Daniel Gessner

All Publications

• Patient Perspectives on Accessing, Understanding, and Using Their Anesthetic Records: A Qualitative Study. Anesthesia and analgesia Shi, J., Xie, J., Schmiesing, C., Wang, E. Y., Gessner, D. M. 2025

  View details for DOI 10.1213/ANE.0000000000007609

  View details for PubMedID 40549573

• Sharing Anesthetic Records with Patients: An Opportunity to Embrace Transparency. Anesthesiology Xie, J., Gessner, D., Ramaswamy, P., Tan, J. M., Guffey, P., Gálvez Delgado, J., Lonsdale, H., Kato, M., Taicher, B. M., Zhang, D. A., Wecksell, M., Asher, D., Simpao, A. F., Wang, E., Mudumbai, S. C., O'Reilly-Shah, V. 2025; 142 (5): 950-951

  View details for DOI 10.1097/ALN.0000000000005391

  View details for PubMedID 40197454

• Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system. BMJ open quality Lessios, A. S., Vilendrer, S., Peterson, A., Brown-Johnson, C., Kling, S. M., Veruttipong, D., Arteaga, M., Gessner, D., Gostic, W. J. 2024; 13 (3)

  Abstract

  Incident reporting systems (IRS) can improve care quality and patient safety, yet their impact is limited by clinician engagement. Our objective was to assess barriers to reporting in a hospital-wide IRS and use data to inform ongoing improvement of a specialty-specific IRS embedded in the electronic health record targeting anaesthesiologists.This quality improvement (QI) evaluation used mixed methods, including qualitative interviews, faculty surveys and user data from the specialty-specific IRS. We conducted 24 semi-structured interviews from January to May 2023 in a large academic health system in Northern California. Participants included adult and paediatric anaesthesiologists, operating room nurses, surgeons and QI operators, recruited through convenience and snowball sampling. We identified key themes and factors influencing engagement, which were classified using the Systems Engineering Initiative for Patient Safety framework. We surveyed hospital anaesthesiologists in January and May 2023, and characterised the quantity and type of reports submitted to the new system.Participants shared organisation and technology-related barriers to engagement in traditional system-wide IRSs, many of which the specialty-specific IRS addressed-specifically those related to technological access to the system. Barriers related to building psychological safety for those who report remain. Survey results showed that most barriers to reporting improved following the specialty-specific IRS launch, but limited time remained an ongoing barrier (25 respondents out of 44, 56.8%). A total of 964 reports with quality/safety concerns were submitted over the first 8 months of implementation; 47-76 unique anaesthesiologists engaged per month. The top safety quality categories of concern were equipment and technology (25.9%), clinical complications (25.3%) and communication and scheduling (19.9%).These findings suggest that a specialty-specific IRS can facilitate increased physician engagement in quality and safety reporting and complement existing system-wide IRSs.

  View details for DOI 10.1136/bmjoq-2024-002806

  View details for PubMedID 39089742

• A pilot project to test the feasibility of automated text messaging to collect multi-day patient-reported outcomes related to pain interference after total joint arthroplasty in veterans. Anaesthesia Dorogi, A. H., Hunter, O. O., Gessner, D. M., Leng, J. C., Kou, A., Mariano, E. R. 2024

  View details for DOI 10.1111/anae.16311

  View details for PubMedID 38714498

• Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors: an infographic. Regional anesthesia and pain medicine Xu, L., Gessner, D., Kou, A., Kasimova, K., Memtsoudis, S. G., Mariano, E. R. 2023

  View details for DOI 10.1136/rapm-2023-104578

  View details for PubMedID 37173098

• Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors. Regional anesthesia and pain medicine Xu, L., Gessner, D., Kou, A., Kasimova, K., Memtsoudis, S. G., Mariano, E. R. 2023

  Abstract

  Continuous interscalene nerve block techniques are an effective form of targeted non-opioid postoperative analgesia for shoulder arthroplasty patients. One of the limiting risks, however, is potential phrenic nerve blockade with resulting hemidiaphragmatic paresis and respiratory compromise. While studies have focused on block-related technical aspects to limit the incidence of phrenic nerve palsy, little is known about other factors associated with increased risk of clinical respiratory complications in this population.A single-institution retrospective cohort study was conducted using electronic health records from adult patients who underwent elective shoulder arthroplasty with continuous interscalene brachial plexus blocks (CISB). Data collected included patient, nerve block, and surgery characteristics. Respiratory complications were categorized into four groups (none, mild, moderate, and severe). Univariate and multivariable analyses were conducted.Among 1025 adult shoulder arthroplasty cases, 351 (34%) experienced any respiratory complication. These 351 were subdivided into 279 (27%) mild, 61 (6%) moderate, and 11 (1%) severe respiratory complications. In an adjusted analysis, patient-related factors were associated with an increased likelihood of respiratory complication: ASA Physical Status III (OR 1.69, 95% CI 1.21 to 2.36); asthma (OR 1.59, 95% CI 1.07 to 2.37); congestive heart failure (OR 1.99, 95% CI 1.19 to 3.33); body mass index (OR 1.06, 95% CI 1.03 to 1.09); age (OR 1.02, 95% CI 1.00 to 1.04); and preoperative oxygen saturation (SpO2). For every 1% decrease in preoperative SpO2, there was an associated 32% higher likelihood of a respiratory complication (OR 1.32, 95% CI 1.20 to 1.46, p<0.001).Patient-related factors that can be measured preoperatively are associated with increased likelihood of respiratory complications after elective shoulder arthroplasty with CISB.

  View details for DOI 10.1136/rapm-2022-104264

  View details for PubMedID 37173097

• Variations in operating room staff compliance with mandatory daily electronic COVID-19 symptom screening. British journal of anaesthesia Gessner, D. M., Sun, E., Fielding-Singh, V. 2023; 130 (1): e10-e12

  View details for DOI 10.1016/j.bja.2022.09.014

  View details for PubMedID 36939494

• Performance of the Pain Sensitivity Questionnaire short form in outpatient arthroscopic surgery without preoperative peripheral nerve block: a prospective observational cohort study. Regional anesthesia and pain medicine Gessner, D., Tsui, B. C., Horn, J. 2022

  View details for DOI 10.1136/rapm-2022-103957

  View details for PubMedID 36270751

• Automated text messaging follow-up for patients who receive peripheral nerve blocks. Regional anesthesia and pain medicine Gessner, D. n., Hunter, O. O., Kou, A. n., Mariano, E. R. 2021

  Abstract

  Routine follow-up of patients who receive a nerve block for ambulatory surgery typically consists of a phone call from a regional anesthesia clinician. This process can be burdensome for both patients and clinicians but is necessary to assess the efficacy and complication rate of nerve blocks.We present our experience developing an automated system for completing follow-up via short message service text messaging and our preliminary results using it at three clinical sites. The system is built on REDCap, a secure online research data capture platform developed by Vanderbilt University and currently available worldwide.Our automated system queried patients who received a variety of nerve block techniques, assessed patient-reported nerve block duration, and surveyed patients for potential complications. Patient response rate to text messaging averaged 91% (higher than our rates of daily phone contact reported previously) for patients aged 18 to 90 years.Given the wide availability of REDCap, we believe this automated text messaging system can be implemented in a variety of health systems at low cost with minimal technical expertise and will improve both the consistency of patient follow-up and the service efficiency of regional anesthesia practices.

  View details for DOI 10.1136/rapm-2021-102472

  View details for PubMedID 33649155

• In reply: 'automating patient outcomes: next frontier?' Regional anesthesia and pain medicine Gessner, D., Hunter, O. O., Kou, A., Mariano, E. R. 2021

  View details for DOI 10.1136/rapm-2021-102992

  View details for PubMedID 34226196

• Pain management in the orthopaedic trauma patient: Non-opioid solutions. Injury Gessner, D. M., Horn, J. L., Lowenberg, D. W. 2019

  Abstract

  When treating pain in the orthopaedic trauma patient opioids have classically represented the mainstay of treatment. They are relatively inexpensive and modestly effective for basic pain management. However, they are fraught with considerable side effects as well as the very high risk of addiction. Their use in pain management has been implicated in the opioid epidemic. For this reason, as well as their only moderate efficacy, alternative modes of treatment have been sought for both the patient with isolated limb trauma and the patient with poly trauma. We review alternative treatment methods in pain management for those with isolated limb trauma and poly trauma. These methods include topical agents, as well as non steroidal anti-inflammatory medications, acetaminophen, gabapetoids, intravenous agents, varying degrees of local anesthetic infiltration and peripheral nerve blocks, and the newer modality of fascial plane blocks. Often, it is a combination of these analgesic modalities that gives the most optimum treatment for the trauma patient. This also, more frequently than not, must be individually tailored to the patient, as no two patients act the same in this regard. It is therefore of importance that the physician managing such patients's pain be experienced and well-versed in all these treatment modalities. We also provide a basic stepwise algorithm we have found useful in treating those with single extremity or single site trauma versus those patients with poly trauma and resultant multiple sources as pain generators. It is hoped that this breakdown of the different modalities along with a better understanding of each modality's potential benefits and indications will aid the surgeon in providing better care to patients following orthopedic trauma.

  View details for PubMedID 31079833

• Revisiting Mechanisms of Extraterritorial Allodynia. Current pain and headache reports Gessner, D. M., Sang, C. N. 2017; 21 (5): 25

  View details for DOI 10.1007/s11916-017-0625-9

  View details for PubMedID 28421380

• Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach. Journal of hospital medicine Shieh, L., Go, M., Gessner, D., Chen, J. H., Hopkins, J., Maggio, P. 2015; 10 (9): 599-607

  Abstract

  The Agency for Healthcare Research and Quality has adopted iatrogenic pneumothorax (IAP) as a Patient Safety Indicator. In 2006, in response to a low performance ranking for IAP rate from the University Healthsystem Consortium (UHC), the authors established a multidisciplinary team to reduce our institution's IAP rate. Root-cause analysis found that subclavian insertion of central venous catheterization (CVC) was the most common procedure associated with IAP OBJECTIVE: Our short-term goal was a 50% reduction of both CVC-associated and all-cause IAP rates within 18 months, with long-term goals of sustained reduction.Observational study.Academic tertiary care hospital.Consecutive inpatients from 2006 to 2014.Our multifaceted intervention included: (1) clinical and documentation standards based on evidence, (2) cognitive aids, (3) simulation training, (4) purchase and deployment of ultrasound equipment, and (5) feedback to clinical services.CVC-associated IAP, all-cause IAP rate.We achieved both a short-term (years 2006 to 2008) and long-term (years 2006 to 2008-2014) reduction in our CVC-associated and all-cause IAP rates. Our short-term reduction in our CVC-associated IAP was 53% (P = 0.088), and our long-term reduction was 85% (P < 0.0001). Our short-term reduction in the all-cause IAP rate was 26% (P < 0.0001), and our long-term reduction was 61% (P < 0.0001).A multidisciplinary team, focused on evidence, patient safety, and standardization, can use a set of multifaceted interventions to sustainably improve patient outcomes for several years after implementation. Our hospital was in the highest performance UHC quartile for all-cause IAP in 2012 to 2014. Journal of Hospital Medicine 2015. © 2015 Society of Hospital Medicine.

  View details for DOI 10.1002/jhm.2388

  View details for PubMedID 26041246

• Cost and turn-around time display decreases inpatient ordering of reference laboratory tests: a time series BMJ QUALITY & SAFETY Fang, D. Z., Sran, G., Gessner, D., Loftus, P. D., Folkins, A., Christopher, J. Y., Shieh, L. 2014; 23 (12): 994-1000

  Abstract

  Reference tests, also known as send-out tests, are commonly ordered laboratory tests with variable costs and turn-around times. We aim to examine the effects of displaying reference laboratory costs and turn-around times during computerised physician order entry (CPOE) on inpatient physician ordering behaviour.We conducted a prospective observational study at a tertiary care hospital involving inpatient attending physicians and residents. Physician ordering behaviour was prospectively observed between September 2010 and December 2012. An intervention was implemented to display cost and turn-around time for reference tests within our CPOE. We examined changes in the mean number of monthly physician orders per inpatient day at risk, the mean cost per order, and the average turn-around time per order.After our intervention, the mean number of monthly physician orders per inpatient day at risk decreased by 26% (51 vs 38, p<0.0001) with a decrease in mean cost per order (US$146.50 vs US$134.20, p=0.0004). There were no significant differences in mean turn-around time per order (5.6 vs 5.7 days, p=0.057). A stratified analysis of both cost and turn-around time showed significant decreases in physician ordering. The intervention projected a mean annual savings of US$330 439. Reference test cost and turn-around time variables were poorly correlated (r=0.2). These findings occurred in the setting of non-significant change to physician ordering in a control cohort of non-reference laboratory tests.Display of reference laboratory cost and turn-around time data during real-time ordering may result in significant decreases in ordering of reference laboratory tests with subsequent cost savings.

  View details for DOI 10.1136/bmjqs-2014-003053

  View details for Web of Science ID 000345318300009