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 and 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 over-capacity 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 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 Sept. 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 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 the 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 full-time equivalent (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 Oct. 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.
- Twenty-one 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 SMH 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.
- There were 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 2024-25 is underway.
13. Enhance Fraser Health’s successful in-house learning institute to close critical gaps in allied staff and nursing.
- Work is underway to increase nurse practitioner residency program seats by 50% by December 2023. To date, residency placements completed as follows:
- 1 for UPCC NP (locum – Metrotown)
- 2 for Surrey UPCC
- 2 for Surrey Memorial Hospital Internal Medicine
- 1 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 enrolment 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 (UPCC) 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.
- A staffing model is being developed to enhance supports within the 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.
- The pan is 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 a day, 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 day care, breast health, neurology, chronic pain, and internal medicine clinics.
18. Ensure Family Birthing Unit at SMH 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 6 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 is 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 has been identified for a stand-alone renal in centre service on the Surrey Memorial Hospital campus.
- Ministry approved moving forward with design and planning work. Prime consultant Request for Proposal (RFP) issued Aug. 1 and construction management request (RFP) for proposal issued Aug. 8.
21. Build a second interventional radiology suite at Surrey Memorial Hospital, which will enable stroke and cardiac specialty expansion.
- A site has been identified at which the newly announced second interventional radiology suite can be situated with the two newly announced cardiac catheterization labs. The RFP process is underway.
22. Adding two cardiac catheterization labs at Surrey Memorial Hospital.
- Active planning underway for two catheterization 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 are being considered as an initial step in MRI planning.
- Planning is underway with clinical teams on location and space requirements for replacement CT.
- The business plan for replacement CT is nearing completion.
24. Complete renovations of existing operating rooms (OR) to expand capacity.
- Four ORs are confirmed as needing 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 is underway to enhance home health and home support services to determine FTE requirements. Target completion is October/November 2023.
- Virtual rehab model of care development commenced in August 2023 with the goal to expand services.
- Planning to expand the community wound care clinic is underway.
26. Expand the Urgent Care Response Centre and Gateway Mental Health services to 12 hours a day, seven days a week.
- Targeting expansion of Urgent Care Response Centre is January 2024.
- Planning is underway to expand Gateway Mental Health.
27. Renovate the pediatric emergency waiting areas.
- Physician and leadership teams are in the 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 have been identified for transitional housing capacity.
- Facilities team is reviewing lease options with BC Housing and landlord.
- Clinical teams are working on patient population, model of care, and resource requirements.
29. Significantly increase resident physician allocation at Fraser Health, including Surrey Memorial Hospital as their home residency sites.
- UBC announced five internal medicine residents starting in 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 are 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.
- Wait list 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 modelling for Surrey Memorial Hospital was completed Aug. 12, 2023, to inform clinical services planning.
- OR modelling update is underway for Fraser South with a target completion date of early October.