Nursing — Urgent Referral for Suspected Sepsis in an Elderly Patient
A residential aged care nurse makes an urgent referral for an 82-year-old resident who has deteriorated rapidly with clinical features consistent with sepsis. The proficient case packs in a dense medication list, stable comorbidities and a social history that must all be cut so the urgent clinical picture comes through clearly and the receiving team can act immediately.
Letter type
Referral
Write to
On-Call Physician / Emergency Department
Target length
180–200 words
The case notes
Patient: Mr Walter Adeyemi, 82 years old, permanent resident
Background: Known UTIs (three in past 18 months, last 4 months ago), T2DM, chronic kidney disease (eGFR 42), mild cognitive impairment
Acute presentation: Staff noticed Mr Adeyemi confused and agitated since this morning; not eating or drinking; feels hot
Observations (12:00): Temp 39.1°C; HR 116; RR 24/min; BP 94/62 (baseline 130/80); SpO2 93% on air; blood glucose 18.2 mmol/L
NEWS2 score: NEWS2 = 11 (high clinical concern); escalated to nurse in charge
Urine: Dark, concentrated; strong odour; catheter in situ — urine sent for MC&S
Medications: Metformin 500 mg BD (held due to AKI risk and low BP), sitagliptin 50 mg OD, amlodipine 5 mg, ramipril 2.5 mg (held), atorvastatin 20 mg, vitamin D
Acute management: IV access obtained; 500 mL normal saline commenced; O2 via nasal cannula 2 L/min; family contacted
Incidental: Long-standing benign essential tremor; mild osteoarthritis; regularly attends church social group (no recent contact)
Task: Write an urgent referral letter to the on-call physician requesting immediate assessment of Mr Adeyemi, who has a NEWS2 score of 11 and clinical features of sepsis.
Writing task
Write an urgent referral letter to the on-call physician requesting immediate assessment of Mr Adeyemi, who has a NEWS2 score of 11 and clinical features of sepsis.
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 NEWS2 score of 11 and the deviation from his BP baseline
A NEWS2 of 11 is a clinical trigger for immediate response. The BP drop from 130/80 to 94/62 shows haemodynamic instability — together they convey urgency objectively, not just through language.
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The probable source: UTI, with catheter urine sent
The most likely focus of infection must be stated. The receiving physician will want to know the suspected source and that the sample is already on its way.
-
The acute interventions already taken — IV access, fluids, O2
Shows the physician that initial resuscitation has begun, so they arrive knowing the current status, not having to ask what has been done.
Leave out
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Essential tremor and osteoarthritis
Stable, unchanged, irrelevant to the acute presentation — the clearest distractors in this case. A proficient candidate cuts them without hesitation.
-
Church social group and recent social contact
No bearing on the acute medical referral whatsoever. Including social colour in an urgent referral dilutes the clinical message and costs Purpose and Conciseness & Clarity.
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The full routine medication list in detail
State the medications held due to the acute deterioration — metformin and ramipril — and list the rest briefly. The physician will review the full chart on arrival.
Criterion in focus · Conciseness & Clarity
Urgent referrals are the highest-stakes test of Conciseness & Clarity. The receiving team will read the letter quickly or be briefed from it verbally. Every word must earn its place. The clinical picture — high NEWS2, haemodynamic instability, suspected UTI source — must appear in the first paragraph. Background comorbidities follow briefly. Incidental findings have no place.
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.