PP27 A case study of interprofessional collaborative decision-making dynamics within an NHS ambulance trust advanced paramedic practitioner led integrated care hub

<h3>Background</h3> The goal of delivering ‘<i>the right care in the right place, first time’</i> is central to the Advanced Paramedic Practitioner (APP) led Integrated Care Hub (APPICH). This hub co-locates APPs alongside an emergency department (ED) consultant and community frailty and acute response team clinicians. The APPICH utilises multi-professional expertise, access to records and direct referral capabilities to influence the care provided to patients contacting the ambulance service. The Hub can directly engage with patients, providing alternatives to ambulance attendance, or it can liaise with attending ambulance crews both proactively and reactively. In the relative absence of previous research, this study aimed to ethnographically explore the dynamics of collaborative decision-making within the multi-professional APPICH team. <h3>Methods</h3> After obtaining Health Research Authority and local governance approvals, APPICH clinicians consented to a single observation shift by a researcher with experience of qualitative methods. Observations were recorded over eight hours on the 22nd of February 2024, using a template derived from existing frameworks for competency and influencing factors relating to interprofessional teamwork. <h3>Results</h3> During the observation period, the Hub frequently influenced the delivery of care. Community teams were directly engaged to respond to patients and ambulance crews received advice both on scene and enroute, commonly suggesting management plans alternative to ED attendance. Exploring the influences of relational, processual, organisational and contextual factors, APPICH clinicians demonstrated a high standard of proficiency in our identified core competencies for interprofessional collaboration. <h3>Conclusions</h3> APPICH clinicians demonstrated shared values and an evolving understanding of their distinct roles. Throughout, they engaged in patient-centred shared decision-making, resolved conflicts professionally, and collaboratively reflected on their practice. Whilst there is potential to improve the Hub’s environment and processes, effective communications both within the Hub and with external colleagues resulted in effective intervention in care delivery across a wide variety of incidents.