Diagnosis: Anemia
Treatment: Inpatient admission
The inpatient admission was not medically necessary.

The patient in this case is a female with a history of chronic kidney disease and anemia. She was sent to the emergency department (ED) by the outpatient clinic for evaluation and treatment of worsening anemia. Her only symptom was weakness. Hemoglobin was 6.0 grams per deciliter (g/dl).

Physical examination was notable for pallor. There was no documentation of significant hypotension or tachycardia. She was admitted and treated with blood transfusion. On the next day, the patient was seen by gastroenterology and gynecology. Hemoglobin was improved to 7.3 g/dl. She had no complaints and had not noted any significant vaginal or gastrointestinal bleeding. She had been diagnosed with iron deficiency anemia. Both gynecology and gastroenterology recommended outpatient follow up after hospital discharge. The patient was discharged to home.

This patient had anemia with fatigue/weakness. She did not have significant shortness of breath, hemodynamic instability or hypoxia. She also did not have a history of active bleeding. She was treated with transfusion and discharged the following day. Given lack of ongoing blood loss and lack of hemodynamic instability, hypoxia or significant pulmonary symptoms, she did not require acute care hospital admission. She could have been managed at a lower level of care such as outpatient.