Hallway medicine. Bed shortages. Code orange alerts.

Congestion has long made Surrey Memorial Hospital (SMH) notorious – so much that some patients go out of their way to get to a different hospital.

Those days may finally be coming to an end.

Construction of a massive new emergency department and critical care tower is slated to start next year.

At an expected cost of more than half-a-billion dollars, it will be the biggest health care project in B.C. history.

And it can’t come a minute too soon.

SMH has battled crowded conditions for years, but it’s become particularly severe over the past decade.

The province’s second-biggest hospital, built half a century ago to handle 44,000 patients a year when the city’s population was 75,000, now has the busiest ER in B.C., seeing 77,000 patients a year from a catchment population that now numbers 600,000.

Patients who turn up at the ER can wait many hours to get admitted to a bed. Some spend days parked on a stretcher in a hallway.

The clogged conditions have at times been so severe hospital administrators have declared a “code orange” alert – usually reserved for disasters.

Last year, an average of just 44 per cent of SMH patients admitted through the ER got a bed within 10 hours. That’s far short of the provincial target of 80 per cent.

When the new emergency department opens – slated for sometime in 2013 – it will be five times larger than the existing one and built to handle an expected 101,000 annual patient visits by 2020.

“We hope this will be able to handle growth for the foreseeable future,” says David Ingram, Fraser Health’s executive director in charge of public-private partnerships (P3s) and on the team designing the SMH expansion.

“It’s really important we do our homework at this stage to ensure we build the best facility we possibly can.”

The project is to be built as a P3, so a request for proposals from private bidders must still be conducted.

After that comes site preparation work – the existing SMH annex building must be relocated and the existing Dainard building must be demolished to make room for the five-storey critical care tower.

It was originally to be a more modest $88-million ER expansion to triple the current capacity and open by 2010.

But an extra three levels were added when the provincial government decided it would be more efficient to build one big expansion than have to keep expanding SMH piecemeal.

“It was a great opportunity to do that all through one construction package,” Ingram says.

As a result, the project will deliver an additional 151 beds, increasing SMH to a total of 650 beds.

The additional beds will include intensive care and high-dependency beds to handle patients requiring advanced critical care.

The revised scope has also led to a delay in the opening date, now slated for 2013 for the main ER and 2014 for the rest of the critical care tower.

Ingram expects a request for proposals will be issued soon, perhaps by year end, with a final partner chosen next year ahead of a construction start also expected in 2010.

The delays have been a flashpoint for NDP critics, who say repeated government promises haven’t yet turned to action and the province so far has done little more than stick Band-Aids on SMH.

Pressure for a fix has been on high boil since at least 2005, when crisis conditions prompted Victoria to fire Fraser Health’s CEO and order emergency actions to relieve congestion at Surrey Memorial.

Since then $30 million has been spent adding 73 beds and making various changes, improvements and renovations – including the creation of a separate Minor Treatment Unit – all aimed to deliver temporary relief.

Meanwhile, the plans to build the new ER have gradually taken shape. Advocates predict the long wait will prove to be worthwhile.

“The project is bigger so it will serve the community better than building a smaller building and having it ready earlier,” says Surrey Memorial Hospital Foundation president Jane Adams.

She predicts the number-one thing people will notice when the new ER and tower open is the lack of congestion.

But Adams says the project brings major new improvements beyond that.

“We’ll be the only acute hospital with a separate children’s emergency,” she says. The new child-friendly ER means kids will no longer have to wait mixed in with the scarier adult patients, such as wounded criminals, addicts or the mentally ill.

There will also be dedicated areas for mental health patients and a fast-track unit to quickly treat and release people with minor injuries.

The 25,000-square-metre tower will include a dedicated neonatal intensive care unit for intensely ill newborn and premature babies needing to be ventilated, along with a dedicated pediatric pharmacy.

The tower will include a 25-bed adult Intensive Care Unit as well as three medical/surgical units each with at least 26 beds, some of them high-dependency beds.

A new laboratory will serve all of SMH.

The foundation committed in 2007 to raise $15 million to help equip the new ER with state-of-the-art technology and services.

Adams predicts the foundation will beat its target as it winds up the fundraising campaign in the months ahead.

“The community should take pride,” she says.

A campus of care

The new tower, in concert with the nearby Surrey Outpatient Hospital, will also cement Surrey Memorial’s reputation as a teaching hospital to train new doctors and nurses.

Once finished, the tower will include a UBC Clinical Academic Campus providing classrooms, a library and other educational support for medical students.

Ultimately, it will create what Fraser Health calls a “world-class health campus of care.”

Twin towers?

Fraser Health’s long-range vision for the expansion of Surrey Memorial Hospital doesn’t end with the new ER and critical care tower.

Planners envision building a second tower at the site to add even more capacity.

Building the second tower will have to wait for the province’s finances to improve.

Price tag:

• Estimated cost of new Emergency Department and Critical Care Tower: $500 to $600 million, depending on the bids that come in from private partners.

Number of beds:

• The 151 additional beds being built through the project includes 25 intensive care beds and additional high-dependency beds in three medical/surgical units.

Parking spots:

• The plans call for 350 underground parking stalls below the new tower and 150 stalls at the site of the current ADT Diabetes Clinic, which will be relocated. There will be a helipad on the roof.

ER visits:

• 2006 – 68,000

• 2007 – 71,00

• 2008 – 77,000

• 2020 – 101,000 (projected)

The timeline:

• Summer 2009 – Request for Qualifications issued.

• Late 2009 – Request for Proposals.

• 2010 – Contract award and construction start.

• 2013 – New Emergency Department opens.

• 2014 – Rest of critical care tower opens.

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