Not-so-hidden GEMS

Bridgeport Hospital’s Geriatric Emergency Medical Service takes special care of older adults when they visit the Emergency Department

Bridgeport Hospital’s Rockman Ferrigno, MD, chair of Emergency Medicine and associate chief medical officer; Vivian Argento, MD, executive director of Geriatric and Palliative Care; and Rachel Kinzler, APRN, Geriatric Emergency Medicine Services, are part of the medical team that manages age-friendly care in the Emergency Department.



The last person Michael J. Napychank and his daughter Ellen Parrella expected to meet in the Bridgeport Hospital Emergency Department was their very own angel, but lo and behold, she appeared.

At age 97, Napychank took a fall in his home and his injuries required a trip to the Bridgeport Hospital Emergency Department. That’s where he and Parrella met Rachel Kinzler, APRN, the woman they credit with being their biggest supporter in an otherwise stressful situation.

Kinzler is a member of Bridgeport Hospital’s Geriatric Emergency Medicine Service (GEMS), a dedicated team of advanced practice nurses who work closely with the Emergency Department team to provide specialized care to adults age 65 and over.

Because of his fall, Napychank had to be admitted to the hospital through the Emergency Department. Kinzler consulted with the father and daughter duo. She assessed Napychank’s mental and physical capabilities, along with his living arrangements and family and outside support. This helped her get a holistic sense for his situation, which influenced his care options.

“Rachel was compassionate and knowledgeable, but what really mattered most was how she interacted with my dad directly, making sure he was informed and actively involved in the conversation and his ongoing plan of care,” Parrella said. “She treated him with dignity and respect, and we both appreciated that tremendously."

GEMS provides an extra layer of support for older patients when they visit the Emergency Department. The team oversees Emergency Department care for older patients and their families by partnering with Emergency Department doctors and practitioners to provide treatment and establish whether or not patients need to be admitted to the hospital. They ensure that when patients leave the hospital, they return to a safe environment, whether at home or another facility, with a proper plan of care.

Bridgeport Hospital established GEMS 10 years ago and grew the service from there. “The result is a self-sustaining resource in the Emergency Department at the ready for geriatric patients,” said Rockman Ferrigno, MD, chair of Emergency Medicine and associate chief medical officer at Bridgeport Hospital.

The GEMS team rotates between Bridgeport and the hospital’s recently integrated Milford Campus.

“Having GEMS in our Emergency Department allows us to have a better dialogue with our older patients and their families. We can understand them better and provide better care to help maximize their lives,” Dr. Ferrigno said.

“We try to get to the root of older adults’ needs,” said Kinzler. “As people age, it can become more difficult for them to perform daily tasks such as cooking or bathing. Their hearing, eyesight or memory may not be as sharp as they used to be. They could have difficulty getting around. So we assess their mental and physical health to see if they might benefit from additional support, and we ask fact-finding questions. Do they live alone? Do they have family to help? Can their family provide the level of care they need? What medications are they taking? What is their financial situation? We do this so we can connect them to resources that provide the additional help they may need to live a safer and more comfortable life.”

After GEMS’ assessments of older patients’ needs, the team works closely with visiting nurses and home care, assisted living facilities, specialists, social workers and community organizations as necessary. They talk to patients about the importance of living wills, power of attorney and healthcare representatives, as these arrangements ensure that someone can make decisions on their behalf if they become unable to make them on their own.

“We recommend resources and help to facilitate patients’ and families’ needs inside and outside of the hospital,” Kinzler said.

It is this specialized care that helped Bridgeport Hospital earn the Geriatric Emergency Department Accreditation (GEDA) from the American College of Emergency Physicians (ACEP). Bridgeport Hospital is the first hospital in the state to achieve this recognition. The accreditation means that Bridgeport Hospital’s Emergency Department is focused on the highest standards of care for older adults.

“We’ve reached a major milestone in our evolution of providing age-friendly care to our community,” said Vivian Argento, MD, Bridgeport Hospital’s executive director of Geriatric and Palliative Care. “The GEDA accreditation gives us visibility and motivation to keep challenging ourselves to do better for this growing population.”

An accredited geriatric Emergency Department has staff that are specially trained to identify the mental and physical challenges older adults may face, such as dementia and fall risk, and equipment and supplies like hearing amplifiers, mobility aids and blanket warmers for patients’ safety and comfort.

“Bridgeport Hospital is committed to providing safe, high-quality care that meets the needs of all members of our community,” Dr. Argento added. “Our age-friendly Emergency Department is just one component of care we have in place for older adults, along with outpatient care, home-based care, and psychiatric, surgical and trauma care.”

As for Napychank, he and his daughter found themselves back in the Bridgeport Hospital Emergency Department for a different health issue 10 months after their first visit. The Emergency Department was busy, and Napychank had to have several tests. When they looked up, there was Kinzler, ready to help them navigate their journey again.

“Just seeing her face calmed us down,” Parrella recalled.

“All of the Emergency Department staff were great, but Rachel was our angel. She kept coming into our room and informing us about what was happening – discussing test results, estimating how long it might be until the doctor could see us. She talked to us openly and gave us a sense for what was coming next. When you’re in a stressful situation, it means so much to have someone in your corner. Rachel was there for us with a smile the whole time.”

Bridgeport Hospital has a robust program for geriatrics and palliative medicine. The hospital was recently recognized by the Institute for Health Care Improvement as an age-friendly health system. For more information on Bridgeport Hospital’s services for older adults, call 203-384-3388.