Nursing — Referral to GP for a COPD Exacerbation
A community nurse refers a 69-year-old man with a moderately severe COPD exacerbation to his GP for urgent review and consideration of hospital admission. The referral must convey the change from baseline, the current observations, and the nurse's clinical concern — observations alone are not enough.
Letter type
Referral
Write to
General Practitioner
Target length
180–200 words
The case notes
Patient: Mr Frank Osei, 69 years old
Background: COPD (GOLD Stage III); on salbutamol PRN, tiotropium OD and seretide BD; last exacerbation 4 months ago — treated with oral prednisolone and antibiotics at home
Current presentation: 3-day history of increasing breathlessness; sputum yellow-green and increased in volume; unwell, off food
Observations: RR 24/min (baseline 18); SpO2 89% on air (baseline 94–95%); HR 102, BP 130/80, temp 37.8°C
Respiratory: Using accessory muscles; wheeze on auscultation; reduced air entry at both bases
Current management: Salbutamol 2.5 mg nebulised at home visit — minimal improvement; unable to use inhaler effectively
Concerns: O2 saturation well below baseline; respiratory rate elevated; nebuliser response inadequate; patient increasingly anxious
Social: Lives alone; wife deceased; son lives 40 minutes away
Task: Write a referral letter to the GP, Dr Janet Brown, requesting urgent review of Mr Osei in view of a COPD exacerbation that may require hospital admission.
Writing task
Write a referral letter to the GP, Dr Janet Brown, requesting urgent review of Mr Osei in view of a COPD exacerbation that may require hospital admission.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
-
The change from his baseline: SpO2 89% vs his usual 94–95%
The deviation from baseline is more clinically significant than the absolute number alone. An SpO2 of 89% in a COPD patient with a baseline of 94–95% signals a severe exacerbation, not a routine dip.
-
The inadequate response to nebulised salbutamol
This is the clinical reason the nurse is escalating to the GP rather than managing at home. Without this, the urgency is not justified.
-
The elevated respiratory rate and the signs of respiratory distress
Objective assessment findings that tell the GP the patient needs same-day review — not a routine appointment.
Leave out
-
The full COPD medication list in detail
State his regular regimen in one line; the GP holds the prescription record. The focus is on the acute change, not the stable long-term plan.
-
Social isolation detail beyond a brief mention
Relevant as context for urgency (lives alone), but the family logistics — son 40 minutes away — do not change the clinical decision.
Criterion in focus · Purpose
A nursing referral earns Purpose marks only when the recipient knows within the first sentence both the clinical situation and the specific action requested. 'I am writing to request urgent review of Mr Osei, who is experiencing a moderately severe COPD exacerbation that may require hospital admission' is complete. 'I am writing regarding Mr Osei' is not.
Now write the letter — and find out what is blocking your Grade B
Write a 180–200 words referral letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.