The task
Original independent practice. Time allowed: 45 minutes (5 minutes reading and 40 minutes writing). Assume that today's date is 3 November 2026. Ms Ngei has attended a planned dressing review, and same-day specialist assessment has been agreed.
You are a registered nurse in an outpatient dressing clinic. Using the case notes, write a referral letter to Ms Charity Ndambuki, Burns Outreach Nurse, Specialist Outpatient Clinic, 16 Clinic Road, SW1P 3BT, United Kingdom. Request specialist burn and dressing review because Ms Ngei's hand movement is restricted. 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.
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Which case notes belong in this letter?
Small partial-thickness burn: referral
You are a registered nurse in an outpatient dressing clinic. Using the case notes, write a referral letter to Ms Charity Ndambuki, Burns Outreach Nurse, Specialist Outpatient Clinic, 16 Clinic Road, SW1P 3BT, United Kingdom. Request specialist burn and dressing review because Ms Ngei's hand movement is restricted. 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 Anita Ngei
- DOB: 06/05/1994 (32 yrs)
- Right-handed; attends planned review 03/11/26
Social background
- Lives with sister; sister available to bring her to clinic
- Works as dental receptionist; typing difficult since injury
- Usually independent; now needs help fastening clothes
- Enjoys photography; cancelled an unrelated camera-club meeting
- Sister complained about emergency department parking charges
Medical history
- No diabetes, vascular disease or previous hand impairment
- No known allergies; no regular prescribed medicines
- Previous ankle sprain fully resolved
01/11/26 — emergency assessment
- Hot-water scald: dorsal R hand, extending across index/middle finger bases
- Clinician assessed small partial-thickness burn; not circumferential
- Wound pink, moist and blistered; fingers initially moved fully
- Cooled promptly under running water for 20 minutes; rings removed
- Wound cleaned; non-adherent dressing secured with soft bandage
- Oral paracetamol used for pain; no antibiotics prescribed
- Burns service contacted; agreed outpatient review through local clinic
- Advice given: keep dressing dry, elevate hand, gentle finger movement
03/11/26 — dressing review
- Pain at rest ↓; sleep improved since emergency attendance
- Pink, moist wound; no discharge or spreading redness
- Fingers warm; sensation intact; no colour change reported
- Index/middle finger flexion restricted by pain and dressing bulk
- Difficulty holding utensils and completing personal care
- No fever or systemic symptoms; dressing clean and dry
- Temporary non-adherent dressing reapplied without constriction; flexion still limited
Referral plan
- Burns registrar contacted today; same-day outreach assessment agreed
- Request specialist burn/dressing review to permit safe hand movement
- Please arrange hand therapy advice if appropriate after assessment
- Sister will accompany her today; patient agrees to referral
- Advised urgent reassessment for worsening pain/swelling, fever or feeling unwell
- Patient disliked the waiting-room music during her first attendance
Who is reading, and what do they need?
Ms Ndambuki needs the burn's site, assessed depth, current movement restriction and the agreed same-day assessment arrangements. Right-handedness and effects on typing, utensils and personal care explain functional importance. Relevant medical history and medicines can be brief. The referral should distinguish recorded wound observations from conclusions about infection or tissue viability, and request specialist assessment rather than prescribe its outcome.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 01/11 hot-water scald: dorsal right hand, extending across index/middle finger bases. | Locates the injury precisely and establishes the short interval before the functional review. |
| Initially assessed as small, partial-thickness and not circumferential. | Provides the documented initial classification without allowing size to minimise the present movement problem. |
| Index/middle finger flexion restricted by pain and dressing bulk. | States the specific current finding that drives the specialist referral. |
| Burns registrar agreed same-day outreach assessment; specialist burn/dressing review requested for safe hand movement. | Makes the urgency, existing agreement and intended specialist contribution explicit. |
| Temporary non-adherent dressing reapplied without constriction; flexion still limited. | Shows what has already been done and why specialist review remains necessary. |
| Pink/moist wound; no discharge/spreading redness; warm fingers, intact sensation, no reported colour change. | Supplies current observations for assessment without declaring infection or circulatory compromise excluded. |
| Right-handed; typing, utensils, fastening clothes and personal care affected. | Demonstrates meaningful functional impact beyond the burn's recorded size. |
| Hand therapy advice if appropriate; sister accompanying today; patient agrees to referral. | Supports practical attendance and assessment-led rehabilitation planning without assuming a therapy decision. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Photography hobby and cancelled unrelated camera-club meeting. | The unrelated cancellation does not demonstrate burn-related functional loss; the documented daily activities already do. |
| Sister complained about emergency department parking charges. | The complaint does not affect today's clinical assessment or the sister's confirmed transport support. |
| Previous ankle sprain fully resolved. | It has no bearing on current hand movement or dressing management. |
| Patient disliked the waiting-room music. | This service preference contributes nothing to the specialist handover. |
| Initial 20-minute water cooling and ring removal. | Completed first aid is useful historical context but can be compressed or omitted from this current movement-focused referral. |
| Earlier urgent-reassessment advice. | Recounting prior counselling is optional in this agreed same-day handover; the current findings and confirmed specialist assessment take priority. |
A paragraph plan for this case
Open with the agreed same-day specialist review for restricted finger flexion, then identify the 1 November scald, its exact hand location and initial assessed depth, noting that movement was initially full. Develop today's observations, persisting limitation after temporary redressing and dominant-hand functional effects; pain improvement, absent fever/systemic symptoms, a clean dry dressing, relevant medical history, allergy/medicine status, initial cleaning and dressing, paracetamol without antibiotics, prior burns-service contact and advice to keep the dressing dry, elevate and move fingers gently are optional concise context. Close with the specialist burn/dressing request, conditional hand therapy advice, consent and the sister's accompaniment.
Where candidates slip on this task
- Do not describe a small, non-circumferential burn as harmless: restricted index and middle finger flexion persists after temporary redressing and is the reason for same-day review.
- Keep the initial partial-thickness assessment separate from today's observations; pink moist tissue, warm fingers and intact sensation do not justify excluding infection or other complications.
- Preserve the conditional request for hand therapy after assessment, and avoid inventing exercises, dressing products, antibiotics or work restrictions beyond the documented specialist review request.
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
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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Why refer urgently when pain at rest has improved?
The referral is driven by restricted index and middle finger flexion attributed to pain and dressing bulk, with limitation persisting after temporary redressing. Resting pain and sleep have improved, but that does not establish restored function. The burns registrar has already agreed to same-day outreach assessment.
Which daily-life details best support this referral?
Right-handedness, difficulty typing at work, holding utensils and fastening clothes directly demonstrate the injury's functional impact. They can be grouped briefly rather than narrated separately. Photography and the unrelated camera-club cancellation add little because the notes do not connect that cancellation to impaired hand function.
Sources
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