Dietetics — Discharge to GP following Inpatient Malnutrition Management
A hospital dietitian discharges a 74-year-old woman to the GP following inpatient nutritional rehabilitation for malnutrition secondary to oesophageal cancer. The discharge letter must hand over the supplementation plan, the weight trajectory, and monitoring needs so the GP can continue nutritional support after discharge.
Letter type
Discharge
Write to
General Practitioner
Target length
190–210 words
The case notes
Patient: Mrs Elsie Park, 74 years old; oesophageal adenocarcinoma on palliative chemotherapy
Presentation at admission: Weight 47 kg (BMI 18.2); MUST score 3 (high risk); 6 kg weight loss over 6 weeks; poor oral intake secondary to chemotherapy-related mucositis and dysphagia
Inpatient intervention: Modified texture diet (IDDSI level 4 — pureed); oral nutritional supplements (Fortisip Compact Protein 200 mL BD); antiemetics adjusted; SLT assessment confirmed IDDSI level 4 appropriate
Discharge weight: 49.2 kg (+2.2 kg over 12 days)
Discharge plan: Continue IDDSI level 4 diet; continue Fortisip Compact Protein 200 mL BD (NHS prescription requested); weigh weekly at GP practice
Monitoring required: Weight weekly for 4 weeks then monthly; refer back to hospital dietitian if weight drops below 48 kg or further 1 kg loss in 1 week; albumin and CRP monthly (inflammation masks albumin as nutritional marker)
Task: Write a discharge letter to the GP, Dr Niall Sheridan, summarising the dietetic management and the ongoing nutritional monitoring plan.
Writing task
Write a discharge letter to the GP, Dr Niall Sheridan, summarising the dietetic management and the ongoing nutritional monitoring plan.
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
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The discharge weight (49.2 kg, +2.2 kg) and MUST score 3 at admission
The weight trajectory — severely malnourished at admission, modest but meaningful 2.2 kg gain in 12 days — is the central clinical fact of the handover.
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Fortisip Compact Protein 200 mL BD on NHS prescription, and IDDSI level 4 diet continuation
The GP must issue the ongoing prescription and reinforce the texture level at home reviews. Without knowing the product and dose, they cannot act.
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The monitoring thresholds: refer back if weight drops below 48 kg or 1 kg loss in one week
Specific action-thresholds convert a monitoring instruction into an actionable plan.
Leave out
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The SLT assessment findings in detail
The SLT writes their own discharge communication. A brief mention — 'texture confirmed appropriate by SLT (IDDSI level 4)' — is sufficient.
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The oncology treatment regimen and chemotherapy schedule
A separate care stream. Context only: 'currently on palliative chemotherapy; fatigue and nausea are the primary barriers to oral intake'.
Criterion in focus · Content
Dietetic discharge letters are graded on whether the GP can continue the nutritional plan from the letter alone. The three must-haves: (1) the nutrition supplement product, dose and prescription status, (2) the texture level, (3) the monitoring thresholds that trigger re-referral. A letter that delivers two of three fails Content.
Now write the letter — and find out what is blocking your Grade B
Write a 190–210 words discharge 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.