TRANSFORMING OUTPATIENT HEPATIC CARE IN LATIN AMERICA: A SCALABLE, NURSE-DRIVEN APPROACH

Abstract

Introduction and Objectives

Chronic liver diseases are increasingly prevalent in Latin America, where fragmented care and hospital overcrowding limit timely, cost-effective management. Nurse-led outpatient programs may offer a viable alternative in resource-constrained environments.

To evaluate the safety and cost-effectiveness of a nurse-driven Outpatient Intervention Program (OIP) for patients with liver disease and its potential scalability across Latin America.

Materials and Methods

An OIP was implemented in 2019 at a tertiary care transplantation center. The program included outpatient liver biopsies (LB), albumin and blood product infusions, and diagnostic/therapeutic paracentesis. Retrospective data from 2019-2024 were analyzed.

Results

A total of 418 procedures were performed on 258 patients: 162 LB, 104 albumin or blood product infusions, and 152 paracentesis. This demonstrates a 3,240% increase in the number of LB and a 1,680% increase in paracentesis compared to 2018, before the program began.

The overall complication rate was 0.87% (4 complications), with only 2 major events (0.43%): spontaneous bacterial peritonitis after paracentesis and post-biopsy bleeding.

LB costs dropped from $2,894 to $549, generating $379,890 in savings over six years, due to avoiding overnight hospitalization. Paracentesis, albumin infusions and blood transfusions were previously performed in the emergency department, incurring an additional expense of $420. This transition to OIP generated total savings of $107,160 and contributed to reduced congestion in the emergency department.

Conclusions

This nurse-led model yields promising results in outpatient liver care and represents a cost-effective, Potential intervention. Its integration into public health systems across Latin America could contribute to more efficient management of CLD.