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PAs and NPs in liver transplantation: Perceptions, implementation, and effect
Sarah Nargiso1, Mary Lo, Leyda Ramos
1Sarah Nargiso practices in abdominal organ transplant surgical medicine at Keck Hospital of the University of Southern California (USC) in Los Angeles. Mary Lo is a statistician in the Department of Population and Public Health Sciences at USC's Keck School of Medicine in Los Angeles. Leyda Ramos practices in abdominal organ transplant surgical medicine at Keck Hospital. Amarilis Bolaños is a research coordinator at USC's Keck School of Medicine. Evelyn Lee is an undergraduate research assistant at USC. Linda Sher is a professor of clinical surgery; practices in hepatobiliary and pancreatic surgery and transplant surgery; and is chief of the division of clinical research at USC's Keck School of Medicine. The authors have disclosed no other potential conflicts of interest, financial or otherwise.
Objectives:
This study assessed the use and perceptions of physician associates/assistants (PAs) and NPs at liver transplant centers and sought to determine their financial effect.
Methods:
Leaders of liver transplant programs performing 25 or more transplants in 2020 were contacted to complete an 11-question survey about the role and effect of PAs and NPs in liver transplant. A single-center retrospective analysis compared length of stay (LOS) and readmission rates for primary liver transplants and simultaneous liver-kidney transplants before and after a dedicated PA team was established. Chi-square and t -test analyses were performed.
Results:
The survey achieved a 77% response rate, and 98% of institutions reported using PAs and NPs. The single-center study found the mean LOS post-transplant was significantly shorter in the post-PA cohort ( P = .0005). No significant difference was found in 30-day readmission rates.
Conclusions:
PAs and NPs are used broadly across the post-liver transplant care continuum. Using LOS as a surrogate financial marker suggests that a dedicated PA and NP team may contribute to cost savings.
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