How to transition into the mid-game?

[Silent Ember]

Hi, folks. I've been playing Project Hospital consistently for about a week now and I've started many hospitals to test different things.

For ease of communication, let me define three stages of the game:
Early game: setting up ER, X-ray, first specialist offices, and labs
Mid game: making use of hospitalizations, surgeries, and ambulances
Late game: expanding the hospital to include fully functional departments

I find that I have a pretty optimized early game. I can keep a 5-star prestige rating every day, and there are few enough patients that I can control each one of them manually. I hire the more expensive doctors with the Advanced Diagnosis specialization for all offices (ER and specialist) so that they can solve diagnoses like Contusion vs Fracture or Athlete's Foot vs Nail Fungus without the need for tests (X-ray and Fungal Cultivation respectively) and more quickly diagnose things that are a bit of a pain to narrow down, such as Viral vs Bacterial Tonsillitis. I usually get a consistent 5–7k profit each day or a 9–11k profit with tweaked XML files to get more 5 more patients per insurance company.

However, when I open hospitalization and start receiving more patients, manual management becomes too much to handle. I spend more time clicking on/searching for patients to see if they're on manual mode than actually diagnosing. And when my doctors are "left unsupervised," regardless of their outstanding diagnostic skill, they're still sending patients to labs, radiology, and hospitalization willy-nilly.

Here's a screenshot of my lab waiting room:
https://steamcommunity.com/sharedfiles/filedetails/?id=1855472327

4 of the 10 patients already had a 100% diagnosis selected (two UTIs, Crohn's, and Grave's) and could be treated. Instead, the doctor sent them to get tested.

2 of the 10 patients have a 50/50 change at one disease (Nail Fungus vs Athlete's Foot and Pyelonephritis vs Kidney Stones) and Differential Diagnosis hadn't been attempted. I find that, in these 50/50 situations, differential diagnoses often solve the case. I know that they always do for the Athlete's Foot anyway.

The remaining 4 patients who actually needed a definitive diagnosis all had the Differential Diagnosis option still available, and some of them even had low-discomfort procedures available, such as Physical Examination or Speech Listening. Those are all things I would like my doctors to have attempted before sending the patient to get a time-costly lab test.

A similar situation happens with radiology and hospitalization. All patients who get a 100% Bronchitis diagnosis get sent for a chest X-ray. Patients who have Contusion vs Fracture get sent for an X-ray before Differential Diagnosis. Two days ago I found a patient with an uncertain Athlete's Foot vs Nail Fungus diagnosis hospitalized, taking up an expensive bed and nurse time.

This requires me to hire more technicians and nurses, buy more equipment (with very high costs), and I usually still get long queues with patients complaining about long time and giving me a prestige hit. Invariably, at this stage, my profit margin gets cut to less than 1k, and sometimes I start losing money.

I'd love to know if there's a way to tweak the XML files to assign a higher priority to the Differential Diagnosis option.

I'd also love to hear from fellow players how they manage to transition into the mid-game stage. What's the secret?

Thanks a lot!

[iancw]

I don't have a solution, but I would also like to see differential diagnosis become the default if there are only two things to choose from. It defeats the purpose of hiring the advanced diagnosis skill if it only gets used in manual control.

[Commandokai]

Well, there are a couple of ways to handle it, personally I hire a few more staff to handle all the extra lab tests so they dont get behind and only handle the difficult more interesting cases myself, you could also try changing the diagnostic certainty level required, its default is set to medium in each department panel, I have never changed it, but I assume that if you set it to low they wont run as many tests or try to find the cause of as many lesser symptoms once they pick a diagnosis at an earlier stage, of course the chances of it being an incorrect diagnosis go up, but that's the risk you have to weigh for being more efficient with your staff's time.
But yeah you're not really meant to micromanage every patient once you get more than one department, you have to delegate and just trust your hired staff, of course mistakes often happen, but if it all just worked perfectly it wouldnt be very interesting or realistic IMO, sometimes people need to be fired for their incompetence ;) good luck.
Oh also keep trying to unlock any grants chains that seem close, which also gets you better paying patients as you progress.

[EndlessSauron]

I agree with Commandokai, generally once I feel comfortable that ER is handling the patient load, I will open the next departments clinic. This can then lead into opening more clinics, the bonus to this is that your patient load gets spread out across all clinics. The issue with this is that once you open a hospitalization for any of those clinics people will start demanding that they need hospitalization and ♥♥♥♥ hits the fan lol.

[dr.desastro]

I always wondered, why we are to make so many duplicates of rooms we already have? I mean, we have a general surgery and it needs its own HDU units and observation rooms. Once we start with another department we need those again and again - even if they are equipped identically. The doctors visiting make the difference here. To make things even worse, hospitalisation seems not to generate money at all unless you can do a surgery. Looking at the stat screen I see that all money generated by the clinics will be eaten up by the staff of the hospitalization units as well as labs and radiology departments. Those generate nothing but cost plenty of money to build and uphold. And the number of patiens per day is restricted by the tasks solved for the greatest part. I can have a very profitable clinic but when it comes to hospitalization my budget takes a nosedive because patients pay for a disease and not for the services, treatments and examinations they underwent. If billing was done differently, the game itself would play a lot better.

[MedJet]

I have noticed the proclivity of patients under computer-controlled doctors to invariably end up sitting on their fannies in the STAT lab lobby. I don't employ manual control (excepting for trauma patients) and just deal with the glut of patients leaving. Thus, my patient treatment per day hovers around 68-72%. I wish they'd deal with the ridiculousness of doctors over-utilizing the lab (especially when their stats are appreciable) and the diagnostic panel only includes one or even no other possible disorder to be ruled-out. I am into the later stages of the game, though my hospital isn't processing massive numbers of patients I have unlocked Overcure, maintain a perfect prestige nearly every day (key for profit). I'm not sure there are any "secrets" per-se, but rather managing the rate of your expansion so you maximize capacities for profit and minimize the losses (which will happen); some departments simply post a loss per day simply due to the cost of hospitalization staff even when few patients are being admitted. I routinely make 8-16k (profit), with occasional days of 25-38k (profit) days in between ( say perhaps 2 out of 10 days with a few where I'm in the red). The only other piece I'd mention is to have a robust and finely-tuned cardiology unit. It seems to be a very consistently lucrative dept vs some others.

[Silent Ember]

Thank you all for your valuable suggestions.

After playing the game a bit longer, I realized it would be unfeasible to manually control every patient, and not because of the limit the game places on the number of patients you can "favorite/control," but actually because, in a busy hospital, you'd be getting popups nonstop and each day would take several minutes to finish.

In this respect, I really would like to see the devs improving the behavior of doctors to make the Advanced Diagnosis specialization and Differential Diagnosis procedure more valuable in unclogging labs and radiology. And no more tests for clinic patients who have already been diagnosed to 100% certainty.

After starting anew with multiple hospitals, I believe I have found a decent path that allows me to build a profitable setup without going bankrupt and transition smoothly into the mid-game. It involves opening hospitalization/surgery at the General Surgery department before ER hospitalization, ICU, and even the night clinic.

I've been manually controlling all General Surgery patients from the departmental patient ledger, which enables me to quickly identify and treat dangerous "blinking" conditions before they lead to a collapse. Adding a few more non-surgery nurses and doctors also allowed me to maintain a constant flow of surgeries in the day shift.

For the past 6 in-game days I've been running this, I got an average 22k net profit per day. 100% prestige every day. No collapses, no patient deaths.

Now I have the funds and the cash inflow to expand and open ER hospitalization and ICU without getting dragged down. I can also afford more lab & radiology techs.

Edit: when I don't use manual control at General Surgery, my daily profit seems to fall by 5–8k, mostly due to patients who left before they were hospitalized (doctors overutilizing labs before hospitalizing patients).

[Silent Ember]

Below are examples of what's causing the profit drop when I let the staff run the hospital without manual input:

https://steamcommunity.com/sharedfiles/filedetails/?id=1866713266

https://steamcommunity.com/sharedfiles/filedetails/?id=1866715114

https://steamcommunity.com/sharedfiles/filedetails/?id=1866711617

https://steamcommunity.com/sharedfiles/filedetails/?id=1866722851

https://steamcommunity.com/sharedfiles/filedetails/?id=1866720793

Unfortunately, only the first guy managed to get treated.

Yes, I know I could just open a night clinic and these patients wouldn't be sent home. But wouldn't it be better to change the default behavior of doctors after reaching 100% diagnosis?

[EndlessSauron]

This'll sound stupid, but the reason they are running test at 100% is likely because you have the department set to "high" turn the department to medium and it should reduce this but it wont eliminate it. The downside of doing this is youll have patients come in and be mistreated, but this also can be mitigated by having more skilled doctors.

[Silent Ember]

Originally posted by Endless:

This'll sound stupid, but the reason they are running test at 100% is likely because you have the department set to "high" turn the department to medium and it should reduce this but it wont eliminate it. The downside of doing this is youll have patients come in and be mistreated, but this also can be mitigated by having more skilled doctors.

All my departments are actually at Medium.

[EndlessSauron]

Welp lol, thats what i mean. . . Dev stated that should prevent the issue but I figured it didn't work. Was worth a shot i suppose. . . Sorry

[MedJet]

I certainly wish they'd end the medium confirmation level = running multiple STAT lab tests to confirm a diagnosis that's already showing 100%. It's ridiculous.

[EndlessSauron]

Ive checked the game files but dont see anyway of doing this. Must be something only the devs can do

[Silent Ember]

https://steamcommunity.com/sharedfiles/filedetails/?id=1867098171

Recently came across this.

Patient was put into ER Observation for Lactose Intolerance. He had undergone:

• Triage
  
• Interview --> Diarrhea & Vomiting
  
• Abdominal palpation --> Abdominal cramps
  
• Blood test --> Lactose intolerance
  
• ~~Microbial cultivation~~
  
• ~~Stool analysis~~
  
• Physical examination
  
• Temperature measurement
  
• Speech listening

Only the three examinations in bold uncovered symptoms.

After all that was done and the diagnosis was already confirmed to 100% AND all symptoms had been discovered, the patient was still sent to get a CT - Enterography (which doesn't work at night so he was essentially sitting on his ass).

[dr.desastro]

I still believe the biggest issue is, that you only get money per case and only if you treat the disease 100%. In reality, meet a radiologist - you will get a bill for X-Ray diagnosis. Send blood to the lab...get a bill. Lie in a hospital bed - get a bill for bed and board. Lie in a fancy bed with blinking machines that go beep...get a fancy bill that makes your heart go beep-boop-tilt. Even if you send away the patient because you cannot treat him he is billed for your effords on the case. By expanding we lose more money than we gain, if we are not careful.
The problem is, that we only have a limited number of patients and only in fact the clinics make the money which is eaten up when you expand because you see in reality how hospitals work - and avoid becoming broke.

[MedJet]

Originally posted by dr.desastro:

I still believe the biggest issue is, that you only get money per case and only if you treat the disease 100%. In reality, meet a radiologist - you will get a bill for X-Ray diagnosis. Send blood to the lab...get a bill. Lie in a hospital bed - get a bill for bed and board. Lie in a fance bed with blinking machines that go beep...get a fance bill that makes your heart go beep-boop-tilt.
The problem is, that we only have a limited number of patients and only in fact the clinics make the money which is eaten up when you expand because you see in reality how hospitals work - and avoid becoming broke.

And?