Background The ambulance service was experiencing challenges retaining experienced paramedics, the hospice with recruiting experienced nurses. An opportunity for collaborative working, sharing skills and knowledge (Nolan, Nolan, Sinha. CMAJ. 2018; 190(21):E636-E637) was identified by both organisations.

Aims Improve recruitment and retention of experienced paramedics and nurses.

• Share the skill set between the hospice and ambulance service.

• Improving confidence and knowledge.

• Preventing skill fade.

• Increase the responsiveness of specialist palliative care in the community.

• Improve individualised care.

• Reducing avoidable hospital admissions (Knowles, Long, Turner. Reducing avoidable ambulance conveyance in England: Interventions and associated evidence. 2020).

Methods Recruited four paramedics working alternate weeks between the hospice community team and ambulance service. Week one of a six-week induction – classroom based, focusing on core elements of palliative care:

• Holistic assessment of patient and carers.

• Symptom control.

• Care in the last days of life.

• Communication skills.

Each paramedic was allocated a non-medical prescriber mentor and shadowed the team during induction applying theory to practice. The paramedics:

• Triage phone calls.

• Attend crisis home visits, using their clinical assessment skills.

• Support with decisions regarding potential hospital admissions.

• Identify reversable causes in deteriorating patients.

When on ambulance service shifts the paramedics, identify patients who require palliative/end of life support and cascade specialist palliative care knowledge to their colleagues.

Outcome In the first quarter 82 patients were seen. A random audit of 40 cases showed, 37/40 patients remained out of hospital for 72 hours post paramedic intervention, 22 continued to remain out of hospital three months prior to death. One patient had an appropriate acute admission, one patient was admitted to a community hospital, and one to the hospice IPU. The paramedics are now fully embedded, we anticipate the data to show even greater outcomes.

Feedback received from colleagues in the hospice is 100% positive. Demonstrating that the MDT has benefited from the additional role, improving collaborative working and sharing expertise.