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Care Transitions

Helping patients be more independent after discharge

Program Manager: Paul Smith, RN, BSN
423-778-6815
Fax: 423-778-6590
paul.smith@erlanger.org

The Erlanger Care Transitions program helps patients with chronic conditions successfully transition from the hospital to greater independence, understanding, and ability to care for themselves. Through education and encouragement, we help you “own and be in control of your diagnosis.” Our goal is to help patients and families leave the hospital with increased peace of mind – and lower chances of being readmitted.

We Provide Education and Follow-Up for:

  • Congestive heart failure (primary or secondary)
  • Heart attack (acute myocardial infarction)
  • Pneumonia
  • Chronic obstructive pulmonary disease (COPD – primary or secondary)
  • Total hip replacement
  • Total knee replacement

After discharge, we provide three follow-up calls within 30 days—checking if prescriptions are filled, medications are taken, and appointments are kept. 


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Program Manager