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Editor's Correspondence
July 14, 2008

Opportunity Realized? Medical Consultation for Patients Undergoing Major Surgery—Reply

Arch Intern Med. 2008;168(13):1471. doi:10.1001/archinte.168.13.1471

In reply

Carson and Felibrico have potentially misread our article in a few ways. First, we never made a claim that our single-site study can provide a global assessment of the practice of consultation,1 and we fairly and strongly tempered our discussion in regard to limitations due to its single-site focus and the likely influence of residual confounding. Second, they misinterpret the context of the study—the order set and education program targeted all caregivers in the perioperative period, not just internists. While internists led many of the programs seeking to improve the use of β-blockers and other practices, we would have expected this to have produced a more positive effect of consultation on our key outcomes. Third, while we concur that length of stay in subspecialty-consulted patients was longer, the potential benefit of reducing costs and length of stay via better coordination (“quarterbacking”) are not supported by our data, nor are they supported by prior studies of comanagement models.24

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