23 Common Telephone Triage Nurse Interview Questions & Answers
Prepare for your telephone triage nurse interview with these 23 insightful questions and answers designed to enhance your readiness and confidence.
Prepare for your telephone triage nurse interview with these 23 insightful questions and answers designed to enhance your readiness and confidence.
Landing a job as a Telephone Triage Nurse requires more than just a polished resume and a smile. It demands a unique set of skills, from clinical expertise to the ability to make quick, accurate decisions over the phone. But let’s be real—preparing for the interview can feel like navigating a labyrinth. You need to be ready to tackle a variety of questions that test your medical knowledge, communication skills, and your ability to stay calm under pressure.
Assessing a patient over the phone requires prioritizing key indicators like respiratory distress, chest pain, or neurological symptoms. This approach ensures patient safety and timely decisions that can significantly impact outcomes.
How to Answer: When assessing a patient over the phone, prioritize indicators such as changes in vital signs, the nature and onset of symptoms, and patient history. Explain your systematic approach to triage, highlighting your ability to ask targeted questions that elicit essential information quickly. Use brief examples from your experience where your prioritization led to successful patient outcomes.
Example: “I prioritize the ABCs—airway, breathing, and circulation—right off the bat. If a patient is having trouble breathing, experiencing chest pain, or has severe bleeding, those are immediate red flags that require urgent attention. From there, I ask about the onset and severity of symptoms, any associated pain, and whether there are any pre-existing conditions that might complicate the situation.
For example, I once had a call where a patient described a sudden, severe headache unlike anything they’d experienced before. Given the intensity and sudden onset, I suspected it could be something serious like a brain aneurysm or stroke. I instructed them to get to the ER immediately and coordinated with emergency services to ensure they were seen as soon as possible. It turned out to be a critical situation, and my quick assessment helped them get the urgent care they needed.”
Effective communication in emergencies is essential. Remaining calm and guiding a panicking caller through structured questions helps gather accurate information quickly, ensuring appropriate medical intervention.
How to Answer: Emphasize techniques for calming a panicking caller, such as using a soothing tone, providing clear instructions, and breaking down information into manageable steps. Mention any training or experience in crisis communication, and provide specific examples where you successfully managed a similar situation. Highlight your ability to prioritize information and make quick, informed decisions.
Example: “First, I focus on calming the caller down by using a steady and reassuring tone. It’s important to acknowledge their fear but also to instill confidence that help is on the way. I often use simple and direct language, asking one question at a time to avoid overwhelming them. For example, I might say, “I understand this is scary, but I need you to take a deep breath and tell me exactly what’s happening right now.”
Once I have their attention, I prioritize gathering the most critical information first, such as the patient’s condition, location, and any immediate risks. I use active listening to ensure I don’t miss any key details and repeat back important points to confirm accuracy. There was a situation where a parent called in a panic about their child having a severe allergic reaction. I calmly guided them through the steps to administer an EpiPen while simultaneously dispatching emergency services. By staying calm and methodical, I was able to collect all the necessary information and ensure the child received prompt care.”
Clinical guidelines and protocols are the backbone of decision-making. Familiarity with these frameworks ensures consistent, accurate assessments aligned with best practices, maintaining patient safety and high-quality care.
How to Answer: Cite specific guidelines such as the American Academy of Pediatrics (AAP) protocols for pediatric cases or the American Heart Association (AHA) guidelines for cardiovascular issues. Discuss how you integrate these protocols into your daily practice, perhaps with an example of a challenging case where adhering to these guidelines made a significant difference.
Example: “I rely heavily on evidence-based guidelines like the Schmitt-Thompson protocols. These protocols are incredibly comprehensive and allow me to quickly assess the severity of a patient’s symptoms and make informed decisions on the best course of action. For example, if a parent calls about a child with a high fever, I use these guidelines to determine whether it’s safe to manage at home or if they need to seek immediate medical attention.
Additionally, I frequently reference the CDC guidelines for infectious diseases, especially during peak flu season or COVID-19 surges. These guidelines help me provide accurate and up-to-date information to patients, ensuring they receive the best possible care based on current public health recommendations. This combination of reliable protocols helps me make confident and effective triage decisions, ensuring patient safety and care quality.”
Staying updated with the latest medical guidelines is essential. Continuous learning reflects dedication to professional excellence and the ability to adapt to new information, crucial in a field where guidelines can change rapidly.
How to Answer: Discuss strategies you employ to keep your knowledge current, such as subscribing to medical journals, attending webinars and conferences, participating in professional organizations, or engaging in peer discussions. Highlight any certifications or courses you have completed that are pertinent to the role.
Example: “I make it a priority to stay updated through a combination of professional development and leveraging technology. I subscribe to several key medical journals and newsletters that focus on telehealth and triage nursing, such as the Journal of Telemedicine and Telecare. These sources provide valuable insights and updates on best practices and emerging trends.
Additionally, I actively participate in online forums and professional networks where telehealth nurses share experiences and discuss new guidelines. I also attend relevant webinars and continuing education courses whenever possible. A recent example is a webinar on the latest CDC guidelines for managing chronic conditions via telehealth, which I found particularly useful and immediately applicable. These activities ensure that my knowledge remains current and that I can provide the best possible care to patients.”
Effective communication with non-English speaking patients impacts outcomes and safety. Demonstrating cultural competence and resourcefulness in these situations shows the ability to maintain high standards of care under challenging circumstances.
How to Answer: Emphasize your familiarity with tools and strategies, such as using professional medical interpreters, translation services, or multilingual staff. Highlight any specific training or experiences that have prepared you to handle these interactions effectively. Mention your proactive approach in learning key medical phrases in different languages or your ability to use visual aids and simplified language.
Example: “I prioritize using professional medical interpreters whenever possible, either through a third-party service or an in-house team if available. This ensures that there’s no loss of critical information due to language barriers. Additionally, I use visual aids and symptom checklists in multiple languages to help patients describe their symptoms more accurately.
There was a specific case where a patient spoke only Mandarin, and we didn’t have an interpreter immediately available. I used a translation app to communicate basic questions while waiting for the interpreter to join the call. This allowed me to gather preliminary information and ensure the patient felt heard and supported. Once the interpreter joined, we were able to conduct a thorough assessment, and the patient received the appropriate care without any delay.”
Rapid decision-making without complete information is common. Synthesizing available data, prioritizing needs, and acting decisively under pressure reflect critical thinking skills and adherence to protocols in urgent situations.
How to Answer: Outline a specific scenario that highlights your thought process and the key factors that influenced your decision. Emphasize your ability to quickly assess symptoms, consider potential risks, and utilize available resources such as guidelines or consultation with colleagues. Illustrate how your decision-making process is rooted in both your training and experience.
Example: “During a late-night shift, I received a call from a mother whose toddler had a high fever and was having difficulty breathing. The mother was understandably panicked, and I had to make a quick assessment without all the details. The child’s symptoms sounded severe, and I knew there wasn’t time to go through a full list of questions.
I immediately advised the mother to call emergency services while I stayed on the line to provide support and monitor the child’s condition. My decision was influenced by the urgency of the symptoms, the child’s age, and the potential for rapid deterioration. Ensuring the child received prompt medical attention was my top priority, and I prioritized clear communication and reassurance to keep the mother as calm and focused as possible during the emergency.”
Understanding software tools provides insight into technical proficiency and readiness. Familiarity with specific tools indicates the ability to integrate into the workflow, reducing errors during critical interactions and leveraging technology to enhance outcomes.
How to Answer: List the software tools you are familiar with and highlight your proficiency level and any specific ways you’ve used these tools to improve patient care or streamline processes. Mention any training or certifications related to these tools. Provide concrete examples of how you’ve effectively used these tools in previous roles.
Example: “I’ve primarily used EPIC and Cerner for managing patient data and call logs. Both systems have robust features that are particularly useful in a triage environment, like real-time updates and integration with electronic health records. One feature I appreciate in EPIC is the ability to quickly access and update patient histories, which is essential when making informed decisions during a call.
In my previous role, I also had the opportunity to work with specialized triage software like TriageLogic, which streamlines call documentation and decision-making protocols. I found its symptom checker tool particularly useful for ensuring that I followed best practices and provided consistent, high-quality care. Using a combination of these tools, I was able to efficiently manage high call volumes and ensure that patient records were accurately maintained, which significantly improved our response times and patient satisfaction.”
Educating patients about recognizing warning signs empowers them to make informed decisions. Effective education can reduce unnecessary ER visits, improve outcomes, and foster trust in the healthcare system.
How to Answer: Emphasize your ability to use clear, simple language and provide practical examples that patients can easily understand and remember. Discuss any specific methods or tools you use, such as visual aids or analogies, and mention the importance of verifying patient understanding through teach-back methods. Highlight any relevant experiences where your guidance led to positive patient outcomes.
Example: “I focus on clear, simple communication and tailoring the information to the patient’s level of understanding. First, I assess what they already know and identify any gaps in their knowledge. Using straightforward language, I explain the specific symptoms they should watch for, such as sudden chest pain, difficulty breathing, or severe headaches, and why these symptoms are critical.
I often use analogies or everyday scenarios to make the information more relatable. For example, I might compare the body’s warning signs to a car’s dashboard lights—when a light comes on, you don’t ignore it; you check it out immediately. I also provide written materials or direct them to reliable online resources for further reading. To ensure they understand, I always ask them to repeat the key points back to me. This approach not only educates them effectively but also empowers them to take control of their health.”
Maintaining empathy and professionalism is essential when dealing with distressed patients. Emotional resilience and communication skills are crucial for accurate assessments and providing appropriate guidance, impacting outcomes and satisfaction.
How to Answer: Highlight specific strategies you use to manage your emotions and maintain a professional demeanor. Mention techniques such as active listening, staying patient-focused, and using de-escalation tactics. Share examples from your experience where you successfully navigated challenging interactions.
Example: “Staying empathetic and professional with difficult or uncooperative callers is crucial, especially in healthcare. I focus on active listening and patience, acknowledging the caller’s emotions without taking their frustration personally. It’s important to remember that they might be scared or in pain, and my role is to provide reassurance and guidance.
In one instance, a caller was very agitated because they couldn’t get an immediate appointment for their child. I calmly listened to their concerns, validated their feelings by saying, “I understand how stressful this must be for you,” and then provided clear, actionable steps for what they could do next. By maintaining a calm tone, offering practical advice, and showing genuine concern, I was able to de-escalate the situation and ensure the caller felt heard and supported.”
Handling a patient expressing suicidal thoughts requires protocol adherence, crisis management skills, and emotional stability. Providing immediate support without visual cues ensures patient safety and appropriate escalation.
How to Answer: Outline a clear, systematic approach. Emphasize your training in crisis intervention, your familiarity with mental health resources, and your ability to remain calm under pressure. Describe specific steps you would take, such as staying on the line with the patient, using active listening, and contacting emergency services or a crisis intervention team.
Example: “First, I would ensure the patient is in a safe environment and stay on the line with them to provide immediate support. I would calmly but urgently assess the severity of their situation by asking direct questions about their thoughts and plans. Based on their responses, I would follow our protocol by contacting emergency services to intervene if there is an imminent risk.
While waiting for help to arrive, I would continue talking to the patient to keep them engaged and focused on the conversation, providing reassurance and empathy. I would also gather any necessary information to pass on to the emergency responders to ensure they have the details needed to provide appropriate care. Throughout the process, maintaining a calm and composed demeanor is crucial to help de-escalate the patient’s distress.”
Effective collaboration with other healthcare professionals ensures continuity of care. Demonstrating the ability to build a cohesive network prioritizes patient safety and outcomes, reflecting an understanding of multidisciplinary teamwork.
How to Answer: Emphasize specific strategies you use to ensure smooth and efficient collaboration. Discuss how you maintain detailed and accurate records, the importance of clear and concise communication, and your methods for following up to ensure the referred care is administered. Mention any protocols or systems you rely on, such as electronic medical records or standardized handoff procedures.
Example: “My process starts with a thorough assessment of the patient’s current situation and medical history. Once I’ve gathered all the pertinent information, I prioritize clear and concise communication. For instance, I provide a detailed yet succinct report to the specialist or healthcare professional I’m referring the patient to, highlighting critical symptoms, any immediate concerns, and relevant medical background.
I also ensure I follow up on the referral. This means I might check in with both the patient and the receiving healthcare professional to confirm that the necessary steps have been taken and that the patient is receiving appropriate care. I find that maintaining an open line of communication fosters trust and ensures continuity of care, which is vital for patient outcomes. This collaborative approach ensures that everyone involved is on the same page, ultimately benefiting the patient’s health and well-being.”
Ensuring patient confidentiality and data security is paramount. Protecting sensitive information fosters a sense of safety and reliability, enhancing patient trust and the credibility of the healthcare provider.
How to Answer: Highlight specific measures you take to protect patient data during calls, such as using secure communication systems, verifying patient identity, and adhering to HIPAA guidelines. Discuss any training you’ve received in data security and provide examples of how you have implemented these practices in real scenarios.
Example: “I always start by verifying the patient’s identity with multiple pieces of information, such as their date of birth, address, and a specific detail from their medical history. This ensures I’m speaking to the right person. I also make sure to conduct these assessments in a private space where no unauthorized individuals can overhear the conversation.
Additionally, I use secure, encrypted software for recording and accessing patient information, and I follow strict protocols for logging out of systems and securing my workstation. A good example of this in practice was when I noticed a colleague inadvertently left their computer unlocked with patient information visible. I immediately locked it and reminded them of our confidentiality protocols to prevent any data breaches. This vigilance helps maintain a high standard of patient confidentiality and data security.”
Balancing thoroughness with efficiency is crucial. Managing competing demands without compromising care reflects critical thinking and prioritization skills, essential when dealing with patients in distress or experiencing urgent issues.
How to Answer: Highlight specific strategies you employ to maintain accuracy while managing time effectively. Discuss techniques such as using structured questioning protocols, leveraging technology for quick information retrieval, and prioritizing cases based on urgency. Illustrate your answer with examples from past experiences where you successfully balanced these demands.
Example: “Balancing thoroughness with efficiency is all about having a solid triage protocol and trusting your training. When handling high call volumes, I prioritize quickly identifying the most critical cases through a series of focused, yet comprehensive, questions. This allows me to assess the severity of each situation without wasting time on unnecessary details.
For instance, when I was working during flu season, the call volumes were exceptionally high. I streamlined my approach by using a checklist of key symptoms and questions, which helped me determine the urgency of each call within the first few minutes. If a case required immediate attention, I escalated it right away; otherwise, I provided clear, concise advice and moved on to the next caller. By sticking to this structured yet flexible approach, I was able to maintain high standards of care without compromising on efficiency.”
Handling language barriers without an interpreter requires ingenuity and patience. Utilizing creative problem-solving skills and non-verbal communication techniques ensures patient safety and effective communication.
How to Answer: Highlight specific strategies you have used or would use, such as leveraging translation apps, using simple and clear language, or finding a colleague who can assist. Emphasize your commitment to patient care and how you prioritize understanding and being understood, even in challenging situations. Share a relevant anecdote if possible.
Example: “In situations where there’s a language barrier and no interpreter is immediately available, I first focus on using clear, simple language and non-verbal communication methods. I leverage translation apps as a temporary solution to understand key symptoms and concerns. Additionally, I often use visual aids like diagrams or charts to help convey important medical information.
Once, I had a patient who spoke very little English and was experiencing chest pain. I remained calm and used a translation app to ask basic questions about their condition. I also demonstrated breathing techniques and pointed to relevant areas on a medical diagram to better understand their symptoms. Meanwhile, I contacted an interpreter service and ensured the patient was stable until we could get more detailed information. This approach helped me provide immediate care while ensuring the patient felt understood and safe.”
Medication management involves ensuring patient safety and maintaining trust. Understanding protocols, attention to detail, and accurate communication prevent potentially harmful mistakes in a remote setting.
How to Answer: Highlight your systematic approach to verifying patient information, your familiarity with medication databases or resources, and your methods for clear communication. Describe any specific steps you take, such as repeating back instructions to the patient, using teach-back methods to confirm understanding, and documenting all interactions meticulously.
Example: “I always start by confirming the patient’s identity with multiple identifiers, such as their full name and date of birth, to ensure I have the correct medical records. I then review their medication history thoroughly, cross-referencing it with their current medication list and any recent changes.
Another precaution I take is using the teach-back method—having the patient repeat the instructions back to me in their own words to ensure they understand. I also provide written instructions and encourage them to ask questions if they’re unsure about anything. Double-checking dosages and potential interactions with their current medications is crucial, and I make sure to document every interaction meticulously in their medical record to maintain accurate and up-to-date information.”
Preparation for shifts is essential due to the unpredictable nature of calls. A well-thought-out strategy reveals organizational skills, adaptability, and continuous learning, maintaining high standards of care.
How to Answer: Detail a structured routine that includes reviewing recent medical updates, ensuring your workspace is organized, and mentally preparing for the emotional and intellectual demands of the job. Mention specific actions you take, such as revisiting protocols for less common conditions or setting up a distraction-free environment.
Example: “Before each shift, I start by reviewing any updates or alerts from the previous shift, such as changes in protocols or any urgent cases that might require follow-up. This helps me stay informed about any ongoing situations. I also make sure that my environment is organized and all my reference materials are easily accessible, from medical guidelines to contact lists for specialists.
Additionally, I spend a few minutes mentally preparing myself, focusing on remaining calm and empathetic, as this is crucial when dealing with patients who might be in distress. I do a quick scan of my own health and energy levels, ensuring I’ve had water, a snack, and a short break if needed. This routine helps me maintain a clear head and be fully present for each call, ready to handle everything from routine inquiries to emergency situations.”
Metrics for evaluating effectiveness go beyond call handling times, reflecting the quality of interactions, diagnostic accuracy, and prioritization of cases. Effective triage impacts outcomes, reduces hospital admissions, and improves efficiency.
How to Answer: Emphasize metrics such as patient satisfaction scores, accuracy of triage decisions, adherence to clinical guidelines, and follow-up outcomes. Highlight any experience you have with data analysis or quality improvement initiatives.
Example: “The most crucial metrics include the accuracy of triage decisions, patient satisfaction, and call resolution time. Ensuring that patients are accurately assessed and directed to the appropriate level of care is paramount, as it impacts their health outcomes and the efficiency of healthcare resources. Patient satisfaction is also key, as it reflects the quality of the interaction and the patient’s confidence in the guidance provided.
In my previous role, we closely monitored call resolution times to ensure we were efficient without compromising the quality of care. This involved analyzing call data to identify patterns and areas for improvement. For instance, by implementing a decision-support tool, we reduced average call times by 15% while maintaining high accuracy and satisfaction scores. This balanced approach allowed us to handle a higher volume of calls effectively, improving overall service delivery.”
Handling potential abuse or neglect cases demands sensitivity, empathy, and professionalism. Gathering accurate information, prioritizing safety, and collaborating with authorities test judgment and commitment to patient advocacy.
How to Answer: Describe specific strategies you use to remain calm and composed, such as employing active listening techniques to fully understand the caller’s situation. Highlight your knowledge of mandatory reporting laws and procedures, and explain how you ensure that you follow them precisely. Sharing an example from your experience can illustrate your ability to handle such sensitive cases effectively.
Example: “In calls involving potential abuse or neglect, my number one priority is to ensure the caller’s immediate safety. I remain calm and empathetic, creating a safe space for the caller to share their situation. I carefully listen and document all details while assessing the urgency and severity of the situation.
If the circumstances suggest immediate danger, I quickly contact emergency services and provide them with all necessary information. For cases that require further investigation, I follow established protocols to report the case to the appropriate authorities. Throughout the call, I offer support and resources to the caller, ensuring they feel heard and understood. I also make sure to follow up and document the case as required by my workplace’s policies. My goal is always to act swiftly and compassionately, providing the best possible care and support in such critical situations.”
Ensuring continuity of care through phone communication impacts outcomes and satisfaction. Strategies for maintaining detailed records, effective communication, and follow-up create a sense of reliability and trust.
How to Answer: Highlight specific methods you use to track patient information, such as detailed note-taking and use of electronic health records (EHRs). Discuss how you prioritize clear and compassionate communication to ensure patients understand their care plans and feel comfortable reaching out with questions. Mention any protocols or systems you follow to ensure that no patient falls through the cracks.
Example: “First, I make sure to document every detail from the initial call in the patient’s file, including symptoms, advice given, and any follow-up instructions. This way, there’s a clear record for both myself and any other healthcare providers that might be involved later.
Then, I schedule a follow-up call at a specific time, making sure to confirm the patient’s availability. During the follow-up, I review the notes from our previous conversation to ensure a seamless continuation. I also ask the patient to recount any changes or improvements in their condition to identify if further action is needed. If additional care or an in-person visit is required, I coordinate with the relevant healthcare providers and ensure the patient has all the necessary information to proceed. This methodical approach helps maintain a high standard of care and keeps the patient informed and supported throughout their treatment.”
Assessing and prioritizing patient needs remotely requires clinical judgment, communication skills, and swift decision-making. Effective action in a high-stakes environment significantly impacts care and outcomes.
How to Answer: Focus on a specific instance where your triage intervention made a tangible difference in a patient’s care. Detail the situation, the decision-making process, and the outcome, emphasizing your ability to synthesize information quickly and accurately. Highlight any collaboration with other healthcare professionals.
Example: “A patient called in late one evening experiencing chest pain and shortness of breath. They were concerned it might be something less critical like indigestion or anxiety. After listening to their symptoms and asking targeted questions, I identified that their pain radiated to the left arm and jaw, which are classic signs of a potential heart attack.
Recognizing the urgency, I calmly instructed them to call 911 immediately and not attempt to drive themselves to the hospital. I stayed on the line to provide reassurance until emergency services arrived. Later, I learned that they were indeed having a heart attack and received timely treatment because of the swift intervention. It was a powerful reminder of how crucial accurate triage and calm communication can be in saving lives.”
Stress management and burnout prevention are crucial due to the high-pressure nature of the job. Maintaining mental and emotional well-being impacts the quality of care and efficiency, reflecting dedication to personal and professional sustainability.
How to Answer: Highlight specific techniques you use, such as mindfulness practices, regular breaks, peer support systems, or structured debriefing sessions. Mention any ongoing professional development or self-care routines that help you stay grounded and effective under pressure.
Example: “I prioritize self-care and healthy boundaries to manage stress. I make sure to take short breaks between calls, even if it’s just to stand up and stretch or take a few deep breaths. This helps reset my mind and body. Outside of work, I stay physically active through regular exercise, which I find incredibly effective for stress relief.
I’m also a big believer in peer support. Discussing challenging cases with colleagues not only helps me gain new perspectives but also lightens the emotional load. Finally, I practice mindfulness and meditation daily to keep my mental state balanced. These techniques collectively ensure I stay focused and provide the best care possible without burning out.”
Handling disagreements with patients tests medical judgment, communication skills, and the ability to build trust. Resolving such conflicts effectively ensures adherence to protocols and fosters reassurance in a remote setting.
How to Answer: Emphasize your approach to listening actively to the patient’s concerns, validating their feelings, and providing clear, evidence-based explanations for your decisions. Share specific strategies you use to de-escalate tension and create a collaborative atmosphere, such as offering additional resources or involving other healthcare professionals when necessary.
Example: “Yes, I had an elderly patient who was experiencing chest pain but insisted it was just indigestion and didn’t want to go to the ER. I calmly listened to her concerns and acknowledged her feelings, but I knew the potential seriousness of her symptoms. I explained the risks associated with chest pain, emphasizing the importance of erring on the side of caution, especially given her age and medical history.
I also shared a story about a similar case where prompt medical attention made a significant difference. This helped her understand that my recommendation was based on genuine concern for her well-being. Ultimately, she agreed to go to the ER, and it turned out she was indeed having a heart attack. She later thanked me for my persistence, and it reinforced the importance of clear communication and empathy in such situations.”
Adapting quickly to changes in a patient’s condition during a call reflects critical thinking and effective response under pressure. Maintaining composure and delivering appropriate care recommendations promptly ensures positive outcomes.
How to Answer: Focus on a specific instance where you successfully navigated a sudden change in a patient’s condition. Detail the steps you took to assess the situation, the actions you implemented, and the rationale behind your decisions. Emphasize your ability to remain calm and convey clear, concise instructions to the patient or their caregiver.
Example: “Absolutely. During one of my shifts, I received a call from a patient who initially reported mild chest discomfort. As we were discussing their symptoms, I noticed a shift in their tone and breathing pattern— they began to sound more distressed and mentioned the pain was intensifying and radiating to their arm.
Recognizing these as potential signs of a heart attack, I quickly adapted my approach. I calmly instructed the patient to stop any activity and sit down, and then immediately contacted emergency services while keeping the patient on the line and providing reassurance. I stayed with them, continually assessing their condition and offering support until the paramedics arrived. Later, I learned that the timely intervention was crucial in getting the patient the urgent care they needed. This experience reinforced the importance of being alert and responsive to changes in a patient’s condition.”