Urgent Referral Letter Writing Guide for OET Candidates

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OET letter writing is categorised in 3 types mainly. These are

It’s important to note that regardless of the type of letter, the approach to writing an OET letter is the same.

A referral letter is typically addressed to a new medical professional with a request for specific care/investigations/management. An urgent referral letter is similar to a typical referral letter, but the order of information is slightly different.

Given below is the preparation of a sample urgent referral letter based on Official OET Case notes (Nursing). The scenario involves an urgent referral of a patient to the emergency department.

Follow the 40 tips given in the sample, and you will find that securing A or B for OET writing sub-test is much easier than thought

OET Case Notes for Urgent Referral Letter
Date, Recipient’s Address, Greeting and Re: Line
Introduction – Patient, Medical Issue & the Purpose
Body Paragraph 1 – The Latest Information about the Patient
Body Paragraph 2 – Summary of the Recent Hospitalization
Body Paragraph 3 – Past Medical History
Conclusion – Expected care/action by the reader
Closing Sentence – Not Included in Word Count
Complimentary Close – Yours…
Mock Test – Test Your Writing Skills
Final Sample Letter
Quiz – Check Your Knowledge

The following scenario involves a nurse home visit post-discharge, and the patient is found to have possible complications related to the relapse of the condition for which hospitalization was required earlier.

OET Urgent Case Notes (SOURCE)

Occupational English Test

WRITING SUB-TEST:

NURSING

TIME ALLOWED:

READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES

Read the case notes and complete the writing task which follows.

Notes:

Assume that today's date is 30 August 2019.

You are a nurse conducting a Nurse Home Visit as part of routine follow-up care after this patient’s recent hospital discharge

PATIENT DETAILS:

Name:

Ms Patricia Styles

DOB:

27 Apr 1957 (Age 62)

Address:

57 Market Drive, Newtown

Social background:

Retired primary school teacher Lives on her own Husband died 3 yrs ago (lung cancer); no children

Medical history: Hypertension (HT)

Diagnosed 2011 – mild 145/95 2013 – moderate 168/105, commenced quinapril Regular monitoring, currently well managed at around 140/90 Diabetes mellitus (DM) Type 2 Diagnosed 2013 – Pt counselled re diet/lifestyle, incl. weight loss 2014 – commenced oral hypoglycaemics (metformin + gliclazide) Well managed generally Depression Diagnosed June 2016 Triggered by death of husband Regular counselling since July 2016 to control mood swings and support DM management

Family medical history:

Mother – HT, DM

Lifestyle:

Smoking/Alcohol: Non-smoker; 1-2 glasses wine/wk Exercise: Walks dog 20mins/day Diet: Ongoing counselling re DM management to maintain balanced diet

Medications:

Quinapril (Accupril) oral 40mg/2xday Metformin (Diabex) oral 500mg/2xday Gliclazide (APO-Gliclazide MR) oral 30mg daily

Green Valley Hospital Treatment Record:

3 Aug 2019

Pt visiting sister for weekend, sister lives 3hrs away from Newtown in Green Valley Pt admitted to Green Valley Hospital late evening with fever, sharp & pleuritic chest pain (worse on breathing), general weakness & malaise, tachycardia (rapid heartbeat)

24 Aug 2019 Assessment:

Vital signs RR 29; BP 170/106; HR 98; T 39.3ºC Full blood examination (FBE):↑ ESR (erythrocyte sedimentation rate),↑ CRP (C-reactive protein),↑ WCC (white cell count) i.e. inflammation/stress Throat swab: viral influenza type B Chest X-ray (CXR) – normal Echocardiogram – pericarditis

Management:

IV saline Ibuprofen 600mg every 8hrs

valuation:

IV saline Viral influenza type B plus pericarditis

25 Aug 2019

Pt discharged and advised on self-care at home Niece drove Pt home & agreed to stay overnight for 3 nights Follow-up Nurse Home Visit arranged for 30 Aug 2019

Nurse Home Visit – 30 Aug 2019:

Observations:

Pt unhappy. Reports feeling chest pain (relieved by sitting up), shortness of breath (SOB), fatigue. Frustrated with progress of recovery Medication adherence – reports compliance & regular blood glucose monitoring Vital signs: low-grade fever: T 38.1°C. Elevated RR 28 & HR 115 BP: 125/78 (usual BP 140/90) Niece no longer staying overnight – work commitments in Green Valley

Assessment:

Pt unwell. Nil improvement ?relapse/complications of pericarditis

Plan:

Organise urgent hospital transfer to Newtown Hospital (nearest hospital) Write referral to Emergency Department, include relevant: • Medications • Patient history • Test results/observations

Writing Task:

Using the information in the case notes, write a letter of referral to the Emergency Department Consultant on Duty, outlining the case and requesting urgent assessment and management for pericarditis. Address the letter to Emergency Department Consultant on Duty, Newtown Hospital, 100 Main Street, Newtown.

In your answer:

● Expand the relevant notes into complete sentences

● Do not use note form

● Use letter format

The body of the letter should be approximately 180–200 words.

Summary of the case notes:

The patient has relevant past medical history
She was hospitalized recently for pericarditis.
She is demonstrating features of possible relapse of the same condition, which requires urgent attention.

Let us structure the first part of the sample referral letter and see what information should be included there.

Date, Recipient’s Address, Greeting and Re: Line

Date (Given in the case notes as ‘Assume that today’s date is …’)

Designation/Job title (The recipient’s name is not given)
Address

Greeting (Dear ……. )

Reference line (Re: the patient’s full name & DOB)

Tip 1: ‘20 January 2022’ is the preferred date format at the start.

Tip 2: dd/mm/yyyy is the preferred date format in in the reference line and paragraphs. (Avoid switching date formats in the reference line and paragraphs.)

Tip 3: Interchanging the order of Date & Recipient’s Details is acceptable.

Tip 4: Interchanging the order of Greeting & Reference Line is acceptable.

Tip 5: If the name of the recipient is not given in the case notes, use appropriate title or job profile name (Dear Doctor, Dear Nurse, etc.). In this case, the designation is ‘Emergency Department Consultant’; therefore, you may use ‘Doctor’.

Tip 6: If date of birth (DOB) is given, write that in the reference line. If age is also given, mention that in introduction.

Tip 7: Watch the spelling. If you are using British/American spelling, be consistent in the letter. Avoid mixing the styles.

30 August 2019

Emergency Department Consultant on Duty
Newtown Hospital
100 Main Street
Newtown

Dear Doctor
RE: Ms Patricia Styles, DOB: 27/04/1957

Now, let us take a stepwise approach to composing each paragraph.

Introduction
Patient, Medical Issue & Purpose

The purpose of the letter should be immediately apparent to the reader; therefore, it is discussed in the introduction paragraph.

Writing ‘introduction’ of a referral OET letter is similar to other types of letters such as a transfer or a discharge letter. It covers the full name of the patient, introduces the medical complaint and generally discusses the reason(s) for writing the letter.

Tip 8: Keep in mind that excluding the purpose would affect your score negatively.

Tip 9: Read the ‘Note’ & ‘Writing Task’ given at the start and end of the case notes respectively to identify the purpose.

Tip 10: You may use the key word ‘refer’ to indicate the purpose as you are introducing the patient to another healthcare professional for the first time. It is also important to highlight the urgency of the situation in the introduction.

Tip 11: Keep the introduction succinct to make the purpose immediately apparent to the reader.

TIP 12: Avoid secondary information/details that may obscure the objective of introduction.

However, in this case, mentioning the recent hospitalization in the introduction adds more clarity to the reason for referral (‘possible relapse of pericarditis’)

Tip 13: Avoid using ‘a/the/this/my patient’ to refer to the patient in the letter as it is considered less polite.

Tip 14: Write full name with title at the first occurrence in the introduction as the patient is an adult.

Tip 15: In introduction, the purpose should be general information related to expected care/action. A specific & detailed plan should be included in conclusion.

Tip 16: Avoid using note/short forms; it is informal.

For example, ? indicates possible/probably

Introduce the patient: Refer NOTES and PATIENT DETAILS

PATIENT DETAILS:
Name: Ms Patricia Styles
DOB: 27 Apr 1957 (Age 62)
Social background: Retired primary school teacher

Medical Complaint: Refer Plan under Nurse Home Visit – 30 Aug 2019

Assessment: Pt unwell. Nil improvement
?relapse/complications of pericarditis

Reason for writing the letter: Refer Writing Task.

… urgent assessment and management for pericarditis

The introduction of your OET letter is now

I am writing to urgently refer Ms Patricia Styles, a 62-year-old retired teacher, who was admitted a week ago due to pericarditis. She requires further assessment and management of pericarditis.

Body Paragraph 1
Latest Information on the condition of the Patient

Refer ‘Nurse Home Visit – 30 Aug 2019’.

Tip 17: Body paragraph 1 in an urgent referral letter should discuss the latest information about the patient. It is the most relevant to the reader and should get his/her immediate attention.

(In this case, it is the observation and findings of the nurse during the scheduled home visit following the patient’s discharge.)

Tip 18: Use last name (surname) with appropriate title when referring to the (adult – aged above 16) patient initially in a body paragraph.

Tip 19: Avoid using pronouns to refer to the patient at the first occurrence in a paragraph.

Tip 20: Avoid using brackets; it is informal. Rephrase without them.

Let’s compile relevant information and compose the body paragraph 1 as follows.

On home visit today after discharge, Ms Styles reported chest pain that improved by sitting up, shortness of breath and fatigue. Her temperature was 38.1°C, respiratory rate was 28 and pulse was 115. Her blood pressure was 125/78, which was lower than her usual 140/90.

Body Paragraph 2
Summary of the Recent Hospitalization

Tip 21: Relevant information/details:

Brief the complaints on admission
Investigation findings and diagnosis
Management
Discharge
(Indicate the patient was on a short visit to the place)

Tip 22: Sequence relevant information based on importance.

Tip 23: Irrelevant information/details: Information not related to the chief complaint of the patient and not useful to the reader, an emergency department consultant, to initiate the expected care/action should be ignored. Otherwise, it may confuse the reader, and even be counter-productive as it may increase the length of your letter.

Tip 24: Common medical abbreviations can be used as the reader (a doctor) must be familiar with them.

Tip 25: Avoid capitalizing generic drug name(s). (If you are using brand names, capitalize accordingly.)

Refer ‘Green Valley Hospital Treatment Record’

23 Aug 2019
Pt visiting sister for weekend, sister lives 3hrs away from Newtown in Green Valley
Pt admitted to Green Valley Hospital late evening with fever, sharp & pleuritic chest pain (worse on breathing), general weakness & malaise, tachycardia (rapid heartbeat)

24 Aug 2019
Assessment: Vital signs RR 29; BP 170/106; HR 98; T 39.3ºC
Full blood examination (FBE): ↑ ESR (erythrocyte sedimentation rate), ↑ CRP (C-reactive
protein), ↑ WCC (white cell count) i.e. inflammation/stress
Throat swab: viral influenza type B
Chest X-ray (CXR) – normal
Echocardiogram – pericarditis

Management:
IV saline
Ibuprofen 600mg every 8hrs

Evaluation: Viral influenza type B plus pericarditis

25 Aug 2019
Pt discharged and advised on self-care at home
Niece drove Pt home & agreed to stay overnight for 3 nights
Follow-up Nurse Home Visit arranged for 30 Aug 2019

Let’s compile relevant information and compose the body paragraph 2 as follows.

On 23/08/2019, Ms Styles, who was visiting her sister in Green Valley, was admitted to Green Valley Hospital with fever, pleuritic chest pain, tachycardia and malaise. Her chest X-ray was unremarkable, but throat swab confirmed viral influenza type B, and echocardiography indicated pericarditis. Subsequently, she was started on IV saline and ibuprofen 600mg every 8 hours. On 25/08/2019, she was discharged home with advice on self-care, and a nurse home visit was scheduled for today.

Body Paragraph 3
Past Medical History

Refer ‘Medical History’ and ‘Medications’

Tip 26: Focus more on medical history related to the referral (cardiac issue).

Tip 27: Avoid information that does not impact the expected care/action by the reader.

Tip 28: Family history of HT and DM is not relevant as the patient was already diagnosed with the same conditions.

Tip 29: Lifestyle is not relevant as it does not impact the expected care/action

Tip 30: Punctuate the sentence appropriately when listing the medications.

This paragraph can be written as below.

Ms Styles was diagnosed with mild hypertension in 2011, which progressed to moderate in 2013, diabetes type 2 in 2013 and depression in 2016. Her current medications are quinapril, 40mg and metformin, 500mg both twice a day and gliclazide, 30mg daily.

Conclusion
Expected Care/Action by the Reader

After briefing the reader on the patient’s complaints and past medical history, conclude the letter explaining the purpose of the letter (what exactly is expected from the reader).

In this case, the purpose need not be explained in detail as it is the same. Therefore, emphasise the purpose.

Refer ‘Plan’.

Plan: Organise urgent hospital transfer to Newtown Hospital (nearest hospital)

Write referral to Emergency Department, include relevant:

Medications
Patient history
Test results/observations

Tip 31: Give an introductory phrase to link the conclusion to the patient’s complaints and past medical history.

Tip 32: To demonstrate your proficiency, avoid repeating the sentence in the introduction. (‘She requires further assessment and management of pericarditis.’)

Tip 34: Make sure the tone used is polite and formal.

Therefore, the letter can be concluded as below.

Given the above, it would be appreciated if you could further assess and promptly manage Ms Styles for suspected pericarditis.

Closing Sentence
Not included in Word Count

Tip 35: You can be relieved that the closing sentence is not considered for ‘word count’. However, remember not writing closing sentence may affect your score negatively.

Tip 36: A typical polite closing sentence can be written as the addressee can get back to the writer if he needs more information about the patient.

Tip 37: It should be polite and should not include informal words and phrases.

In case of any queries, please contact me.

Complementary Close
Yours…..

Tip 38: Use appropriate salutations in the letter.

Yours sincerely (If the name of the recipient is given.)

Yours faithfully (If the name of the recipient is NOT given.)

Tip 39: Write the name of the profession/designation indicated in the case notes. You may give the name of the hospital or organization if given (optional).

Tip 40: Leave a single blank space between all sections

In this case, the name of the reader is not given. Therefore,

Yours faithfully,
Nurse

Mock Test
Test Your Writing Skills

30 2019

Emergency Department Consultant on Duty
Newtown Hospital
100 Main Street
Newtown

Dear

Re: Ms Patricia Styles, DOB: 27/04/1957

I am writing to urgently refer Ms Patricia Styles, a retired teacher, who was admitted a week ago due to pericarditis. She requires further assessment and management of its possible relapse.

On home visit today after discharge, Ms Styles reported chest pain that improved by sitting up, shortness of and fatigue. Her temperature was 38.1°C, respiratory rate was 28 and pulse was 115. Her BP was 125/78, which was lower than her usual 140/90.

On 23/08/2019, Ms Styles, who was visiting her sister in Green Valley, was admitted to Green Valley Hospital with fever, pleuritic chest pain, tachycardia and malaise. Her chest was unremarkable, but throat swab confirmed viral influenza type B, and echocardiography indicated pericarditis. Subsequently, she was started on IV saline and ibuprofen 600mg every 8 hours. On 25/08/2019, she was discharged home with on self-care, and a nurse home visit was scheduled for today.

Ms Styles was diagnosed with mild hypertension in 2011, which progressed to moderate in 2013, diabetes type 2 in 2013 and depression in 2016. Her current medications are quinapril, 40mg and , 500mg both twice a day and gliclazide, 30mg daily.

Given the above, it would be appreciated if you could further assess and promptly manage Ms Styles for suspected pericarditis. In case of any queries, please contact me.

Yours
Nurse

/ 8

Final Sample Letter

30 August 2019

Emergency Department Consultant on Duty
Newtown Hospital
100 Main Street
Newtown

Dear Doctor

Re: Ms Patricia Styles, DOB: 27/04/1957

I am writing to urgently refer Ms Patricia Styles, a 62-year-old retired teacher, who was admitted a week ago due to pericarditis. She requires further assessment and management of its possible relapse.

On home visit today after discharge, Ms Styles reported chest pain that improved by sitting up, shortness of breath and fatigue. Her temperature was 38.1°C, respiratory rate was 28 and pulse was 115. Her BP was 125/78, which was lower than her usual 140/90.

On 23/08/2019, Ms Styles, who was visiting her sister in Green Valley, was admitted to Green Valley Hospital with fever, pleuritic chest pain, tachycardia and malaise. Her chest X-ray was unremarkable, but throat swab confirmed viral influenza type B, and echocardiography indicated pericarditis. Subsequently, she was started on IV saline and ibuprofen 600mg every 8 hours. On 25/08/2019, she was discharged home with advice on self-care, and a nurse home visit was scheduled for today.

Ms Styles was diagnosed with mild hypertension in 2011, which progressed to moderate in 2013, diabetes type 2 in 2013 and depression in 2016. Her current medications are quinapril, 40mg and metformin, 500mg both twice a day and gliclazide, 30mg daily.

Given the above, it would be appreciated if you could further assess and promptly manage Ms Styles for suspected pericarditis. In case of any queries, please contact me.

Yours faithfully
Nurse

Check Your Knowledge

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4 thoughts on “Urgent Referral Letter Writing Guide for OET Candidates”

Gopalakrishna says:
December 18, 2021 at 10:07 am
I forgot to mention in the letter; please contact me if you require further information. Will it affect my score?
Reply
Dr. Hind says:
February 13, 2022 at 9:57 pm
Dr. Silver Bullet
Neurologist
Prospect Hospital
22 Prospect Road
Prospect 5086,
28.04.2021
Dear Dr. Bullet,
Re: Ms. Julia Robert
Thank you for urgently seen Ms. Roberts, a 39- year-old female who has features suggestive of space occupying lesion with increase intracranial pressure . Your assessment and further management would be highly valued
On 22 .04.2021 , Ms. Roberts visited the clinic with complain of a 5 – hour – history of mild frontal headache which is accompanied with nausea and blurred vision but no vomiting or aura . It worth mentioning that there is no family history of migrane . she was vitally stable and her examination was entirely normal . Rest was advised and Paracetamol was prescribe to treat her tension headache .
5 days later, her condition was deteriorating with worsening throbbing headache, frequent vomiting and blurred vision and parasethia was noted . she became tackycardic and hypertensive ; however her neurological exam remain intact . She was treated as sever migirane and hence given pethedine; 100mg and Maxolon intramuscular injection ; 10 mg .
On home visit today, Ms. Robert was felt down after she has experienced sever left sided headache which is on going for 5 hours . she was found semi conscious with slurred speech . she has injuries on the right arm and bruises on the left arm . Her vital sign showed that the Bp reached 150/90 and the pulse is 100 . Neurological evaluation revealed decreased left knee reflex .
Space occupying pathology with raised intracranial pressure was suspected . Therefore, urgent referral to the emergency department to further managed and stabilized her condition.
Please keep me update regarding her progress
Yours sincerely,
Doctor
Could you please correct it with grading
Reply
Rani says:
February 17, 2022 at 3:56 am
Thank u bench mark team .it was very help full letter .I am looking forward to More letters like this.I am planning to take my test on April 9 th. Which will be held in Durban .please help me .this will be my 3 rd time writing oet .I always has a problem with Reading And wtitinng .
Hop benchmark will bring light in to my life .
Thank you
Reply
salim says:
August 26, 2023 at 12:39 pm
please, can i start with this intro:
I’m writing for urgent refer for ms Roberts, a 39-year-old woman who shows signs of… she requires urgent neurological assessment and management.
thanks for your answer.
Reply

Urgent Referral Letter Writing Guide for OET Candidates

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