BOSTON, MA January 13, 2014 – The culmination of years of planning and groundwork, the long-anticipated Comprehensive Ophthalmology Service (COS) of the New England Eye Center opened today on Biewend 11 (260 Tremont St, 11th Floor; Boston MA 02111) next to the Citi Wang Theatre. The new service will contribute to the delivery of general ophthalmic care and the education of resident physicians.
This service is also the first point of contact for all eye care emergencies in Boston and for the entire New England Eye Center network on a 24/7 basis: call 617-636-0705.
The service is directed by Jordana G. Fein, MD, MS, right, who completed both her Ophthalmology residency and her Fellowship in Medical Retina at Tufts University School of Medicine and the New England Eye Center. She is a member of both the Comprehensive Ophthalmology service and the Vitreoretinal Diseases and Surgery Service at New England Eye Center.
The service has been built from the experience of residents and attending physicians in treating patients at the New England Eye Center. Its mission and organization are thus informed by the inseparable collaboration between faculty and resident.
When Dr. Fein started her residency in 2009, a “general” ophthalmology service had already been on the mind of Jay Duker, MD, chairman of the department. Such a service would provide for the needs of the emergency patients as well as routine eye exams. It would also be the service where residents, even in their first year, could have the substantial responsibility for care management, and the opportunity to follow patients from first presentation through the course of their care.
While requiring the knowledge and supervision of the experienced attending physician, the delivery of patient care in all specialties is largely dependent on the work of the resident. Dru Krishnan, MD, director of residency training, felt the COS must address challenges of both resident education and expeditious delivery of eye care.
Dr. Fein, during her residency and fellowship under the tutelage of Drs. Duker and Krishnan, made a commitment to establish the COS. Drs. Duker and Krishnan had obtained institutional approval and support, and planned space, funding and planning. Dr. Fein became the administrative coordinator who would see the plan to completion.
The new service is organized and staffed in such a way as to facilitate the care and follow-up of patients presenting through emergency services and urgent consults, and, additionally, provide a dedicated area where patients with general ophthalmological needs may obtain convenient appointments and be seen in a timely way.
"COS provides a service in which residents, under appropriate supervision, can participate in the care and follow-up of their own patients and develop the continuing relationship that is beneficial to both the patient as well as the educational need of the resident," said Dr. Fein.
“The first year residents will begin to realize early in their training the advantages of independent, albeit supervised, management of patient care that previously had not been so available until the third year of training. The resident will be the patient’s doctor and both will benefit from the continuity of care and its efficient management,” she added.
Previously, emergency patients would be seen by the resident on call. However, due to the resident’s responsibility to the subspecialty service to which he or she was assigned, and lacking a designated time or place for a follow up visit, the patient would likely not then be followed by the original resident and so there would not be the long-term follow-up for the resident.
“Now they have a dedicated place and time to see such patients," noted Fein.
“At the same time in the past, patients who came to our eye center for routine examination or for undiagnosed problems would be given excellent care, but within a subspecialty unit,. There was a degree of competition for the available facilities and provider time. This system resulted in longer waits for routine appointments, longer stays in the waiting room, and impinged teaching time. The system worked, but as an educational environment and comfortable patient experience it needed improvement.”
In the planning, Dr. Fein explained, director of clinical services Nathan Knowles analyzed patient flow data and derived the number of appointment slots necessary to build into the system to accommodate emergency patients in COS. Currently there are four slots are reserved daily for emergency add-ons; the remainder are available for scheduling routine appointments and follow-ups.
COS also has the advantage of being located in the same place as New England Eye Center's optometry service. This provides the advantage of excellent teaching our experienced optometrists can provide, especially for refraction.
The work distribution and teaching conduciveness in a resident-centered academic practice are arguably superior to other systems. Supervision and teaching are more uniform and dedicated. Patient care is standardized at the highest level. Patients benefit from a team effort and have the advantage of access to the very latest diagnostic and treatment protocols.
“Such a system allows for the efficient delivery of the highest quality of care, it is really the state-of the-art academic care structure. COS will operate at the same level of excellence as all of the subspecialty and adjunct services of our highly respected, world-class tertiary referral center.”
Patients already are getting appointments within weeks rather than months. “If the best situation ensues and we grow our volume enough, we may have to address staffing and facilities expansion to keep up the pace, but that would not be a bad situation to be in.” Dr. Fein also observes that billing for emergency visits isnow more consistent, with far fewer chances that billing for services might be overlooked.
Tom Bigelow, manager of the New England Eyewear, NEEC's optical dispensary, adds his witness that patients are happier and better served. “Patients have reported to me that they are now getting appointments in a far more timely way. They’re very satisfied.”
In addition to the full-time participation of Dr. Fein, COS is attended by Brooke Miller, MD, top right, and Sergey Urman, MD, lower right, as well as Dr. Lauren Taney and Dr. Michael Tibbets, our current medical retina fellows.
Senior optometrist Cynthia D’Auria, OD, left, comments, “The Optometry Service is thrilled to be on the 11th floor working alongside the COS. It is refreshing to be in a new space with new equipment. The patient flow works well with the (New England Eyewear) optical shop just steps away to service our patients for their glasses and contact lens needs.”
Upon the opening of COS, administrative director Linnea Olsson observed, “The Comprehensive Ophthalmology Service will allow us to better serve patient needs for both urgent and routine comprehensive ophthalmology care. It will be much easier to accommodate new patients who wish to come to New England Eye Center, with faster appointment times. We believe that the structure of COS will greatly enhance our residency training program. The optometry department has been relocated to Biewend 11, and our optometrists and technicians as well as physicians are very excited about the beautiful new space and equipment!
“Many people have worked hard on the planning and set-up of the new area. Drs. Jordana Fein and Dru Krishnan have spent countless hours conceptualizing and organizing how COS will run, and I would like to particularly acknowledge the contributions of Dr. Cynthia D’Auria, Chris Kiernan, Bianca Cardona, Nathan Knowles, Meredith Dunbar, Jean McGeary, Amanda Bruce, and our unsung hero of logistics, David Schultz!”
The establishment of the COS will enable the NEEC and the Tufts Department of Ophthalmology to grow, and represents the strength and foresight that will serve us through many years of change and challenges in the future of eye care.
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