Night Shifts, Codes, and More

Hello! Figured it was probably about time I directed a few more questions your way since I haven't posted one since the old forum.

1) As you all have mentioned earlier, there will be a day/night cycle and we will be allowed to assign staff to work the nightshifts for inpatient wards and the ER/A&E. However, I was curious how these night shifts would be handled. Here in America it's common practice to have residents on a rotating call shift for overnights or using a night float system, depending on the hospital. I was wondering if we will be able to torture our residents like this, assigning them to work the occasional 24hr shift or placing them on a rotating night schedule. Or, conversely, will we be hiring a completely different staff to manage the night shifts? This question is also relevant for general surgery, where it is common to have a surgeons sleeping over at the hospital on a rotating schedule to handle any emergent cases that come in overnight.

2. I was also wondering how codes will be handled in-game. Obviously the doctors and nurses working a particular ward/department will respond, but it's also common to have a code team comprised of people throughout the hospital responding as well. How will codes and the medical response be simulated?

3. Also curious how staff recruiting will be handled. Will there be any incentive to train and level up our own staff or will we be tempted to build up our bank account and then fire our inexperienced staff and go out and hire doctors/nurses with higher skills?

4. Finally, also curious how long patients will generally be held in the ER until they are transferred to another department. Do they need to wait for a doctor to do an admit to be transferred or for a bed to open up? Or do they get transferred out of the ER pretty quickly.

Anyway, that's probably enough questions for now. I've been saving them up for a few weeks if you can't tell.

Great questions!

My hope for Q3 is that we value the staff and are incentivised to train them and keep them on board. I'm really against the idea of being able to hire and fire with reckless abandon because I feel it's an unfaithful representation of the real world workplace. It's one of those things in management games where you can cheese the gameplay by hiring and firing in a way that simply isn't possible in the real world which is detrimental to the overall gameplay experience.

For Q4 I'm hoping that patients can only be admitted (or discharged) by a doctor and that beds have to be free! I do not work in the medical field, but this is how I understand it to work in the real world. Would be interesting to see how an overflow of patients is dealt with in that scenario. Recently in the UK we have had issues where the hospitals were not able to deal with patients due to the number of patients visiting them over the winter which led to patients left waiting in corridors. I'd love to see how Project Hospital could approach this during the emergencies they have planned for us.

Re: Q4, and Numptychops reply - Yes, it's normally a senior member of staff, usually but not always a doctor* who admits a patient. The Consultant (highest grade of doctor) is usually the one with discharge sign off powers, though the actual discharge process is handled by juniors and some non-medical staff. Doctors or ANP's from a specialty then assess a patient before accepting a transfer/referral to their service, and then moving them from A&E to ward. Once the patient is stabilised and underlying cause found, the patient is usually transferred or discharged pretty quickly. I don't know how it'll be handled in game, but that's typically how it works in practice.

*Some non-medical staff such as a Advanced Care Practitioner/Advanced Nurse Practitioner/Emergency Care Practitioner also have admission and discharge rights, it depends on the individual hospital's policy but is becoming more common. ACP's/ANP's/ENP's et al, are typically (some are paramedics/physios) advanced nurses who undertake additional training to perform medical roles - usually to masters/doctorate level.

The game is keeping it simple and not mixing the nurse/non-medical and doctor roles, but I thought you might appreciate some extra info, hope it's of interest!

Fading Qualia wrote:Hello! Figured it was probably about time I directed a few more questions your way since I haven't posted one since the old forum.

1) As you all have mentioned earlier, there will be a day/night cycle and we will be allowed to assign staff to work the nightshifts for inpatient wards and the ER/A&E. However, I was curious how these night shifts would be handled. Here in America it's common practice to have residents on a rotating call shift for overnights or using a night float system, depending on the hospital. I was wondering if we will be able to torture our residents like this, assigning them to work the occasional 24hr shift or placing them on a rotating night schedule. Or, conversely, will we be hiring a completely different staff to manage the night shifts? This question is also relevant for general surgery, where it is common to have a surgeons sleeping over at the hospital on a rotating schedule to handle any emergent cases that come in overnight.

2. I was also wondering how codes will be handled in-game. Obviously the doctors and nurses working a particular ward/department will respond, but it's also common to have a code team comprised of people throughout the hospital responding as well. How will codes and the medical response be simulated?

3. Also curious how staff recruiting will be handled. Will there be any incentive to train and level up our own staff or will we be tempted to build up our bank account and then fire our inexperienced staff and go out and hire doctors/nurses with higher skills?

4. Finally, also curious how long patients will generally be held in the ER until they are transferred to another department. Do they need to wait for a doctor to do an admit to be transferred or for a bed to open up? Or do they get transferred out of the ER pretty quickly.

Anyway, that's probably enough questions for now. I've been saving them up for a few weeks if you can't tell.

Hi, welcome to the new forum! Here are a few quick answers:

1) The way shifts work is you hire staff separately for dayshift/nightshift, but you can also transfer your employees between shifts if needed - so you can actually tell your residents that they're working night shift right before the day shift ends. I don't expect they'll be very happy though.

2) It's based on the department the patient belongs to and it's usually the closest employees who react first.

3) It will be generally beneficial to train your staff, hiring skilled employees makes most sense when staffing a new department or when you quickly need more people to deal with a crisis of some sort.

4) Generally the patients get transferred as soon as it's clear which department they belong to - and there indeed needs to be a free bed that can be reserved for them. (Edit: And as along as they've been stabilized of course )

Thank you for taking the time to write that Saorsa, it was of interest!

Excellent answers as always Jan!

Interesting question about resusc codes. My partner works in ITU/ICU and they respond to crash calls throughout the hospital - first responder provides immediate response but the life support specialists are intended to take over. Would be an interesting mechanism to be able to use in larger hospitals where more advanced code response could be coordinated. A small community health centre would obviously not have his ability, of course.

Just some input from my experience in the UK.

1) Most medical and nursing staff work predominately day shifts supplemented by occasional night shifts. Very few people work only nights, some nurse practioners work only on hospital at night (HAN or H@N), and very little only work days, consultants usually work on-call from home and get called when needed. Medical consultants are less likely to need to come in versus surgical consultants.

2) Most U.K. hospitals have a cardiac arrest team also known as the crash team made up of various grades of Doctors from different departments. An arrest team is run by the med reg (medical registrar), there is usually an anaesthetics doctor, an ICU doctor, and a couple of junior doctors (usually an F1 or F2). Each member carries a crash bleep which will go off with a voice announcing “cardiac arrest/medical emergency/major haemorrhage ward x”. Cardiac arrest/medical emergency/major haemorrhage calls are activated when someone calls switchboard, usually via an emergency number such as 2222, stating what the emergency is and the location.

4) This all comes down to hospital flow. Generally the biggest issue which causes delays in a&e is bed blocking on wards. People who are medically fit for discharge block beds usually because they are a) waiting for meds b) waiting for transport or c) waiting for social care such as a care home or setting up of carers (biggest reason). Until these patients are discharged, patients can’t be admitted to the wards. This means people will be stuck in A&E for hours taking up space there. This means patients are left either waiting to be seen in beds or (as with this winter) sitting in ambulances outside.

Also, will the game A&Es have 4 hour waiting targets?

Every day is clear that Project Hospital will be the definitive hospital game. Everything you're telling us is amazing and you are setting the bar very high. I have no doubt of your hard job and success.

Joshi wrote:Every day is clear that Project Hospital will be the definitive hospital game. Everything you're telling us is amazing and you are setting the bar very high. I have no doubt of your hard job and success.

Agree 100%

As for the work-time-routine here an example from germany.
The usual staffing of a general ward is 3-5 nurses in the day and one in the night (depending of the amount of beds and the discipline / demand of care) of which not all of the dayshift have to be nurse with examination. Most common is to work 2-3 weeks dayshift and one week night shift (here the nurse needs to have examination).
For the game this would give the opportunity to include roster-management. Fairly a nice idea, if not too complex.
Maybe (later) one could implement, that certain staff has special skills or status that is needed to run a station / functional area etc.

In Bremen we have the Klinikum Links der Weser which is the main cardiac clinic here. They have the "Weser"-Team, which is their cardiac arrest response team consisting of one anaesthesist, two anaesthetic nurses and one intensive care physician (internist).
In the Klinikum Bremen Ost there is the "Eberhardt"-Team. It's a team of doctors, security staff and nurses for psychiatric incidents. They get informed of their need by a loudspeaker announcement in A&E, telling the codeword "Eberhardt" and the location (the psychiatric clinic has various dependencies within the area).

For the last point, our patients wait in the emergency department for hours and in the corridor as well (up to 14 hours are common). A&E staff told me, the problem would be that the stations have no free beds or personal capacity to transfer the patients. Often enough we experience that monitoring requiring patients stay in A&E since the only free monitor is there.
But that we have to wait for hours to hand over patients is something I luckily didn't experience so far (may be for the fact that Bremen is not that metropolitan )
Even though this is reality, I think one should not regard the simulation of these conditions in game.

Morning shift 7.00-14.00/15.00
Evening shift 12.00/13.00/14.00/15.00-21.00
And night shift 21.00-7.00
This is In finland usually
30 patient ward this mean morning shift 6-8 nurse and evening shift 3-5 nurse and night shift 1-2 nurse.

In the Netherlands you have rotating shifts. I think its the same as in Germany. However I like the solution of the developers to hire separate staff for day and night shifts. Too much reality will only hurt the game. Imagine that you have to plan the staff for all departments and you have to take into account ; Rotating shifts, each shift differs in number in staff but requires a minimum number of skills; holidays ; staff may work a max of 5 days a week with lesser staff in weekends; part- timers ; trainees etc. etc. In that case this will not be an Hospital sim but a HRM-sim.

TLTR : Reality in staff planning is good, but too much reality will not make the game more fun too play.

Based on a recent real life experience I think there's an interesting dynamic for the game play. Most of the transfers from A&E to a ward or between wards have happened early in the morning. We tried to find out why and the reason is that the nurses are often too busy during the day (when people are typically discharged) to change the bed and prepare the area, and it is left to the night shift who have more time. In other words, the efficiency or productivity of staff can seem really high but actually they're overworked which has a knock on effect on the efficiency of the hospital. Just a thought...

Hi there fellow peoples, and devs (if you end up looking at this)

Being a prior ER technician, as well as a Med school student from the states, I'm greatly loving the insight into each your own countries and the way your healthcare systems do things. In the hospitals I have worked at we do things differently depending on whichever hospital you are at. We normally do use rotating shifts, and I think we have actually phased out 24-hour shifts for any trainees, (mainly due to the death of a patient, Libby Zion , from sleep deprived residents). Additionally in several hospitals and the one I currently work in, a code team from the Emergency Department consisting of at least an ER technician (Grade 1 or 2) and an Emergency Physician as well as nurses from the specific department, will work the code. However what I'm interested in seeing though is how the Emergency department in the game will do when faced with a Code situation via ambulance comes in. Mainly I've got questions on whether the player would have Major Treatment or trauma rooms/bays, where stabilization of level one acuity patients would happen. Additionally for major accuities like respiratory and cardiac arrest, when you are diagnosing and treating, are you able to perform such interventions.

Because my specialty is Emergency Dept. would love clarity regarding labs, radiology, and surgery, and if departments would have to share these services or if we can have these rooms a part of a specific department. I know in my ER's we have our own services, separate from the hospital Additionally could you have a certain zone in the department dealing with certain acuities, and if you can assign multiple beds to a nurse and doctor.

And while I figured that the whole psychiatric ward thing will not happen in the base game, for future consideration, while we do have a behavioral health hospital and ward in the major hospitals in my city, in other hospitals patients with major psychiatric issues (Suicidal Ideation, and homicidal Ideation) are put in an ER bed (ideally an isolation bed) and watched by sitters, until they are medically cleared for transfer or discharge... If one really must know, yes, we have had a patient in the ER where i work for 2 months.

Also...

Research hospitals...

I hope that will be a thing here.

mbouanani wrote:Hi there fellow peoples, and devs (if you end up looking at this)

....
However what I'm interested in seeing though is how the Emergency department in the game will do when faced with a Code situation via ambulance comes in. Mainly I've got questions on whether the player would have Major Treatment or trauma rooms/bays, where stabilization of level one acuity patients would happen. Additionally for major accuities like respiratory and cardiac arrest, when you are diagnosing and treating, are you able to perform such interventions.

Because my specialty is Emergency Dept. would love clarity regarding labs, radiology, and surgery, and if departments would have to share these services or if we can have these rooms a part of a specific department. I know in my ER's we have our own services, separate from the hospital Additionally could you have a certain zone in the department dealing with certain acuities, and if you can assign multiple beds to a nurse and doctor.
...

Hi, within the gameplay limitations all the situations you mention can occur - some patients will be brought in by ambulances to trauma rooms, some will collapse while waiting or in bed and the staff will have to respond accordingly.

We've recently added an infographic showing the different paths patients can take through the ingame hospitals, so I'll add it here as well. It should show that for example radiology is a separate department providing services to everybody else, while labs are specific to each department.

jan.oxymoron wrote:

mbouanani wrote:Hi there fellow peoples, and devs (if you end up looking at this)

....
However what I'm interested in seeing though is how the Emergency department in the game will do when faced with a Code situation via ambulance comes in. Mainly I've got questions on whether the player would have Major Treatment or trauma rooms/bays, where stabilization of level one acuity patients would happen. Additionally for major accuities like respiratory and cardiac arrest, when you are diagnosing and treating, are you able to perform such interventions.

Because my specialty is Emergency Dept. would love clarity regarding labs, radiology, and surgery, and if departments would have to share these services or if we can have these rooms a part of a specific department. I know in my ER's we have our own services, separate from the hospital Additionally could you have a certain zone in the department dealing with certain acuities, and if you can assign multiple beds to a nurse and doctor.
...

Hi, within the gameplay limitations all the situations you mention can occur - some patients will be brought in by ambulances to trauma rooms, some will collapse while waiting or in bed and the staff will have to respond accordingly.

We've recently added an infographic showing the different paths patients can take through the ingame hospitals, so I'll add it here as well. It should show that for example radiology is a separate department providing services to everybody else, while labs are specific to each department.

Hi Jan,

Thank you for indulging my curiosity.... Just saying i'm loving how everything is coming thus far, and you definitely have got a customer of this game with me .

I did have a question about the routes though now that the diagram is posted. High and medium risk patients check in with reception and low risk go straight into waiting room. Do you guys have it planned that patients able to walk and are higher priority can be triaged at the reception before seeing a doctor (ie, when high priorities are identified then they are seen first, rather then low priority like a case of the sniffles).

Additionally, just from personal experience, and while right now you guys might be working on just simply making the game run with all current features and like... sometimes ambulances come in with a patient that merely just feel to sick to drive, are two week to walk, or are patients from other facilities, and thus my question: Just because a patient is immobile, does that mean they are automatically critical in the game thus far? If so might i suggest a system where ambulance come in with less "fun stuff" as a way of annoying us tedious inquisitors