OET urgent transfer letter for a deteriorating patient (sepsis, worsening condition)
When the case notes describe a patient who is getting worse, for example with suspected sepsis, the OET letter should state the urgency and the request in the first sentence, then give only the recent changes the receiving team needs: when the deterioration started, the key observations or results named in the notes, what has already been done and when, and current risks such as allergies. Background history should be brief and placed after the urgent information.
Why deterioration letters are different
Most OET-style letters describe a stable patient and a plan. Some case notes describe a patient who is getting worse: a nursing home resident with a new fever and confusion, a post-operative patient whose observations are changing, or a community patient with a worsening wound and signs of infection. The writing task may ask you to refer or transfer the patient for urgent assessment.
In these letters, the reader's first question is "how urgent is this, and what do you need from me?" The structure must answer that before anything else. For general urgency wording, see urgent letter language.
Accuracy note: this guide is about letter writing. It does not explain how to recognise or treat sepsis. In a real letter, use only the observations, results and actions in the case notes, and follow local clinical guidance.
Order of information
| Order | Content | Example (invented) |
|---|---|---|
| 1 | Urgency, patient and request | "I am writing to request urgent assessment of Mrs Pires, who has shown signs of possible sepsis since this morning." |
| 2 | What has changed and when | "She developed a fever and new confusion at 06:00 today." |
| 3 | Key observations and results named in the notes | "Her temperature was 38.9°C and her heart rate 118 beats per minute at 08:00." |
| 4 | Action already taken, with times | "A urine sample was sent at 07:30, and her GP was contacted at 08:15." |
| 5 | Safety information | "She is allergic to trimethoprim." |
| 6 | Brief background | "She has dementia and normally walks with a frame." |
| 7 | Contact and handover detail | "Her daughter has been informed and will meet her at the hospital." |
All values in the table are invented and are examples of format, not clinical thresholds.
Showing change, not just numbers
A number alone does not show deterioration; a comparison does. Where the notes give a baseline, use it.
| Weak | Better |
|---|---|
| "Confused." | "She has become confused since this morning; she is normally oriented." |
| "BP 92/58." | "Her blood pressure has fallen to 92/58 mmHg from her usual 130/80 mmHg." |
| "Not eating." | "She has eaten and drunk very little over the past 24 hours." |
| "Wound red, hot, pus." | "The wound has become red and hot, with discharge, over the past two days." |
For formatting units and results, see vital signs and test results in letters. For times and dates, see dates and times.
Worked example (invented case)
Notes (invented): Sunnybank Care Home. Mr Arturo Lindqvist, 84. Background: Parkinson's disease, type 2 diabetes, indwelling urinary catheter since Feb. Usual state: alert, walks short distances with frame, eats independently. Today 1 Nov: 05:30 found shivering, temp 39.1°C. 06:00 new confusion, pulling at catheter. 07:00 HR 112, BP 96/60 (usual approx 135/80), RR 24. Catheter urine dark, cloudy, offensive. Drank little since yesterday evening. Paracetamol 1 g given 06:15. On-call GP spoke to at 07:15: advised hospital transfer, suspected sepsis, possible catheter-related urinary infection. Ambulance called 07:20. Allergy: penicillin (anaphylaxis 2015). Medications list attached. Daughter (Ms Rosa Lindqvist) informed 07:25, will go to ED. Enjoys watching football. Wife died 2019.
Selection:
- Keep: urgency, suspected sepsis wording, onset times, observations compared with usual, catheter and urine changes, reduced intake, paracetamol with time, GP advice, penicillin anaphylaxis, Parkinson's and diabetes (briefly), usual function, daughter.
- Leave out: football, wife's death, and the care home's internal routine.
Letter body:
I am writing to request urgent assessment of Mr Arturo Lindqvist, aged 84, who is being transferred to your department this morning with suspected sepsis, possibly from a catheter-related urinary tract infection.
Mr Lindqvist was found shivering at 05:30 today, with a temperature of 39.1°C, and he became confused at 06:00. He is normally alert. At 07:00, his heart rate was 112 beats per minute, his respiratory rate was 24 breaths per minute, and his blood pressure was 96/60 mmHg, compared with his usual reading of approximately 135/80 mmHg. His catheter urine is dark, cloudy and offensive, and he has drunk very little since yesterday evening.
He was given paracetamol 1 g at 06:15. The on-call GP was contacted at 07:15 and advised hospital transfer. Please note that Mr Lindqvist is allergic to penicillin, which caused anaphylaxis in 2015.
He has Parkinson's disease and type 2 diabetes, and he has had an indwelling urinary catheter since February. Before today, he walked short distances with a frame and ate independently. A list of his current medications is enclosed.
His daughter, Ms Rosa Lindqvist, has been informed and will meet him in the emergency department. Please do not hesitate to contact us if you require further information.
Points to notice
- "Suspected" stays "suspected". The writer does not upgrade the GP's working diagnosis.
- Times are given for each action, so the hospital knows when paracetamol was given.
- The allergy is flagged with "Please note", and the reaction is stated.
- Background comes after the urgent information, in two short sentences.
- Medicines are referred to an attached list, if the notes say one is attached, rather than copied in full.
Common mistakes
- Opening with age, history and social background, so the urgency appears in paragraph three.
- Copying every observation from every hour.
- Using unclear note language: "↑HR, ↓BP, confused++" must become full sentences. See case notes to full sentences.
- Making the letter sound calm and routine ("I would appreciate it if you could see him at your convenience").
- Adding treatment that was not given or advice the notes do not contain.
Practise and check
Practise timed letters at /writing/, or check a letter you have written to see whether the key information comes through clearly. medEmu is an independent practice tool for OET Writing for Nursing; grades are estimates, and it is not affiliated with OET.
Related: discharge and transfer letters, infection and antibiotic letters and the Purpose criterion.
Sources
This guide is medEmu's writing advice, not official OET guidance and not clinical advice; all patients, observations and actions are invented for practice, and a real letter must follow the case notes and local clinical guidance. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.