Urgent Referral Letter Writing Guide for OET Candidates

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

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.

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.

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.

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.

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.

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.

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

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