Diagnosis: Rectal bleeding
Issue Under Review: Inpatient admission

Determination: The inpatient admission was not medically necessary.

The patient is a male. He was admitted via the emergency department to the hospital. The patient noted rectal bleeding and generalized weakness the morning of presentation. The impression was hemorrhoidal bleeding as the most likely cause. The patient evidenced anemia.

On presentation, the patient had a hemoglobin of 6. He received two units of blood and evidenced no bleeding during the hospitalization. The patient was discharged with a plan for close follow-up.

The patient presented with anemia and received two units of blood. The patient evidenced only generalized weakness from the anemia. There was no reported hypoxia, active bleeding, coagulopathy, or planned surgery. The care as rendered could have been delivered at a lower level of care in its entirety.