OET letter for a patient with a head injury after a fall: how to write observations, warning signs and the plan
In an OET Nursing letter about a patient with a head injury, state when and how the injury happened, the key findings and scan result from the case notes, the observations and any warning signs the reader is asked to watch for, and who to contact. Write each instruction as a clear sentence the reader can act on, and include blood-thinning medicines if the notes mention them, because they change the risk.
Why head injury letters need precise instructions
A head injury after a fall is a common situation for older patients and for patients on blood-thinning medicines. Often the patient is observed for a period, has a scan, and is then discharged or transferred with instructions for the person who will look after them.
The reader of this letter has one main job: keep watching. So the letter must tell them clearly what happened, what was found, what to observe, what to do if something changes and who to contact. Vague wording such as "please monitor her" gives the reader nothing to act on. This is a Conciseness & Clarity issue as much as a content issue.
What to include
- The event: date, time if relevant, how the patient fell and what they hit, as in the notes.
- Key findings: level of alertness, any loss of consciousness, wound or bruising, and the scan result if given.
- Relevant medicines: especially anticoagulants or antiplatelet medicines, and any change made. See anticoagulant letters.
- Wound care: sutures, glue or dressing, and when it should be checked or removed, if the notes say.
- What to watch for: the warning signs listed in the notes.
- What to do: who to call, and how urgently, as the notes state.
- Falls follow-up: if the notes give a cause or a referral, include it briefly. Our falls and mobility guide covers this.
What to leave out
Remove anything that does not change what the reader will do: unrelated old operations, stable conditions with no new plan, minute-by-minute observation charts and details of the transport to hospital. One summary sentence about observations ("Her neurological observations remained normal for 24 hours") is usually better than a table of numbers.
Turning the warning signs into clear language
Case notes often list warning signs in shorthand. Your task is to turn them into instructions the reader can follow. Keep the meaning exactly; change only the form.
| Case-note style (invented) | Letter style |
|---|---|
| Return if: ↑ drowsiness, vomiting x2+, severe H/A, new confusion | "Please seek urgent medical review if she becomes more drowsy, vomits more than once, develops a severe headache or becomes newly confused." |
| Neuro obs 2-hrly overnight then 4-hrly | "Please continue neurological observations every two hours overnight and then every four hours." |
| Steri-strips, keep dry 5/7 | "The wound has been closed with adhesive strips and should be kept dry for five days." |
| Warfarin withheld, GP to review INR Mon | "Her warfarin has been withheld, and I would be grateful if you could review her INR on Monday." |
If the reader is a family carer, replace terms such as "neurological observations" with a description from the notes, for example "checking that she wakes easily and answers questions normally". See writing for a non-clinical reader.
Worked example (invented case)
Case summary (invented): Mrs Agnes Whitlow, 81, lives in sheltered housing with a warden on site. Tripped on a step outside 9 November, hit forehead, no loss of consciousness reported. Atrial fibrillation on apixaban. In ED: alert, GCS 15/15, 3 cm forehead laceration closed with glue. CT head: no bleeding. Observed 24 h on ward, neuro obs normal throughout. Apixaban continued per medical team. Bruising to forehead, mild headache relieved by paracetamol. Walks with stick, steady. Discharge 10 November. Warning signs per medical team: increasing drowsiness, repeated vomiting, worsening headache, confusion, weakness in arms or legs → call ambulance. Glue: keep dry 5 days. Cataract surgery 2019. Task: write to the sheltered housing warden (non-clinical).
Sample letter body:
Dear Mr Price,
Re: Mrs Agnes Whitlow, aged 81
I am writing to let you know that Mrs Whitlow, who injured her head in a fall, is returning home today. I would be grateful if you could check on her regularly over the next few days and call an ambulance if you notice any of the warning signs below.
On 9 November, Mrs Whitlow tripped on a step and hit her forehead. She did not lose consciousness. A scan of her head showed no bleeding, and the cut on her forehead was closed with skin glue, which should be kept dry for five days. She was watched closely on our ward for 24 hours and remained alert and well. She takes a blood-thinning medicine, apixaban, which the doctors have decided to continue.
She still has some bruising and a mild headache, which paracetamol relieves. She is walking steadily with her stick.
Please call an ambulance if she becomes increasingly sleepy, vomits repeatedly, has a worsening headache, becomes confused, or develops weakness in her arms or legs.
Yours sincerely,
The reader is non-clinical, so "GCS 15/15" becomes "remained alert and well", and "CT head" becomes "a scan of her head". The warning signs are exactly those in the notes, nothing added.
Mistakes to avoid
- "Please monitor her" with no detail. Say what to watch for and what to do.
- Adding warning signs from your own knowledge. Use the notes only.
- Forgetting the blood thinner. It changes the risk and may change the plan.
- Clinical jargon for a lay reader. Explain or replace it.
- A long story of the fall. One or two sentences are enough.
For the structure of the final request, see closing paragraph examples, and for urgent wording see urgent letter language.
Practise and check
Write a timed letter at /writing/, or check a letter you have written for an estimated grade and line-by-line corrections. medEmu is an independent practice tool for OET Writing for Nursing; its grades are estimates, and it is not affiliated with OET.
Sources
This guide is medEmu's writing advice, not official OET guidance and not clinical advice. All patients, findings, medicines and warning signs are invented for language practice; in the test, take every clinical detail from the case notes. The network used for this run could not reach oet.com, so no OET test facts are stated. For OET's official Writing information, see oet.com.