVAC, plumbing and electrical), interior and exterior finishes and the building site, is complete. The external appearance of the building is being finalized.

26. Build two interventional radiology suites at Surrey Memorial Hospital that will enable stroke and cardiac specialty expansion.

• A location has been identified. The second interventional radiology suite will be located with the two new cardiac catheterization labs. Operational planning is in progress, staff planning has been developed and equipment planning is complete.

27. Adding two cardiac catheterization suites at Surrey Memorial Hospital.

• Refer to action number 26.
• Governance structure is in place and project plans are being developed.
• Business plan is complete.
• Clinical processes and workflows for regional catheterization lab triage are developed.

28. Add new MRI and CT and replacing existing CT with cardiac capabilities to increase access to diagnostic services.

• Work is progressing on the new MRI at Surrey Memorial Hospital. Work to order two new MRI units is underway and a mobile MRI machine is being prepared to ensure continued access to diagnostic imaging during construction.
• Preparation for the purchase of a new CT is underway.

29. Complete renovations of existing operating rooms to expand capacity.

• The feasibility study will be completed for four operating rooms requiring modernization.
• The estimated completion for all operating room modernization is Winter 2026.

30. Significantly increase resident physician allocation at Fraser Health and including Surrey Memorial Hospital as their home residency sites.

• Current resident allocation from the University of British Columbia:
  
  • Five internal medicine residents starting July 2024.
  • Three additional emergency medicine residents (five in total) allocated to Surrey Memorial Hospital as of July 2024.
  • Two pediatric residents starting July 2024.
• Fraser Health is prioritizing emergency medicine (College of Physicians and Surgeons of BC), addictions medicine, cardiology and palliative medicine as part of Fraser Health's Medical Education Expansion Plan.