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resident
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When do doctors decide to hospitalize a patient?

on Thu Nov 01, 2018 1:57 pm
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Hi there, loving the game so far!

One thing that stands out to me in the few couple hours of play is that while the tutorials did a good job of teaching me the controls, they didn't really explain the mechanics of some of the game systems. One in particular is ED hospitalization, when should patients be treated directly by the clinician and when should they be moved into observation? My initial guess would have been that observation is for outpatient treatments that aren't avalible as prescriptions (e.g. a patient needs a round of IV fluids), but in my small emergency clinic my doctors are sending patients to observation that I wouldn't expect. PT comes in complaining of elbow pain, Dr orders a limb x-ray and sends the PT to observation. Seems like tennis elbow or golfers elbow both have a very low risk of the PT crashing, so why do they get one of my precious few monitored beds? Shouldn't those be for non-ambulatory patients, or ones at risk of a collapse?

Venturing into feature request territory, but I would really enjoy an option to have physicians request approval from the player for all transfers: clinic to observation, ED to general surgery, etc. It would add a nice logistics level to the management part of the game and would help teach the underlying systems by showing rather than telling.
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specialist
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Re: When do doctors decide to hospitalize a patient?

on Fri Nov 02, 2018 12:35 am
I agree that the doctors AI does some strange things. What is your certainty level. I noticed that it becomes better when you set it on medium. On high level your lab, observation and radiology seems to get flooded with patients.
resident
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Re: When do doctors decide to hospitalize a patient?

on Fri Nov 02, 2018 1:26 pm
Hmm, interesting. I left it on the default for the department, not sure what that is. Do you understand the goal of observation? Like if I were treating 100% of the patients manually when would it make sense to send one to an observation bed? Is it just for conplex cases to free up clinicians? Or are there diagnosis that will change/progress that I should be watching instead of allowing them to wait in the waiting area?
resident
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Re: When do doctors decide to hospitalize a patient?

on Sat Nov 03, 2018 12:32 am
From the tool-tip, I believe observation has a chance of uncovering symptoms over time (visits by nurse/doctor).
resident
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Re: When do doctors decide to hospitalize a patient?

on Sat Nov 03, 2018 6:43 pm
I was wondering this too. The only time I use the observation ward is when it nears the end of open clinic and I don't want them to go home Laughing It would be great if a pop up came up asking our permission to hospitalize patients. I also hate it that if you accidently send someone for observation then discover they can only be treated in the general surgery dept that you cant transfer them quickly, you have to wait for observation to stop flashing orange in treatment which is usually a day. I wish you could cancel treatments or move patients around easier.
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Re: When do doctors decide to hospitalize a patient?

on Mon Nov 05, 2018 11:28 pm
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Observation is infuriating for me. I constantly see patients send there who need an xray or a simple test done. in stead they lie in bed and have to be wheeled around all the time. In my opinion these mechanics are completely broken. Observation should be for internal medicine like diseases not a broken fcking arm or influenza......
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Re: When do doctors decide to hospitalize a patient?

on Tue Nov 06, 2018 3:54 am
Dr. Bluehelmet wrote:Observation is infuriating for me. I constantly see patients send there who need an xray or a simple test done. in stead they lie in bed and have to be wheeled around all the time. In my opinion these mechanics are completely broken. Observation should be for internal medicine like diseases not a broken fcking arm or influenza......

For real, it gets really back up in there for all the chumps who don't need to be there. Almost as bad as when the doctor doesn't choose the disease/issue and sends them for fifty lab tests leading you to micro the hell out of the patients.
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fellow
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Re: When do doctors decide to hospitalize a patient?

on Thu Nov 08, 2018 7:56 pm
Doctors chosing tests that have no results is simply them trying to test for one of the possible diagnosises and it not being the correct one. I assume the higher their skills the higher the chance they will go for a more likely test first. Also, cases where patients get thrown through 50 different tests are usually caused by you not having the necessary equipment for the diagnosis. Such as a CT.

As for observation, it is essentially a HDU ward for your emergency department, where all the normal clinic patients represent the "normal ward". HDU patients are selected based on their diagnosis as far as I can tell, also symptoms that say "immobile" will qualify you for HDU as well. So it's more a case of policy than case-by-case necessity.
As far as what is observation for in the first place? You basically keep the patient in a permanent doctors office/diagnosis room. You can apply all treatments that don't require specialized equipment instantly in observation, specific treatments also require a bed, such a IV treatments. And yes, nurses will come check up on patients and can uncover symptoms, but that's not really a big reason to put a patient in observation.

Most of the time from what I have seen, the patients that are in observation are patients that will be referred to a special ward later, but are still waiting for test results from your lab.
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Re: When do doctors decide to hospitalize a patient?

on Tue Dec 04, 2018 9:15 am
cTrix wrote:Doctors chosing tests that have no results is simply them trying to test for one of the possible diagnosises and it not being the correct one. I assume the higher their skills the higher the chance they will go for a more likely test first. Also, cases where patients get thrown through 50 different tests are usually caused by you not having the necessary equipment for the diagnosis. Such as a CT.

As for observation, it is essentially a HDU ward for your emergency department, where all the normal clinic patients represent the "normal ward". HDU patients are selected based on their diagnosis as far as I can tell, also symptoms that say "immobile" will qualify you for HDU as well. So it's more a case of policy than case-by-case necessity.
As far as what is observation for in the first place? You basically keep the patient in a permanent doctors office/diagnosis room. You can apply all treatments that don't require specialized equipment instantly in observation, specific treatments also require a bed, such a IV treatments. And yes, nurses will come check up on patients and can uncover symptoms, but that's not really a big reason to put a patient in observation.

Most of the time from what I have seen, the patients that are in observation are patients that will be referred to a special ward later, but are still waiting for test results from your lab.

I'm sorry, but I don't agree. Why then, do we see the majority of the observation patients being guys with something like a finger injury? That could, at the wooorst, be a fracture, but 90% of the time it needs ointment. Now the same nurse that is configured to wheel a cardiac arrest guy in emergency, must wheel these throngs of people back and forth between X-ray and intake.

Due to this setup, I have actually come to the belief that the emergency ward is the best place to do manual diagnosis of patients, as it is the primary choke point in the larger patient flow. In fact, I now use the best diagnostician here, so I could differentially diagnose all the fractures to dodge X-ray (seeing that they represent the majority of observation patients).

This game is beyond brilliant, but this is a serious balance bottleneck. I would still play it for hours even if it is not fixed, but just saying.
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fellow
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Re: When do doctors decide to hospitalize a patient?

on Wed Dec 05, 2018 12:22 am
I think doctors will assign patients to observation if their skill is too low. Ideally they would only assign patients to observation that require a lot of lab tests.
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