title: Role Development of Nurse Practitioners and Physician Assistants in Liver Transplantation.
abstract: BACKGROUND
  Nurse practitioners (NPs) and physician assistants (PAs) are increasingly utilized in health care. However, their roles in liver transplantation (LT) have not been investigated.
  
  
  METHODS
  In this study, we reviewed the employment and development of NPs and PAs and their impact on our deceased-donor LT (DDLT) program.
  
  
  RESULTS
  We found a safe and efficient way to utilize NPs and PAs in a DDLT program. Since the beginning of our program, Model of End-Stage Liver Disease (MELD) scores have increased significantly, suggesting patients are sicker at the time of transplant, and wait times of patients have become longer. With the incorporation of NPs and PAs, we found that length of stay (LOS) was not affected. The overall median warm ischemic time did not increase. Outcomes of LT for both patient and graft survival actually improved and remain at or above the expected values. These results collectively support the usefulness and validity of NPs and PAs in a DDLT program.
  
  
  CONCLUSIONS
  We have determined that surgical and medical NPs and PAs are essential for optimal patient outcomes. They facilitate a better learning experience for residents and fellows on their transplant rotations. Further investigations to assess the roles of these providers and their impact on the education of residents and fellows in transplantation are warranted. Further transplant hepatology education programs and/or fellowships are recommended to assist in the education and professional development of transplant NPs and PAs.
authors.affiliation: Divisions of Transplant Medicine and Surgery, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA chaney.amanda@mayo.edu.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Chaney
authors.affiliation: Divisions of Transplant Medicine and Surgery, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Harnois
authors.affiliation: Divisions of Transplant Medicine and Surgery, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Kaitlyn R
authors.initials: KR
authors.lastname: Musto
authors.affiliation: Divisions of Transplant Medicine and Surgery, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Justin H
authors.initials: JH
authors.lastname: Nguyen
mesh_terms: D058625:End Stage Liver Disease / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation; D009722:Nurse Practitioners; D024802:Nurse's Role; D010348:Patient Care Team / Q000458:organization & administration*; D010823:Physician Assistants; D024382:Professional Role; D015397:Program Evaluation; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D052096:Warm Ischemia / Q000706:statistics & numerical data
keywords: liver transplantation; nurse practitioners; physician assistants; role development