The task
Assume that today's date is 22 October 2026. Mr Merriman is being discharged home this afternoon.
You are the ward dietitian on the upper gastrointestinal surgical ward. Using the information in the case notes, write a letter to Ms Roisin Ballantyne, Home Enteral Nutrition Dietitian, referring Mr Merriman for ongoing monitoring of his jejunostomy feeds, his weight and his transition to a full oral diet. Address the letter to Ms Roisin Ballantyne, Home Enteral Nutrition Dietitian, Community Home Enteral Nutrition Service, 61 Fairview Road. 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.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Referral letter.
Case notes
Patient details
- Name: Mr Mwangi Merriman
- DOB: 14/03/1969 (57 yrs)
- Address: 27 Kestrel Street
- Admitted: 28/09/26; discharge: 22/10/26
Social background
- Lives with wife; she attended feed training and manages pump set-up and flushes
- Bus depot supervisor; hopes to return to work in 3/12
- Keen amateur fisherman
- Ex-smoker (quit 2010); nil alcohol since diagnosis
- Wife complained to staff that hospital parking fees are 'a disgrace'
Medical history
- Adenocarcinoma lower oesophagus, diagnosed 05/26
- Neoadjuvant chemotherapy completed 08/26
- Long-standing GORD
- Appendicectomy age 19
- Allergies: nil known
Surgery and inpatient course
- 29/09: Ivor Lewis oesophagectomy + feeding jejunostomy placed
- Jejunal feeds started day 1 post-op; refeeding risk — ↓ phosphate day 3, replaced, now within normal range
- Contrast swallow day 7: no leak → oral fluids; soft diet from day 10
- Pt complained hospital meals 'bland and cold'
Nutrition assessment
- Ht 178 cm; usual wt 84 kg (03/26); pre-op 79 kg; discharge wt 74 kg (BMI 23.4) — ~12% loss since 03/26
- Oral: soft, moist diet, 6 small meals/day; meeting approx. 40% of est. requirements
- Early satiety; mild dumping symptoms (dizziness, sweating) after sweet drinks → advised avoid high-sugar drinks, take fluids between meals
- Est. requirements ~2200 kcal, 110 g protein/day
- Bowels regular; no diarrhoea on current feed
Feeding regimen
- 1.5 kcal/mL polymeric formula, 1000 mL via pump over 12 hrs (20:00–08:00)
- Flush jejunostomy with sterile water before and after feeds and any medications; flush volumes as per individually prescribed feed + water chart (copy sent with referral)
- Head of bed elevated ≥ 30° during feed and when sleeping
- Jejunostomy site clean and dry; retention suture in situ until surgical review
- Pump, giving sets + 2/52 formula supplied by hospital
Plan
- Community dietitian: weekly wt + oral intake review
- ↓ overnight feed volume as oral intake ↑; cease feeds only when oral intake meets most of requirements AND wt stable
- Tube dislodged (partly or fully): stop using; do not flush, advance or reinsert; secure tube / cover site if fallen out → immediate surgical assessment or ED. Tube blocked: do not force; contact upper GI surgical team same day
- Surgical review 05/11/26 — timing of tube removal per surgeon
- Oncology review 12/11/26 re adjuvant treatment
- GP informed via discharge summary
Who is reading, and what do they need?
Ms Ballantyne is a specialist community dietitian who will take over feeding and weight review but has not seen the patient. She needs diagnosis, surgery, current regimen, nutrition status, risks and clear criteria for reducing feeds. She does not need ward-level detail or background explanations of enteral feeding.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Ivor Lewis oesophagectomy with feeding jejunostomy on 29/09 for lower oesophageal adenocarcinoma | Gives the reader the diagnosis, the operation and the reason the patient is tube fed, which frames the whole referral. |
| Refeeding risk: low phosphate day 3, replaced, now within normal range | Relevant nutrition-related risk the community dietitian should know, and it is resolved, so state both the event and the current result. |
| Discharge weight 74 kg, about 12% loss since usual weight of 84 kg in 03/26 | Baseline for the weekly weight monitoring being requested; the dates and loss show how much has been lost. |
| Oral intake about 40% of requirements; soft moist diet, 6 small meals, early satiety | Shows how far he is from full oral nutrition, which drives the feed-reduction decisions the reader will make. |
| Mild dumping symptoms after sweet drinks; advised to avoid high-sugar drinks, take fluids between meals | Affects oral diet progression and advice already given, so the reader can reinforce it consistently. |
| 1.5 kcal/mL formula, 1000 mL over 12 hours, 20:00–08:00; requirements ~2200 kcal, 110 g protein | The reader must know the current regimen and the targets against which intake and feeds are adjusted. |
| Reduce overnight volume as oral intake rises; stop only when oral meets most requirements AND weight is stable | This is the core request and both conditions must be stated, as stopping on one alone would not match the plan. |
| Tube dislodged: stop using, do not flush, advance or reinsert; secure tube/cover site if out; immediate surgical assessment or ED. Blocked: do not force; contact upper GI team same day | Complete tube-problem actions the community service needs; give all steps for both dislodged and blocked tube together, not partially. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Wife complained that hospital parking fees are 'a disgrace' | Complaint unrelated to nutrition care; a trap that looks like family information but has no bearing on the referral. |
| Patient found hospital meals 'bland and cold' | Hospital meal complaint that does not affect home feeding; if food preferences matter, they are not recorded here. |
| Keen amateur fisherman; appendicectomy at age 19 | Social and remote history with no effect on feeding or weight monitoring. |
| Ex-smoker (quit 2010); nil alcohol since diagnosis | Not needed for a nutrition monitoring referral and adds length within a tight word limit. |
| Neoadjuvant chemotherapy completed 08/26; long-standing GORD | Background that can be compressed or dropped; the diagnosis and surgery already give context. GORD does not change the requested monitoring. |
| Pump, giving sets and 2/52 formula supplied by hospital; bowels regular | Supply and bowel detail is minor; compress or omit unless space allows, as the reader needs the regimen and tolerance more than logistics. |
A paragraph plan for this case
Open with the referral purpose and the patient's diagnosis, surgery and discharge date. Then cover nutrition status, intake, symptoms and the current feeding regimen with safety points. Close with the monitoring request, the criteria for reducing and stopping feeds, and the upcoming reviews.
Where candidates slip on this task
- Stopping feeds depends on two conditions together, oral intake meeting most requirements and stable weight; stating only one changes the plan the community dietitian will follow.
- Tube-problem advice must cover dislodged and blocked tubes completely, including securing the tube or covering the site if it has fallen out, or it is better to summarise the actions accurately.
- Weight loss is about 12% since 03/26, not since surgery; the dates matter, so give the usual weight, discharge weight and period correctly without adding trends not in the notes.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Dietetics letter tasks
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Your profession's guide: OET Dietetics. Layout and structure: OET letter format.
Questions about this task
Should the letter mention the surgical and oncology review dates?
Yes, briefly. Surgical review on 05/11/26 will decide when the tube is removed, and oncology review on 12/11/26 concerns adjuvant treatment. Both affect how long feeding support may be needed, so the reader should know them.
Is the wife's role worth including?
Yes, in brief. She attended feed training and manages pump set-up and flushes, which tells the reader who is operating the feeds at home. Her parking complaint should be left out.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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