The task
Assume that today's date is 22 October 2026. Mr Ioannou is being discharged home this afternoon.
You are the ward physiotherapist on the respiratory ward of the hospital. Using the information in the case notes, write a letter to Ms Keerthana Hossain, Senior Physiotherapist, Community Pulmonary Rehabilitation Service, referring Mr Ioannou for pulmonary rehabilitation. Address the letter to Ms Keerthana Hossain, Senior Physiotherapist, Community Pulmonary Rehabilitation Service, Community Health Centre, 45 Station 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 Stavros Ioannou
- DOB: 14/03/1952 (74 yrs)
- Address: Flat 6, 8 Park Lane
- Admitted: 12/10/26; discharge: 22/10/26
Social background
- Lives alone in 1st-floor flat; 14 stairs, no lift
- Daughter visits 3x/wk, does shopping; able to drive pt to appointments
- Retired carpenter; enjoys watching football on TV
- Ex-smoker: quit 2021, 50 pack-yrs
- Daughter going through divorce — pt says she is 'stressed and short-tempered with everyone'
Medical history
- COPD dx 2014; FEV1 42% predicted (spirometry 03/26)
- 2 hospital admissions for COPD exacerbation in past 12/12
- Hypertension — amlodipine
- OA R knee — occasional pain on stairs
- Appendicectomy 1979
- Bilateral cataract surgery 2022
- Allergies: nil known
Admission
- Infective exacerbation of COPD: ↑ SOB, ↑ purulent sputum
- Treated with nebulised bronchodilators, oral prednisolone (5-day course completed), oral antibiotics (completed)
- Required O2 via nasal prongs, target SpO2 88–92%; weaned to room air (RA) 18/10
- Complained about hospital food and slow response to call bell at night
Physiotherapy assessment
- Mobility: independent with 4-wheeled walker; walks ~50 m before stopping to rest (pre-admission ~200 m, no aid)
- Stairs: 1 flight with rail, 1 rest halfway; requires supervision. Daughter agreed to supervise on stairs whenever pt goes out (incl. appointments)
- 6MWT 20/10 on RA: 190 m; SpO2 93% at rest → 87% at 4 min, recovered to 92% after 2 min rest; Borg dyspnoea 6/10
- Medical team: long-term O2 therapy for resting hypoxaemia not indicated at present (resting SpO2 93–95% RA); need for ambulatory O2 assessment to be reviewed at resp clinic; advise SpO2 monitoring during exercise
- Airway clearance: ACBT with PEP device, 15 min BD (morning + evening); moderate white sputum
- Inhalers: LAMA/LABA/ICS once daily + salbutamol MDI via spacer PRN — technique checked, correct
- Anxious re breathlessness; panics when SOB, avoids leaving flat; taught breathing control + recovery positions (forward lean sitting/standing)
- Pt says he 'used to walk to the pub every day' when younger
- Pt goals: walk to local shops (~400 m) and manage stairs without stopping
Plan
- Refer community pulmonary rehabilitation — start within 4/52 of discharge
- Written COPD action plan given; advised to seek urgent medical help if severe SOB or chest pain
- GP review 1/52
- Respiratory outpatient clinic 6/52
Who is reading, and what do they need?
Ms Hossain is a senior physiotherapist in community pulmonary rehabilitation, so she knows COPD and exercise programmes but not this patient. She needs his current function, exercise-related oxygen findings, safety points, anxiety, home support and follow-up dates to plan assessment and monitoring. The hospital course can be brief.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Admitted 12/10/26 with infective exacerbation; on room air since 18/10; COPD FEV1 42%, 2 admissions | Gives the reason for referral and disease severity in brief; recurrent admissions support the need for rehabilitation. |
| 6MWT 190 m on RA; SpO2 93% to 87% at 4 min; Borg 6/10 | Baseline exercise capacity and exertional desaturation are essential for exercise prescription; the recovery to 92% after 2 minutes' rest should accompany it. |
| Long-term O2 not indicated now; ambulatory O2 to be reviewed at resp clinic | States the medical position accurately and explains the advice to monitor SpO2 during exercise, which affects how the programme is run. |
| Walker, ~50 m (pre-admission ~200 m, no aid); one flight with rail, rest, supervision | Shows functional decline and the current stair limit; daughter agreed to supervise on stairs whenever he goes out, including appointments, which matters for attendance. |
| Anxious about breathlessness; panics, avoids leaving flat; taught breathing control, recovery positions | Avoidance may affect attendance and participation; the receiving physio should reinforce what he has already been taught. |
| ACBT with PEP device 15 min BD; inhaler technique correct | Tells the service what airway clearance he is doing and that inhaler technique has been checked, avoiding repetition. |
| Goals: walk to local shops (~400 m), manage stairs without stopping | Patient-defined goals give the programme its direction and a measurable target. |
| Start within 4/52; action plan given; urgent help if severe SOB or chest pain; GP 1/52; clinic 6/52 | Sets the referral timeframe, records the safety advice exactly as given, and shows who else is following him up. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Complained about hospital food and slow call bell response at night | Complaints about the hospital are not clinical and have no place in a referral. |
| Daughter going through divorce, 'stressed and short-tempered' | Private family matter. Trap: only her practical role (visits, driving, stair supervision) matters to the plan. |
| Retired carpenter, football on TV, 'used to walk to the pub every day' | Trap: the pub remark is about his past; his current goal is walking to the shops, so social colour adds nothing. |
| Appendicectomy 1979; bilateral cataract surgery 2022 | Old, unrelated surgery with no bearing on rehabilitation. |
| Hypertension on amlodipine; OA R knee with occasional stair pain | Peripheral to this referral and not described as limiting exercise; omit or compress to a brief mention. |
| Nebulised bronchodilators, prednisolone and antibiotic courses completed | Inpatient treatment detail the rehabilitation service does not need to act on; completed courses need no follow-up. |
A paragraph plan for this case
Begin with the reason for referral, the admission and the COPD background. Use the next paragraph for function, the 6MWT with oxygen findings, home and stair support, anxiety and treatments taught. End with goals, timeframe, safety advice, follow-up appointments and a closing line.
Where candidates slip on this task
- Record the safety advice as written: the written COPD action plan plus advice to seek urgent medical help if severe shortness of breath or chest pain. Do not add other symptoms or instructions.
- Describe the oxygen position carefully: long-term oxygen was not indicated at present with resting SpO2 93–95% on room air, but he fell to 87% on exertion, and ambulatory need is for clinic review.
- Make the stair arrangement clear: he needs supervision for one flight with a rest, and his daughter agreed to supervise whenever he goes out, including appointments. Do not imply he manages the 14 stairs alone.
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 Physiotherapy. Layout and structure: OET letter format.
Questions about this task
Should the daughter's divorce stress be mentioned?
No. It is personal and does not change the plan. Mention only what is useful: she visits three times a week, can drive him to appointments, and has agreed to supervise him on stairs when he goes out.
How much of the 6MWT should be included?
Give the distance on room air, the SpO2 at rest, at 4 minutes and after the 2-minute rest, and the Borg score. The receiving physio needs these for exercise prescription and monitoring, so do not add interpretation beyond the notes.
Sources
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