Fraser Health is BC's largest and fastest growing health authority, serving more than 1.6 million people, or one out of every three British Columbians. Fraser Health's population has doubled since 1986, and by 2020, our population is expected to grow by 20 per cent, or another 327,000 people. Our population is also rapidly aging. Fraser Health is home to 32 per cent of BC citizens over the age of 65, and by 2020, the over 65 age group in our region is expected to increase by about 49 per cent, or another 104,500 people. Where there are two seniors standing now, there will be three in just eight years.
These demographic changes have put pressure on our ability to meet demand for services. Visits to Fraser Health emergency department have increased by more than 25 per cent since 2004 and on most days, every single one of Fraser Health's more than 2,200 hospital beds are full. Numbers vary daily and by season, but at times we can be caring for several hundred patients who needed to be admitted to hospital either in our emergency departments or in other locations outside of our normal patient care areas, such as hallways and hospital lounges.
Fraser Health has responded to increased demand for services by building capacity, working to be more efficient in everything that we do and strengthening primary care and community care so people stay healthier and out of hospital longer. Even with these strategies in place, hospital congestion continues to be a daily challenge.
In February 2012, Fraser Health and the Ministry of Health engaged a panel of independent experts to identify additional solutions to ease congestion and improve patient access and flow at Fraser Health hospitals. The panel focused its efforts on Surrey Memorial hospital and Royal Columbian hospital; however, its findings are relevant across Fraser Health's network of care.
The panel interviewed more than 500 clinicians and leaders and found that Fraser Health's current access and flow strategies form a strong base on which to build. The panel's findings helped Fraser Health to develop a Congestion Action Plan to expand and strengthen work already underway. The panel report is posted below.
To monitor the health authority's performance at reducing congestion, the Ministry of Health identified five targets related to hospital congestion, wait times and patient care to be achieved within 150 days:
- Fewer patients cared for in locations not designed for clinical care
- A decrease in the rate of C. difficile infections in all hospitals
- A decrease in the average length of stay in Fraser Health hospitals
- 90 per cent of hip fracture repairs in Fraser Health performed within 48 hours
- An increase in the percentage of admitted emergency room patients being transferred to hospital units within 10 hours of decision to admit
Using the Congestion Action Plan as the framework and focusing on these targets, Fraser Health is taking the following actions.
Actions to reduce congestion and improve patient care
- Identify up to 50 additional hospital beds by using spaces in hospitals that can be converted to patient care beds through minor renovations or the reorganization of current services
End result: Fewer patients receiving care in hallways or lounges
Target(s) supported: Fewer patients receiving care in hallways or lounges
- Expansion of outpatient services, including outpatient rehab, community management of COPD patients and Assertive Community Treatment for mental health and substance use patients
End result: Patients who can safely go home and continue to recover or manage chronic illnesses using outpatient services will have access to these services freeing up hospital beds for patients who need them
Target(s) supported: Decrease in the average length of stay; fewer patients cared for in hallways; increase in the percentage of emergency room patients admitted within 10 hours
- Increase home care services in support of Home Is Best philosophy, which states that home is the best place to continue to recover, manage chronic conditions and live out final days
End result: Patients who no longer need to be in hospital can be discharged home more quickly
Target(s) supported: Decrease in the average length of stay; fewer patients cared for in hallways; increase in the percentage of emergency room patients admitted within 10 hours
- Improve and formalize discharge processes on all medical units, including consistent application of First Appropriate Bed policy
End result: Patients are discharged as soon as they no longer need hospital care freeing up hospital beds for new patients who need them
Target(s) supported: Fewer patients cared for in hallways; increase in the percentage of emergency room patients admitted within 10 hours; decrease in the average length of stay
- Case review of patients with complex care needs who have been in hospital more than 30 days
End result: Patients who have been in hospital waiting for community supports and other services so they can be discharged home or to community care settings, such as admission to special care facilities, will receive coordinated care and be fast-tracked to where they need to go
Target(s) supported: Fewer patients cared for in hallways; increase in the percentage of emergency room patients admitted within 10 hours; decrease in the average length
- Strengthen infection prevention and control practices, including adding 16 frontline infection control practitioner and consultant positions, enhanced hospital cleaning program, increased focus on handwashing and proper use of antibiotics, and more rapid testing for C. difficile infections
End result: Reduced incidence of C. difficile and other infections
Target(s) supported: A decrease in the rate of C. difficile; decrease in the average length of stay
- Implementation of standardized care plans and pathways for repairing hip fractures
End result: Reduced wait times for hip repairs
Target(s) supported: 90 per cent of hip fracture repairs in Fraser Health done within 48 hours; decrease in the average length of stay
Additional Background Information
- Fraser Health is responding to increased demand for services by:
- Building/adding acute care/hospital and community capacity
- Working in innovative ways to be more efficient in everything that we do
- Strengthening primary care and community care so people stay healthier and out of hospital so hospital beds are there for people when they need them
- Fraser Health's population of 1.6 million has doubled since 1986. By 2020, our population is expected to grow by 20.4 per cent or another 327,000 people.
- Fraser Health is home to 32 per cent of BC citizens over the age of 65.
- By 2020, the over 65 age group in our region is expected to increase by about 49 per cent or 104,500 people; where there are two seniors standing now, there will be three in just eight years.
- Even though people over 65 make up just 14 per cent of BC's population, they represent:
- 33 % of physician services
- 48 % of acute care services
- 49 % of PharmaCare expenditure,
- 74 % of home and community care services
- 93 % of residential care services
- Visits to Fraser Health emergency department have increased by more than 25 per cent since 2004. More than 570,000 people, the most in BC, will visit our emergency departments this year.
- This fiscal year (2011-12), we have seen a 7.3per cent increase in ER visits, a 3.9per cent increase in the number of inpatients and a 5 per cent increase in the number of days inpatients stay in hospital.
- Demographics are putting growing pressure on our limited capacity and, at times, impeding access to appropriate care. At any given time hundreds of patients are waiting to move from one place to the next.
- The imbalance between the number of acute care inpatients beds available and patients waiting for a bed results in 'congestion' and inpatients being cared for in less-than-ideal locations.
- Fraser Health operates more than 2,200 inpatient beds (not counting Emergency Departments) across our 12 hospitals.
- The $512-million Surrey Memorial hospital Redevelopment and Expansion project, scheduled for completion in 2014, will add another 150 acute care beds.
- Numbers vary daily and by season, but at times we can be caring for several hundred patients who needed to be admitted to hospital either in our emergency departments or in other locations outside of our normal patient care areas, such as hallways and hospital lounges.
This year will see a number of projects to improve access to hospitals, including:
- Start of construction to expand maternity care at Langley Memorial hospital
- Expansion of the Family Birthing Unit at Surrey Memorial hospital
- Opening of a new Multipurpose Interventional Suite at Royal Columbian hospital, the region's tertiary centre for cardiac and neurosciences
- Continued high-level site planning for Delta, Eagle Ridge, Burnaby and Peace Arch hospitals
To improve care and sustainability, redesign of health services to provide more outpatient and community care will continue. This year will see:
- Marking of the one-year anniversary of the opening of the $237 million regional facility, the Jim Pattison Outpatient Care & Surgery Centre
- Innovative clinical approaches to help people manage their conditions while living independently in their own homes rather than in hospital:
- Expansion of the new BreatheWell at Home program to support people with lung disease (Chronic Obstructive Pulmonary Disease or COPD)
- Expansion of the new program to support people with chronic psychosis
- Expansion of the new REDi, Rehabilitation Early Discharge, initiative to reduce hospital stays and improve outpatient rehabilitation care for amputees and stroke-recovery patients
- Opening of new Mental Health & Substance Use services
- First in FH: $2 Assertive Community Team (ACT) to improve access for those with serious & persistent mental illness
- Opening this fall: $23.9 million Timber Creek regional facility for specialized & intensive mental health care
- Opening this fall: Quibble Creek Health and Phoenix Transition Housing Centre
- Now open: Timber Grove supportive housing facility operated by Coast Mental Health
- Opening of new or expanded community-care services for seniors
- Start of construction this spring on a new campus of care alongside a community health centre in Mission
- Opening this summer of an expansion to double the size of the Czorny Alzheimer Centre
- Easier referral from hospital to home support services as part of Home Is Best philosophy of care
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