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 hospitalists have signed a new contract, as have all Fraser Health acute care sites except for Abbotsford Regional Hospital. This finalized long-term contract ensures stability and consistency in hospitalist services across the region.
• Access to inpatient medicine services at Surrey Memorial Hospital improved significantly in 2023 with the expansion of the Internal Medicine Department from 30 to 90 beds. This additional capacity ensures patients receive quicker access to this level of care.

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 678 new positions have been posted for Surrey Memorial Hospital and Surrey communities, including pediatric emergency, emergency clinical staff, support services and more.
  • As of October 2024, 468 of 678 new positions have been filled, including 24 out of 27 pediatric emergency positions.
    
    • In September 2023, 2 nurse practitioners specializing in internal medicine were recruited.
    • Refer to action numbers 6, 7 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.

• As of November 6, 2023, the regional Mental Health and Substance Use Access and Flow Team now provides care 12-hours-a-day, seven-days-a-week. This expansion ensures people have quicker access to mental health and substance use support.
• Regional efforts to bolster support for substance use concerns in emergency departments are ongoing and include hiring substance use patient assessment nurses and an additional psychiatric liaison nurse across multiple sites. Surrey Memorial Hospital has successfully hired all its addiction assessment nurses, with four new nurses onboarded in March 2024.

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

• Fraser Health has launched several regional initiatives to improve pediatric and mental health support in acute care. Since August 2023, Surrey Memorial Hospital has posted 27 new positions to expand pediatric emergency nursing staffing, ensuring better care for young patients.
• Additionally, Fraser Health has established Child and Youth Mental Health Emergency Response Teams to provide timely assessments and collaborative care planning with families, beginning with the launch of a team at Surrey Memorial Hospital and in Fraser South communities on November 6, 2023. In March 2024, Fraser Health launched a team to support Fraser East communities, including Abbotsford Regional Hospital. In February 2024, Fraser Health launched a team at Royal Columbian Hospital to support Fraser North communities and expanded support to Burnaby and Ridge Meadows Hospitals in April 2024.

5. 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:
  
  • 13 general internal medicine physicians (internists) have been hired at Surrey Memorial Hospital since January 2023.
  • 2 nurse practitioners hired and started at Surrey Memorial Hospital to support internal medicine bed expansion, as of September 5, 2023.
• Surrey Memorial Internal Medicine Clinical Teaching Unit:
  
  • The University of British Columbia has confirmed the allocation of 5 internal medicine residents to Fraser Health. All 5 residents started in August 2024.
  • Surrey Memorial Hospital Clinical Teaching Unit Medical Director was hired.

6. 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.

• All 15 relational security officer positions at Surrey Memorial Hospital have been filled to prevent and respond to workplace violence.
• All 13 actions from the July 2023 Violence Risk Assessment are complete, and nearly 80 per cent of emergency department staff have completed annual violence prevention training as of November 2024. These efforts reflect Fraser Health’s commitment to improving health care access, quality and safety across the region.

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

• As of November 2024, at Surrey Memorial Hospital recruitment is ongoing and to date, we have added:
  • 11 new resident clinical associates have been hired to date to support hospitalist and internal medicine groups.
  • 5 professional clinical associate positions have been posted for the internal medicine group.
  • 4 associate physicians.
  • 5 nurse practitioners to support internal medicine, thoracic and general surgery.
  • 13 nurse practitioners have been hired for the Surrey community, including within Urgent and Primary Care Centres, Mental Health and Substance Use and the Jim Pattison Outpatient Care and Surgery Centre.
• Regionally we have hired:
  • 44 resident clinical associates
  • 11 associate physicians
  • Over 50 nurses

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

• Recruitment of staff and medical at Surrey Memorial Hospital recruitment is ongoing. As of November 2024, we have hired:
  
  • 179 internationally educated nurses (since January 2023).
  • 128 physicians (since January 2023).
  • 211 new nursing grads (since April 2023).
  • 412 employed student nurses (since April 2023).
• Regionally, we have hired:
  
  • 688 internationally educated nurses (since January 2023)
  • 510 physicians (since January 2023).
  • 791 new nursing grads (since April 2023).
  • 1,366 employed student nurses (since April 2023).

9. 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.

• As part of our commitment to improving health services in Surrey, Fraser Health has made significant progress toward planning and development, including refreshing the Clinical Service Plan (CSP) for Surrey to address population growth and specialty needs, which will determine service locations at Surrey Memorial Hospital and across the region. The final CSP report and gap analysis were completed on October 10, 2023.
• On March 11, 2024, the Ministry of Health announced that a new acute care tower at Surrey Memorial Hospital has been approved to proceed to the business case stage. Following this announcement, Fraser Health established a development team for project business plan, with a kickoff meeting held on June 17, 2024. Clinical service planning with stakeholder groups is ongoing to ensure this significant investment will meet the needs of the community.

10. 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.

11. 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 44,500 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.

12. 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.

13. 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.

14. 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.

15. 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.

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

• In June 2023, Fraser Health and the Ministry of Health committed to increasing Nurse Practitioner Residency Program seats by 50 per cent. This goal was achieved by October 2023, with 10 nurse practitioners completing the program and 10 more currently enrolled. The program will continue to recruit.
• Fraser Health and the Ministry of Health also committed to expanding in-house allied and nursing programs by 50 seats. This goal has been achieved, with over 50 additional nursing seats enrolled to date. Allied health initiatives, including social work, physiotherapy, and mental health and substance use programs, are in progress.
• Additionally, Fraser Health and the Ministry of Health committed to expanding the Health Career Access Program in acute care for the emergency department cohort. By August 2023, the program expanded from 50 to 66 seats. As of November 2024, 64 of these positions have been filled.

17. 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.

• Since August 2023, one additional operating room slate per-week has been allocated to gynecology cases.
• As of May 2024, the Gynecology Out of Operating Room Procedural Sedation Program has expanded by one-slate-per-week, allowing for an additional eight to 10 procedures per-week.
• As of July 2024, a new schedule has been implemented to optimize operating room utilization across Fraser South.

18. 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 were extended at the Surrey-Whalley Urgent and Primary Care Centre to increase patient access to services, with the goal of increasing to 12 hours-per-day, every day of the week by Winter 2024.
• Fraser Health is working to expand Surrey-Newton Urgent and Primary Care Centre in 2024 to 12 hours-per-day, seven-days-per-week.
• As of Nov. 13, 2023, the Abbotsford Urgent and Primary Care Centre extended its Urgent Care hours by three-hours-per-day on Mondays and Wednesdays. Beginning mid-January 2024, these extended hours expanded again to five-days-per-week, and the opening hours of the Abbotsford Urgent and Primary Care Centre aligned with the opening hours of the other Fraser Health Urgent and Primary Care Centres.

19. 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.
• People living in Surrey can also call HealthLink BC at 811 to speak with a health service navigator to access health services, and connect with an 811 nurse, dietitian, exercise professional, pharmacist, or, if applicable, a physician.
• They may also visit a local community pharmacy for assistance with prescription renewals or assistance with 21 minor ailments.

20. 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.
• 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.
  
  • As of November 2024, 23 assisted living communities have recruited physicians to support residents.
• 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.
  
  • As of November 2024, there have been 441 patient referrals to Community Respiratory Services since the program began in December 2023.

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

• 12 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.

22. 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.
• Expand capacity by operating some Family Birthing Unit rooms as double occupancy rooms, increasing capacity from six to 10. Renovations are complete and all rooms are operational.

23. Expand renal services within 18 months.

• In August 2024, preliminary construction work started. As of October 2024, construction of the renal building’s foundation is underway.
• Business plan is complete and approved by the Ministry as of June 18, 2024.

24. Build two interventional radiology suites at Surrey Memorial Hospital, which 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.

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

• Early construction work started in October 2024.

26. Add new MRI and CT and replace existing CT with cardiac capabilities to increase access to diagnostic services.

• Progress is ongoing at Surrey Memorial Hospital, with plans to order two new MRI units (one new, one replacement).
• In October 2024, construction started on a temporary MRI unit to maintain services during the modernization of the existing MRI unit.
• Preparation for the purchase and construction of a new CT is underway.

27. 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.
  
  • As of 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 of the 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.
  • As of May 2024, minor treatments and procedures service has added an average of 13 additional procedures per-week.
  • Hours in Medical Day Care and Outpatient Parenteral Antimicrobial Therapy are being expanded by 23.5-hours-per-week. Recruitment is complete; extended clinic hours have been implemented.
  • 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.
  • 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 completed by Fall 2024.
• 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 24 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 complete, providing 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.
  • Expansion of the Day Program for Older Adults operated by the Progressive Intercultural Society (PICS) from 138 spaces per-week to 300 spaces per-week.
• 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.
  • By September 2024, Fraser Health completed 100 per cent of virtual screening appointments for patients awaiting hip or knee replacement and reduced wait times by two weeks.

28. Build out innovative and digital services.

• Establish a Surgical Patient Engagement Platform
  
  • We have reduced hospital demand by creating a surgical patient engagement platform. This initiative cut initial consultation wait times from around 100 days to just 17 days during the pilot phase. Planning for regional expansion is underway.
• Establish a virtual hospital (Hospital at Home) 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.
• Expand virtual mental health services to increase access.
  
  • Fraser Health is currently working to establish a regional virtual psychiatry consultation clinic. This project is being rolled out in phases and will continue into 2025. In October 2024, we completed the planning and developed a model of care. We also secured the necessary space and technology to deliver these services. As of November 2024, we are focusing on establishing clinical processes and creating a referral booking system.
  • Fraser Health committed to establishing a Regional Virtual Group Therapy service by December 2024. In October 2024, the first regional therapy group launched as part of a phased rollout, with an additional 17 groups starting before the end of that month.
  • Fraser Health launched a Surgical Patient Optimization pilot in July 2024 as part of our efforts to establish a regional surgical patient engagement platform to reduce in-hospital demand on pre-surgical supports.

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

• Resident allocation from the University of British Columbia:
  
  • Emergency medicine residency program – 8 additional residents across Fraser Health total (5 in July 2024, 3 in 2025), including 5 for Surrey Memorial Hospital.
  • Internal medicine residency program - 5 internal medicine residents started July 2024 and 2 additional residents in 2025.
  • Psychiatry residency program - 2 additional residents in 2025.
  • Pediatric residency program - 2 residents started July 2024 and one additional resident in 2025.
  • New addictions medicine residency program - 2 residents allocated in 2025.
  • New palliative medicine residency program – 2 residents allocated in 2025.

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

• The estimated completion for all operating room modernization is Winter 2026.