The task
Assume that today's date is 23 October 2026. Mrs Salinas is being transferred to the residential aged care facility for permanent placement this afternoon.
You are a resident medical officer on the general medicine ward of the hospital. Using the information in the case notes, write a letter to Ms Akosua Badu, Nurse Unit Manager of the residential aged care facility that will take over Mrs Salinas's ongoing care. Address the letter to Ms Akosua Badu, Nurse Unit Manager, Residential Aged Care Facility, 42 Banksia Street. 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: Transfer letter.
Case notes
Patient details
- Name: Mrs Jocelyn Salinas
- DOB: 07/03/1941 (85 yrs)
- Admitted: 12/10/26; transfer to RACF for permanent placement: 23/10/26
- Allergy: trimethoprim (rash)
Social background
- Widowed; lived alone in 2-storey house; daily home help before admission
- Daughter = substitute decision-maker; agrees with permanent placement
- Retired primary school teacher; enjoys knitting & listening to the radio
- Son & daughter disagree about selling family home; argued loudly at bedside 19/10
- Wears glasses & R hearing aid; both packed with belongings
Medical history
- Mild Alzheimer's disease (dx 2023); baseline: independent personal care with prompting, oriented to person & place, not always to time
- Hypertension
- Osteoarthritis both knees
- Bilateral cataract surgery 2019
- Meds on transfer (reconciled medication chart accompanies pt): donepezil 10 mg nocte; amlodipine 5 mg mane; paracetamol 1 g TDS (knees); macrogol 1 sachet daily
Admission
- Presented: acute confusion, agitation at night, ↓ oral intake, T 38.4 °C
- Urine culture: E. coli; CT brain: no acute change (chronic small vessel changes)
- IV ceftriaxone 3/7 → oral cefalexin; antibiotic course completed 19/10
- Temazepam nocte (long-term): individualised GP-supervised taper commenced 6/52 before admission; taper completed & ceased 18/10, no withdrawal symptoms; sleeping 6–7 hrs/night without it
- Delirium resolved: 4AT 2/12 on 21/10 (9/12 on admission); daughter reports pt close to her usual self
- Pt complained repeatedly that hospital food 'inedible'
Progress: mobility & continence
- Deconditioned after 4/7 bed rest; physio: walks with 4-wheeled walker + supervision; 1 assist for transfers & showering
- Falls risk high: 1 unwitnessed fall at night 14/10 (no injury); bed at lowest height, call bell within reach
- New urge urinary incontinence day & night; using continence pads; bladder scan post-void residual 40 mL (normal)
- Prompted toileting 2-hrly by day & before bed → fewer episodes
- Oxybutynin not started: anticholinergic, risk of worsening cognition
- Skin intact; Braden score 15 (at risk); reposition & check pressure areas
- Normal diet; eats well with meal set-up & encouragement; wt 62 kg (stable)
- Bowels opening every 1–2 days on macrogol
Plan
- Delirium prevention: glasses & hearing aid on, regular orientation, day/night routine, encourage fluids, avoid constipation
- If new confusion/agitation → assess promptly for cause (infection, pain, constipation, urinary retention, meds) & arrange urgent same-day medical review (do not wait for routine GP visit); if clinically unstable or ↓ consciousness → call ambulance (000); urine dipstick not reliable for UTI diagnosis in older people
- Avoid restarting temazepam or other sedatives
- GP (Dr Victor Openshaw) routine review within 1/52; Na 132 mmol/L on 20/10 (baseline 136) → repeat UEC in 1/52
- RACF physio: continue walking program; referral to continence nurse advisor for assessment
- Daughter to visit afternoon of 23/10 to help her settle
Who is reading, and what do they need?
The reader is a nurse unit manager who will run day-to-day care but was not on the ward. She needs what happened, the patient's current baseline, ongoing risks, and exactly what staff should do if confusion returns. She does not need diagnostic reasoning or social history already settled, so detail should be practical and brief.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Acute confusion, night agitation, ↓ oral intake, T 38.4 °C; urine culture E. coli; antibiotics completed 19/10 | Gives the reason for admission and confirms treatment is finished. Report findings and treatment only; the notes do not state a cause for the delirium. |
| Delirium resolved: 4AT 2/12 on 21/10 (9/12 on admission); close to usual self | Sets the current status and a comparison point so staff can recognise any change from the baseline of mild Alzheimer's disease. |
| Temazepam taper completed and ceased 18/10, no withdrawal, sleeping 6–7 hrs; avoid restarting | A long-term sedative has been stopped, so staff must know it is not to be restarted, and that sleep is currently adequate without it. |
| High falls risk: unwitnessed night fall 14/10; walker with supervision; 1 assist for transfers and showering | Directly determines staffing, supervision and night-time safety measures on arrival. |
| New urge incontinence; post-void residual 40 mL; prompted toileting; oxybutynin not started | A new problem needing ongoing management; explaining why the drug was withheld prevents staff or the GP starting it unknowingly. Continence nurse referral follows. |
| Glasses and R hearing aid on, orientation, day/night routine, fluids, avoid constipation | These are the delirium-prevention measures the facility can carry out daily. The aids are packed with belongings, so staff need to know to use them. |
| New confusion or agitation: assess cause, same-day review, ambulance (000) if unstable or ↓ consciousness | The key safety-net. Give the full set from the notes: causes to check, same-day review not routine GP wait, 000 criteria, and that dipstick is unreliable for UTI. |
| Na 132 on 20/10 (baseline 136); repeat UEC in 1/52; GP Dr Openshaw review within 1/52 | An abnormal result needing action after transfer; the reader must know what is to be repeated and who reviews it. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Son and daughter argued about selling the family home at the bedside 19/10 | Private family conflict with no bearing on clinical care. Including it risks breaching confidentiality and distracting the reader. |
| Patient complained repeatedly that hospital food was 'inedible' | A trap: it looks like a nutrition issue, but she eats well with meal set-up and weight is stable. A complaint adds nothing to handover. |
| Retired teacher; enjoys knitting and radio; widowed, lived alone with home help | Background that does not change care on arrival; placement is already agreed. Space is better used on risks and actions. |
| Bilateral cataract surgery 2019; osteoarthritis both knees | Historical or stable conditions that do not affect this transfer. Knee pain is already covered by the accompanying medication chart. |
| Full medication list with doses; CT brain chronic small vessel changes | The reconciled chart accompanies her, so doses need not be repeated. The CT showed no acute change, so detail is unnecessary. |
| Skin intact, Braden 15; bowels every 1–2 days; weight 62 kg stable | Routine nursing observations the facility will reassess. At most compress to one short mention; do not list them. |
A paragraph plan for this case
Open with the transfer purpose and the admission course in brief, covering presentation, findings, treatment completed and delirium resolved. Next cover current status and risks: temazepam cessation, mobility and falls, new incontinence and why oxybutynin was withheld. Close with delirium prevention, the action plan for new confusion, follow-up (UEC, GP review, continence referral) and the allergy.
Where candidates slip on this task
- Do not write that a urinary tract infection caused the delirium. The notes give only fever, confusion and an E. coli urine culture with antibiotic treatment, so report findings and treatment without stating a cause.
- Give the complete new-confusion plan in one place: causes to assess, same-day review rather than waiting for routine GP, 000 if unstable or reduced consciousness, and dipstick unreliability. A partial list loses key safety information.
- Keep temazepam clear: the taper was GP-supervised and completed on 18/10 with no withdrawal, and it should not be restarted. Also make clear oxybutynin was not started, rather than leaving it ambiguous.
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 Medicine letter tasks
- Transfer to orthopaedics: hip fracture in a patient on warfarin transfer letter
- Urgent referral to a gastroenterologist: iron-deficiency anaemia and rectal bleeding referral letter
- Discharge to GP after pneumonia with new atrial fibrillation discharge letter
Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Should the letter mention the E. coli result?
Yes, as a finding with the treatment given and the completion date of 19/10. Do not link it to the delirium as a cause, because the notes do not state one. The reader needs to know treatment is complete.
Is the family disagreement worth a brief mention?
No. The daughter's agreement with placement and her visit that afternoon are already settled, while the argument about the family home is private and clinically irrelevant. With a 180–200 word limit, space belongs to risks and actions.
Sources
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