The task
Original independent practice. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that it is 14:30 on 6 November 2026. Ms Kathy Cowely has already transferred from the Emergency Department to the acute respiratory unit. A laboratory result has subsequently become available.
You are the Emergency Department doctor who arranged Ms Kathy Cowely's transfer. Using the case notes, write a supplementary handover letter to Dr Cherrelle Hardie, Respiratory Receiving Doctor, Acute Respiratory Unit, Level 2, Main Building, 18 Hospital Road. Explain the newly available result, distinguish it from information already handed over, and request acknowledgement and medical review. This written update accompanies direct telephone contact. 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: Update letter.
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Which case notes belong in this letter?
Suspected severe asthma exacerbation: update
You are the Emergency Department doctor who arranged Ms Kathy Cowely's transfer. Using the case notes, write a supplementary handover letter to Dr Cherrelle Hardie, Respiratory Receiving Doctor, Acute Respiratory Unit, Level 2, Main Building, 18 Hospital Road. Explain the newly available result, distinguish it from information already handed over, and request acknowledgement and medical review. This written update accompanies direct telephone contact. 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.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Ms Kathy Cowely
- DOB: 14/03/1992 (34 yrs)
- Hospital number: 604182
Social background
- Lives with partner; independent
- Enjoys pottery classes weekly
- Complained about reception staff's manner
Medical history
- Asthma since childhood
- Asthma admission 2021; no previous intensive care
- Usual inhaler: budesonide/formoterol; established regimen included in first handover
- No known drug allergies
- Appendicectomy 2010; uncomplicated
Assessment and treatment: 06/11/26
- 2 days: cough, coryza, progressive wheeze; reliever incompletely effective
- 12:40 ED: markedly breathless; speaking in short phrases
- Widespread wheeze; alert
- Working diagnosis: suspected severe asthma exacerbation
- Oxygen, nebulised salbutamol, oral prednisolone given; administration record transferred
- Partial improvement; wheeze persisted before transfer
- 13:40 CXR: no focal consolidation or pneumothorax
First handover and completed transfer
- 14:00 first telephone handover to Dr Cherrelle Hardie: presentation, treatment, response, CXR; medication administration record supplied
- 14:15 transfer completed → acute respiratory unit
- 13:00 respiratory swab, sample collected in ED; PCR pending during first handover
Information received after transfer
- 14:25 laboratory report: influenza A detected; SARS-CoV-2 and RSV not detected
- New PCR result absent from first handover; report attached to update
- 14:28 result telephoned to unit nurse; receiving doctor's acknowledgement still pending
- Unit nurse: patient alert, supervised at 14:28
Plan
- ED senior requests urgent receiving-team medical review of new result and care implications
- No additional ED prescription since transfer
- Request confirmation of report receipt and medical review via ED extension 4210
- Send supplementary update through secure clinical messaging
- ED senior contacting receiving registrar directly now; letter supplements call
Who is reading, and what do they need?
Dr Hardie is the respiratory receiving doctor who received the initial telephone handover and medication record. She needs an identifiable patient, the new PCR findings, confirmation of completed transfer, and explicit review and acknowledgement requests. Ms Cowely’s name, date of birth and hospital number support matching; familiar assessment details need only brief context.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 14:15 transfer completed to the acute respiratory unit. | Establishes that responsibility has transferred and this update concerns a patient already on the unit. |
| 14:25 PCR: influenza A detected; SARS-CoV-2 and RSV not detected. | Provides the newly available finding and both accompanying negative results without extending their meaning. |
| New PCR result absent from first handover; report attached. | Explains why supplementary communication is necessary and identifies the supporting report. |
| 14:28 result telephoned to unit nurse; receiving doctor’s acknowledgement pending. | Identifies the communication already attempted and the outstanding confirmation requiring follow-through. |
| ED senior requests urgent receiving-team medical review of result and care implications. | States the immediate clinical action requested without prescribing undocumented management. |
| Confirm report receipt and medical review via ED extension 4210. | Makes the required response explicit and supplies the practical route for closing the communication loop. |
| ED senior contacting receiving registrar directly now; letter supplements call. | Clarifies that written communication accompanies active telephone escalation. |
| 14:00 handover covered presentation, treatment, response and CXR; medication administration record supplied. | A brief reminder establishes continuity and distinguishes familiar information from the new result. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Lives with partner; independent. | Domestic circumstances do not help the receiving doctor interpret or acknowledge this laboratory update. |
| Enjoys weekly pottery classes. | The hobby has no stated connection to the acute presentation or requested review. |
| Complained about reception staff’s manner. | This service complaint does not inform the clinical handover or outstanding acknowledgement. |
| Uncomplicated appendicectomy in 2010. | Remote surgery does not affect the stated purpose of this supplementary respiratory update. |
| Usual budesonide/formoterol regimen already included in first handover. | Although clinically relevant, the established regimen is already available; repeating it would distract from the new information. |
| Asthma admission in 2021; no previous intensive care. | Both historical details may be compressed together or omitted because the recipient already received the acute presentation. |
A paragraph plan for this case
Open with patient identifiers, completed transfer and the newly available PCR result, explaining its absence from the first handover and the attached report. If context is needed, compress the two-day respiratory symptoms, marked breathlessness, short phrases, wheeze, alertness, suspected severe asthma, treatment, partial improvement and CXR findings; childhood asthma and allergy status are optional background. Close with the nurse notification, pending medical acknowledgement, urgent review request, ED extension and direct registrar contact, using secure clinical messaging for the written update.
Where candidates slip on this task
- Keep the chronology explicit: transfer finished at 14:15, PCR was reported at 14:25, and the nurse was called at 14:28; her report of alertness and supervision does not establish stability.
- Distinguish treatments already given from later decisions: no additional ED prescription followed transfer, and the notes do not specify antiviral treatment, isolation measures or any new respiratory-unit orders.
- Report influenza A detection alongside both negative PCR findings; do not treat the CXR findings as excluding other disease or the nurse’s notification as medical acknowledgement.
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
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Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
How much of the original asthma assessment should be repeated?
Dr Hardie already received the presentation, treatment, response, CXR and medication record at 14:00. A short reminder can orient the update, but the full assessment need not be repeated. Prioritise the post-transfer PCR result, the communication gap and the requested urgent review.
Should the update specify treatment for influenza A?
The notes request urgent receiving-team review of the result and its care implications, without specifying influenza treatment. Keep that decision with the receiving team. Distinguish the nurse’s notification from the doctor’s still-pending acknowledgement, and request confirmation of both report receipt and medical review.
Sources
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