Diagnosis: Anemia
Treatment: Inpatient stay

Summary:
The patient is a female with a chief complaint of heavy vaginal bleeding and shortness of breath. She was tachycardic. Her hematocrit was 12.41. She received four units of PRBCs (packed red blood cells) and was given oral progesterone.

This patient was admitted and transfused. Because of her symptoms, she was observed closely. Except for receiving 4 units of PRBCs (packed red blood cells) and monitoring, nothing was done in the hospital. Ideally, this patient could have been transfused in the ED, monitored for a few hours; her CBC (complete blood count) repeated and then discharged home with a follow up with her primary physician or gynecologist. Nothing was done in the hospital that could not be done as an outpatient.

Milliman care guidelines list the clinical indication for inpatient care for patients with anemia. These include active massive hemorrhage, active hemolysis, cognitive impairment, tachycardia, orthostatic changes, heart failure, chest pain, syncope. Following, the transfusion, the patient had none of the above.

Based on all of the above, admission was not medically necessary.