Emergency Observation -> ECG

[iancw]

Is anyone else having this issue? It could be a Mod thing but thought I'd check.

1. Emergency patients sent to Observation
2. Various diagnosis tests run, patient diagnosed
3. Patient is booked for ECG (after diagnosis)
4. ECG never occurs but patient is kept in Observation waiting (ECG card has gone gray)
5. Patient collapses as they haven't been sent to a department for treatment, but have been waiting in Obs for an ECG.

I have ECG available in my Radiology department. At first I thought it was overworked but having built another ECG there has been no change to the issue (and the techs have plenty of time to wander around to various common rooms). There are also spare nurses to transport patients to ECG.

The ECG doesn't appear connect to the diagnosis- for example I've had patients with no unknown symptoms and an ankle contusion stuck waiting for a phantom ECG.

If I manually change patient department and cancel the ECG they are immediately redirected to the treatment department.

[Flex0r75]

Observation and TC from emergency dept. and ICU should never order ECG in my opinion. They have the 'Heart Monitoring' which has the same diagnostic function without need for patient transport.

[jirka_oxymoron]

Originally posted by iancw:

Is anyone else having this issue? It could be a Mod thing but thought I'd check.

1. Emergency patients sent to Observation
2. Various diagnosis tests run, patient diagnosed
3. Patient is booked for ECG (after diagnosis)
4. ECG never occurs but patient is kept in Observation waiting (ECG card has gone gray)
5. Patient collapses as they haven't been sent to a department for treatment, but have been waiting in Obs for an ECG.

I have ECG available in my Radiology department. At first I thought it was overworked but having built another ECG there has been no change to the issue (and the techs have plenty of time to wander around to various common rooms). There are also spare nurses to transport patients to ECG.

The ECG doesn't appear connect to the diagnosis- for example I've had patients with no unknown symptoms and an ankle contusion stuck waiting for a phantom ECG.

If I manually change patient department and cancel the ECG they are immediately redirected to the treatment department.

Hi, would you please send us the save file with the stuck ECG patient at Observation? As far we know the only way for patients with ECG in the queue while hospitalized at observation is if the examination was prescribed before hospitalization and even after that ECG is performed without problem when we check. Please upload the file to forum [projecthospital.forumotion.com] or send us by any other means.

Save file location:
- Win: C:\Users\USERNAME\AppData\LocalLow\Oxymoron Games\Project Hospital\maps
- Linux: /home/USERNAME/.config/unity3d/Oxymoron Games/Project Hospital/maps/
- Mac: /Users/USERNAME/Library/Application Support/unity.Oxymoron Games.Project Hospital/map

[Flex0r75]

Originally posted by jirka_oxymoron:

Originally posted by iancw:

Is anyone else having this issue? It could be a Mod thing but thought I'd check.

Hi, would you please send us the save file with the stuck ECG patient at Observation? As far we know the only way for patients with ECG in the queue while hospitalized at observation is if the examination was prescribed before hospitalization and even after that ECG is performed without problem when we check. Please upload the file to forum [projecthospital.forumotion.com] or send us by any other means.

Save file location:
- Win: C:\Users\USERNAME\AppData\LocalLow\Oxymoron Games\Project Hospital\maps
- Linux: /home/USERNAME/.config/unity3d/Oxymoron Games/Project Hospital/maps/
- Mac: /Users/USERNAME/Library/Application Support/unity.Oxymoron Games.Project Hospital/map

Hi, I think that may explain what happens to me. I have the cardiology room set to clinic patients only (because hospitalized patients either have their specific dept. cardiology room or they can use Heart Monitoring if sent to observation on the Emergency dept.). So if the clinic doctor orders tests, including an ECG, it is fine. But if the clinic doctor also sends the patient to observation, the patient is now stuck with an ordered ECG which can no longer be performed.

It should be easy to recreate in a normal fully functional hospital with a cardiology room on Radiology dept. with the technician set to accept clinic patients only. It happens to about 5-10 Emergency clinic patients sent to observation every day.

[alcangel_neal]

Not sure if this thread is still alive but I'm having a similar problem. I built a Cardiography Unit (as part of the Radiology Department) and set it to only do Clinic exams, but when patients are sent to Observation the Doctors will queue an ECG instead of a Heart Monitoring exam and the patient will sit waiting for hours until it complains about their wait time :/

[Flex0r75]

You can get around this by either not building the cardiography unit at all or disabling it completely.

Because many patients being sent to cardiography by the clinic doctor end up being hospitalized anyway this removes the ECG test and sends the patient straight to observation to get their heart monitored.

I ended up taking (in addition to above workaround) control of all observation and trauma patients anyway as my hospital grew in number of departments and patients. I want to keep lower priority patients on observation as long as possible, for them to be as fully diagnosed and treated as possible, before sending them to their departments. Once you get the penetrated kidneys, traumatic brain injuries, ruptured aortas and thorassic gunshot victims you want every specialized dept. doctor and nurse as freed up as possible for emergency back to back surgeries.

But this is getting into real min-max territory. Your hospital will do fine, even with a death or 2 a day, if you like the more hands-off approach. In any case I would forego using a radiology dept. cardiology room.

Just in case the dev is reading along. The problem is very simple, the clinic doctor orders a valid test (ECG at the clinic-patient-only cardiology room) but then ALSO sends him to observation (as it's probably serious I guess) to carry out that test. Once he is sent to observation however, he stops being a clinic patient and is now a hospitalized patient. So now your patient will wait hours upon hours for an invalid test that no one can perform while having the machine that can also perform the test right next to his bed. It is rather silly.

[alcangel_neal]

@Flex0r75 Thanks for the response, wasn't sure anyone would pick this up!

TBF I find a lot of the clinic Dr's behaviours a little odd at times; pretty much every patient coming in starts with an interview then... a speech listening test, regardless of known symptoms... but hey I'm not gonna question their diagnostic process!

So I ended up binning the cardiography lab for Radiology as you suggested and it fixed the problem immediately, I do however have some follow up questions: Can you auto manage patients who are admitted to observation (Presumably if you auto manage all patients for Emergency Department that covers all clinic patients too?) as I already auto manage Ambulance patients via the ambulance info page.

Also I tend to try to shift patients from observation as soon as possible so my 'Trauma Centre' staff are all free when the ambulance comes screeching in, do you find this to make a difference holding them up in observation instead of punting them to a ward quicker?

I do very much enjoy the hands on approach, and quite often end up with a dozen or so patients under my control each day, even if it's just to stop them being sent for a CT/MRI/Angio just to find that last unknown symptom (i.e. to save them using up my diagnostic bandwidth for menial symptoms). On a side note, if a Dev does come across this, is there any way to mark a patients as 'Treated/no further diagnosis required' and therefore stop doctors auto queuing any more diagnostics without having to have them under user control?

[Flex0r75]

Happy to help! I left each clinic to their own devices and would love a feature similar to the automatic patient takeover of ambulance arrivals for when a clinic doctor hospitalizes a patient. Not just General Clinic -> Observation, but every dept. even. I just manually take over the ones on their way over to observation as they get admitted. Throughout each day I would make a few passes through the specific departments' hospitalized patient lists to spot the ones hospitalized by the clinic doctors of those departments.

The last hospital I played was mostly pre-fab and I left the Trauma Center and Observation as they were, on seperate floors, with each their own doctor and nurse stations. You can set the doctors and nurses to specific tasks so that both the Trauma Center and Observation each have their completely seperate dedicated doctor and nurses staff. This way Observation patients will never interfere with your ability to treat ambulance arrivals and collapses. I also had some nurses that didn't tend to patients care and needs but were on patient transport duty only.

I tend to just go with the doctors ordering tests when obviously no longer required, even going as far as pre-emptively ordering them myself just to make sure they don't go around ordering a few duds before the actual required one to discover the final symptom. They will often still do patient interviews and basic tests on completely treated and diagnosed patients prior to release but I also condone that as it 'feels' like it would (or should) happen in real life as well.

Some more general tips.
If you have a cardiac arrest collapse on a patient that is already hospitalized in Cardiology, scheduled for surgery (a common occurance), do this to streamline his treatment. Pause the game, set patient to manual control, clear all patient queues, then order defibrilation, then order the surgery and then, importantly, clear the diagnosis and leave it empty. The patient will now be re-animated in his hospital bed (make sure there is a defib inside the ward with the patient) and be operated on after. This will prevent the patient being sent to the ICU which is a bonus because ICU means an extra day of being admitted. This only works for this specific type of collapse.

In this same vein, if you have any other type of collapse on a patient that already has a diagnosis and want to prevent a transfer to the ICU you can use the same trick as above. Manual control, clear queue and remove diagnosis. The patient will now be sent to Trauma instead. This too is mainly to streamline the treatment and release of patients that simply aren't sick enough to justify being admitted to ICU, spending an entire extra day in hospital. A mild affliction leading to the dehydration collapse? The water in Trauma is just as good. Traumatic Brain Injury and you go into a coma? Have all the ICU and please live!

You can switch departments mid-scan. If you already know what's wrong and where the Trauma/Observation patient needs to go but you still need the scan taken to actually be able to treat the patient you can have Traume/Observation order the test and deliver the patient to the test and switch to the department you already know the patient has to go to. The patient will now be picked up by one of the relevant departments' nurses and be on his way to getting treated.

Set ICU doctors to also be an anesthesiologist. As you might have noticed I like to keep the ICU as empty as possible. But I still like to have doctors there of course. If you set a few of them to also be an anesthesiologist they can still be useful by alleviating pressure on surgery teams for the different departments.

Just a few of the things I remember from playing this game way way way too much haha,

[❆🎄Douglas 🎁 🎂]

This was reported in 2020 and still not fixed. In 2 day having hospitalization I already got this bug twice.