Flow Clinical Charge Nurse (CCN) Adult Emergency Department, Auckland City Hospital
This role commenced in January 2010 in the Adult Emergency Department at Auckland City Hospital. Every 6-8 weeks a
CCN from either department (AED / APU) is rostered to undertake this role. This rotation is to provide an opportunity for the
CCN to see how the other department (ED or APU) worked as well as improving their understanding of how the whole
hospital operates. This appears to have improved the relationships across Emergency Department and APU, as well as with the
inpatient ward staff.
Patient Flow Accountabilities:
 Responsible for all acute patients in AED / APU who have been admitted under an in-patient specialty.
 Single point of contact for AED / APU patient flow issues.
 Acts as a liaison person for other departments and works closely with the Daily Operations Centre to ensure
appropriate and flexible patient flow to inpatient areas.
 Collaborates with L2 & Daily Operations Centre to prioritise patient placement.
 Ensures that AED / APU inpatient specialty patients are designated to the most appropriate in-patient ward bed in a
safe and efficient manner.
 Reports on the patient flow status to senior staff.
 Provide support, encouragement and teaching as required in the areas of:
- Nurse sign-on pathways,
- Nurse initiated standing orders
- Documentation: transfer of care
- Fast tracking Radiology
- Ordering appropriate in-patient specialty beds
- Admission / Discharge and Transfer white board processes
 Identifies and investigates any delays in the L2 processes including triage referrals, one way referrals to inpatient
teams, radiology, research studies, cleaning requirements, isolation requirements and discharge processes.
 Assists in expediting patient transfers from Monitoring Room to Acute Care Area in APU by supporting the senior
staff nurse to co-ordinate the process.
 Identifies and investigates appropriateness of referrals from rest homes / private hospitals.
 Evaluate the appropriateness of patient watches in AED and APU.
Evaluation of the Role:
A formal evaluation of the role has not as yet been undertaken however we can show that in terms of results to date patients
who are transferred from ED to APU during the weekday (8am-5pm) performance is better than other times of the day / week;
this is not solely due to the introduction of the role but this has definitely assisted in the process.
The following graph also demonstrates the trend in performance by month to APU is improving in the later months.
The introduction of the Flow CCN role has relieved the departmental CCN of the constant burden of patient placement and
allows the floor CCN to concentrate on their core function of providing clinical supervision to the nursing staff and clinical
coordination of the acute nursing workload.