[NEED MORE INFO] ICU patients not going in for surgery.

Dear Project Hospital,

i really like the game, it has me hooked. However, I noticed a troubling issue that prevents me from reliably let my hospital run on its own devices, and manually I cant fix it either.

This is a repost from the Steam forum, knowing that here it might reach you guys faster, and I can post save files.
bear in mind, this thread has already become quite long,  as a helpful person on the steam forum by the name of vonMoo has come to add to the thread.

"As the title says it,

my patients are laying in the ICU, and require surgery, however they are never scheduled or even brought in, up to the point where on of my patients got 5 stacks of septic shock just because they waited too long.

i have enough doctors and nurses in the surgery department to staff 2 theatres (and some extra) but nothing starts or shows up, Funny enough, patients that needs surgery in the Surgery Ward HDU or regular wards, go in just fine as soon as the doctors are available.

it seems like the ICU department first wants to discharge the patient back to Trauma, Surgery departments HDU before getting them into surgery however i cant manually pass them back to those departments, and they wont stabilize because they wont enter surgery.

so any patient that enters the ICU that needs surgery dies, or i have to ship them out to another hospital to prevent them from dying...

9 doctors on shift (including surgeon and anesthesiologist) seen them all idle, while ICU patient needed surgery
10 nurses on shift (including surgery nurse) seen them all idle, while ICU patient needed surgery

Version 1.2.21996 (all 4 DLC's) GOG version"



vonMoo's reply;
"Something isn't right there, the expected behaviour is that ICU will send the patient directly to surgery and then move them back to ICU once the procedure is finished. ICU patients usually have top priority and the ICU seems to reserve staff from the relevant department for surgery as a priority too. If it's a critical patient, the ICU will not transfer them anywhere until they've been fully treated and stable for some time. In fact, I always transfer critical patients manually to the ICU because they are so effective at getting surgery started quickly.


I can think of a few things to check.

Are the patients under automatic or player control? I find automatic control seems to work best for ICU patients, unless you want to force a diagnostic test to happen before a treatment or suchlike.

Are there other treatments queued up before the surgery? This usually doesn't matter with ICU patients, the surgery happens as soon as it can, but it might be worth cancelling any that are queued. And check for queued diagnostic procedures too. Sometimes some queued procedure seems to cause patients to get stuck.

The patient transfer from ICU to surgery is done by an ICU nurse, so check that there's one free most of the time (in practice, ICU doesn't need very many nurses, but having more than one is a good idea, unless you never get more than one ICU patient at any time). Similarly, make sure your ICU doctors aren't overworked.

Are any of your ICU nurses, doctors or patients stuck?

Are there enough stretchers that belong to the ICU department?

Although your other departments seem to be working fine and getting surgery done internally, it's worth checking if there are ever any issues. It's also worth restricting your surgical teams to just perform their main role, if you haven't already, including a regular doctor to assist at surgery only (you can then prevent the doctors and nurses who do normal ward work from taking part in surgery)."



Merreck:
"Dear VanMoo,

lets see, there are 3 ICU doctors and i think 9 beds?, plus 3 or 4 nurses i believe, all of them have the options for patient care, transport.

what i have noticed is that the patients that have this issue have both diagnostic and treatments queued some of which i cant turn off, they have been put there but i cant turn them off again. tried switching doctors, doesnt allow me to change departments, and ive tried to turn off diagnostic tests.

since ive been trouble shooting, i have 9 doctors per shift (5 or so solely on surgery/anesthesiologist duty) 2 surgery nurses on sole surgery, and a remaining 5 or 6 nurses for transport and patient care per shift in the General Surgery department

some trouble making ICU patients came from my Traumatology department which had a deficiency of staff (nurse and doctors) in the beginning, but i have enough staff to run 2 surgery suits at the same time now, however this might have been after i got rid of the trouble making ICU patients. all i can definitely say is that there was at least enough doctors and nurses for 1 surgery suite at the time for a trauma based surgery.

but i cant remove pending treatments, Say its heptic shock, and a abdominal surgery. The IV antibiotics aren't administered and the surgery is never performed, Everyone is just sitting there, and i cant remove any of the treatments (some diagnostics can be removed but to no effect)

usually in the case of stomach and abdominal issues that cause heptic shocks is what lands them in the ICU and gets the stuck"


vonMoo's reply;
"Your troubleshooting is good.

It's interesting that the affected patients all have procedures queued. Have you tried setting these patients to player control and then removing the queued procedures? Using player control you should be able to cancel any diagnostics and treatments that are queued. You can set player control by pressing the button highlighted in orange on the patient information window, just where the tool tip is near the top left.

Project Hospital
A Screenshot of Project Hospital
By: vonMoo

If you can't remove pending treatments using player control then there might be a bug or a glitch.

It's also interesting that the ICU staff aren't administering IV antibiotics.

I think that you have a good number of doctors and nurses, and like you mentioned earlier if the departments are doing surgeries for non ICU patients then they should be fine. Your ICU staffing is good too.

If you can upload a saved game file somewhere, I'd be happy to take a look when I get a chance. You can find save files here:

C:\Users\[Username]\AppData\LocalLow\Oxymoron Games\Project Hospital\maps"



Merreck's reply;
"i believe i figured out what happened... but i cant be sure...

the ICU reserves staff from the respective department from which the diagnosis comes from for the surgery, i had just finished setting up traumatology, and was getting the hang of it. Now i have a backlog of surgeries... from traumatology and those that end up in the ICU.

ICU patients are backing up and all beds are now full because they never got to surgery...
since i have gotten enough staff for traumatology to run 2 surgery suites 24/7, they have been going at it non stop. trying to work away the backlog... which is substantial right now.

so i cant say if this fixes the problem, but what i can say, is that people need surgery from both ICU and traumatology, however ICU surgeries are not prioritzed at all leading to death quickly"

"update:

i had turned on my computer and started my save game, and like i said there was a flurry of activity, so much so that both surgery teams from the traumatology department were doing surgeries. First all the pending surgeries from trauma department, then some pending surgeries from the ICU, however, now i still have some 4 to 5 patients (some ex-ICU patients [2] and some currently in the ICU [4]) that need surgery a trauma surgery. Doctors are running around and treating patients but no surgeries what so ever, out of the 3 teams (10 doctors 24/7) that i have hired for surgeries are idling, filing needs or treating patients in the wards. nurses have increased to 9 or so, and again nothing.... i found my save file, however i dont know how to post it"


this is where it has been left off and since it has gotten worse, check trauma department and the ICU department as i send my save game file to you.

Sadly i cant post any save game file or even a simple screen shot, the file manager on the website says ive exceeded file size 241.... the file i have is 2,796Kb zip file, and even a simple screenshot gives me the same result.

You could try google drive and provide the link. Or some other method.

Okay figured out what to do, and hey presto, i have a link;

drive.google.com/file/d/12_lYVgaUJhztiDvvxFn8axqmyuq9TZZX/view?usp=sharing

PS, don't forget to add the "https://",

I'm a new member, i can't post external links

Hi, welcome to the forums and thanks for finding a way to send us the save file!

Having read through the original conversation above and looking at the hospital (the save is at day 11), everything now seems to be working as expected - there are not a lot of patients at the ICU, but if I 'summon' some via an event, they get their surgeries done at traumatology even when hospitalized at the ICU. Maybe let me try to write down a few more details about the internal rules (feel free to give us an update whether these match what you're seeing when you continue the save):
- It's always the department where the patient's diagnosis belongs that performs the surgery - if you open the surgeries table from management, you should see all scheduled surgeries from the active department + ICU
- The priorities are based on the state of the patients, so a patient in a critical state at the ICU should go to surgery first even if there are other non-critical patients with surgeries scheduled directly at the department
- You can use the surgeries table to give priority to a certain patient
- If you haven't done this already, you can use employee roles to make sure your surgical teams at traumatology only do surgeries and don't get distracted by examining hospitalized patients

I hope this helps! (:

(In the meantime we managed to free some space on the forum, so it should be now possible to upload attachments, you can get to the file upload dialog using the "Reply to topic" button)

Dear Jan. Oxymoron,

I kept playing with the save since I posted it, and funny enough none of the patients that we're ignored at first got surgery at all, and most ended up dying, bouncing back and forth with ICU, or hospitalized to another hospital to prevent death. Yes, there were new patients who did get surgery, but it leaves me not trusting the system to prioritize or even perform surgeries on all the patients that need it, especially since I can't do it manually (I mean yes I can select the procedure, but I can't trigger, the doctors, nurses, and the room being reserved at all, I can only watch and hope the system kicks in)

Funny that you mention the surgeries table, it never gets populated, no surgery shows up there, even patients currently in surgery. i found that table and hoped it would enlighten me to any conflict, but it was empty, for both general surgery or traumatology.

Hi, thanks for the update! Do you think you could attach a save with a patient that has a surgery planned but it fails to start? Looking at the screenshots, both patients already had their surgery, but died or are collapsing because of other symptoms or possibly surgery complications.

In this save, not much earlier than Save 12 that I sent you, there are the following patients;

Karen Lewis, HDU, trauma
Richard Robinson , HDU, trauma
Jennifer Lewis, HDU, trauma
Nancy White, HDU, trauma
Charles Wright, HDU, trauma
Daniel Jackson, ICU, trauma
Paul Cole, ICU, trauma

all the following patients are not, and have not received surgery or treatment for the last 16 in-game hours, neither have the doctors as you shall see in the trauma department done anything except visit patients, and idle or free timing this while

Hi, well, looking at all the patients, these are already treated in the save and when I run the game, they get released around 8 in the morning (and the two patients at the ICU go back to traumatology for one more day). Is it possibe the issue is something as simple as the treatments not being immediately visible as they end up on the second page of Active treatments in the patient's card? This is normal for all these more complicated cases that are pretty common at traumatology.

Karen Lewis, HDU, trauma - has had thoratic trauma surgery
Richard Robinson , HDU, trauma - has had thoratic trauma surgery
Jennifer Lewis, HDU, trauma - has had thoratic trauma surgery
Nancy White, HDU, trauma - has had thoratic trauma surgery
Charles Wright, HDU, trauma - has had thoratic trauma surgery
Daniel Jackson, ICU, trauma - has had vascular surgery and upper limb trauma surgery
Paul Cole, ICU, trauma - has had thoratic trauma surgery and trauma fracture surgery - thorax