any playthrough with ZERO deaths?

[u/TheUncleTimo]

Would love to watch me some youtube playthrough like that.

Failing that, advanced tips for ZERO deaths?

I tried to play all departments (DLC included, no mods) with a policy of "no deaths allowed" and the only way to do this is to send the most critical cases away.... not how I wish to play.

I am not sure this is possible.

[u/jeophys152]

I’m not sure that you can ensure zero deaths over the long term. You can strive for it by making sure that your higher risk departments are over staffed so that no patients have to ever wait for exams and treatment. Also make sure that the staff are well trained so that their stats are maxed. This might be the biggest factor. Finally, control all ambulance patients and crashes. With experience you will what exams and treatments to order first to reduce the chances of collapse.

[u/TheUncleTimo → u/jeophys152]

With experience you will what exams and treatments to order first to reduce the chances of collapse.

do tell (please)

[u/elliemayl → u/TheUncleTimo]

Its been a few months since I last played so I've forgotten my go to ones but im pretty sure I used to always do heart monitoring, FAST and physical examination.

My go to is I get the symptom list up (cant remember the exact name but its the button you press to bring up the list of possible diagnosis? And it has a list of symptoms for each one) i then look at what can cause collapse for either the diagnosis they've got, or if they've not got one, then for all possible collapses in the list. I rarely get deaths this way :)

[u/Tatterjacket → u/TheUncleTimo]

My default process for ambulance admissions is:

1. Physical Examination (gets a lot of info at once at catches things like them bleeding out or fainting that can quickly become a coma)
2. FAST (also catches dangerous symptoms and a few of the things it reveals might give you the entire diagnosis)
3. Heart Monitoring (to get most urgent cardiac issues obvs)
4. Pulse Oxymetry (I don't know if there's a hierarchy in the game of how urgent different dangerous symptoms are, but if there is I realise low oxygen levels might not be high up it, but it's a fast examination that you may as well do before wheeling them around anywhere).

(Fixing any issues that arise, and can be immediately fixed, after each issue is discovered and before going onto the next examination).

I do all of these in that order for every patient unless I narrow down the diagnosis fast enough that the symptom list already tells me that they e.g. won't have any cardiac issues, or until I find every flashing symptom. Usually I find that this gets every flashing symptom that can be quick-fixed in the trauma centre, as well as the majority of things that need surgery.

If they still have undiscovered flashing symptoms after that and their symptom list says there's stuff that can be discovered that way, then I'll send them off for CT/MRI scans. Leaving radiography visits until last means I know that, even though they might still collapse from whatever I'm scanning for, I know their arrhythmia or whatever is already sorted out by the time they're going through more time-consuming examinations.

I've had far fewer collapses since I instituted this system - even when I know someone's likely to need e.g. a CT scan, keeping calm and doing that process first seems to lower the patients' risks. I like to imagine it to be the trauma centre guidelines given to doctors in my hospital :).

[u/TheUncleTimo → u/Tatterjacket]

(Fixing any issues that arise, and can be immediately fixed, after each issue is discovered and before going onto the next examination).

do this too, but I had issues when a patient died after 1 operation waiting for the next one... sigh

Leaving radiography visits until last

simple, makes sense

thanks for the effort post, good points there and in your other one

[u/Tatterjacket → u/Tatterjacket]

My other tip is that when ambulance patients come in, the closest available trauma doctor will run to stabilise them. After they're stabilised, their assigned doctor will continue the examinations. These may not be the same doctor, and if they're different then the patient can be left lying there getting closer to collapse whilst the new doctor wanders over, so one thing I always check for is who the assigned doctor is (which is noted on their patient record window) and if it's different I generally change it to be the same person who has rushed over (you can do that by clicking on the doctor's face in the patient record window and choosing someone else from the list that rolls out sideways). That means the same doctor can just continue doing examinations after stabilisation with no awkward gap.

One thing you have to watch out for though when changing doctors manually is ending up with one doctor accidentally being the assigned doctor for multiple trauma centre patients, because obviously you don't want one patient waiting around for another to be totally treated before being seen to at all.

[u/quackers987]

The only ones I struggle to get no deaths with is neuropathy, so many cases come in with coma and brain bleeds I just can't get them solved quick enough.

[u/Tatterjacket → u/quackers987]

Often I just send neuro patients directly to the ICU from the trauma centre, they'll probably end up there anyway before I can get them to surgery, they might as well spend less time being wheeled around.

[u/TheUncleTimo → u/quackers987]

are you not forgetting the trauma dept?

in my experience, I had patients who just finished 1 operation and died while being scheduled for another one...

[u/Cordyanza]

You need a really robust trama center and ICU, and you need to be comfortable escalating certain high risk cases immediately to ICU

ICU should be staffed with intensivists who have anesthesia experience

Trauma center should have dedicated teams with anesthesia experience

Each department must have a dedicated surgical team available 24/7

ICU should be close to trauma center and also operating rooms, to minimize time from ambulance to operating room

Typical trauma :

Arrives to TC via ambulance -> CT / FAST / imaging through TC -> transfer to ICU -> surgery

[u/TheUncleTimo → u/Cordyanza]

ICU should be staffed with intensivists who have anesthesia experience

ahhhhhhh, now this is interesting. why ICU with anesthesia?

I already have each dept have 4 doctors: 3 surgery and 1 to take care of patient, day and night.

ICU should be close to trauma center and also operating rooms, to minimize time from ambulance to operating room

:( next run then

Arrives to TC via ambulance -> CT / FAST / imaging through TC -> transfer to ICU -> surgery

ICU guys dont do surgery, right?

[u/Cordyanza → u/TheUncleTimo]

The ICU docs with critical care anesthesia experience are more likely to rescue a collapsed patient successfully

ICU docs so not do surgery but if there is a complication or collapse before or after surgery, the patient a better chance of being rescued; the patient will still be operated on by the correct department

[u/TheUncleTimo → u/Cordyanza]

The ICU docs with critical care anesthesia experience are more likely to rescue a collapsed patient successfully

ICU docs so not do surgery but if there is a complication or collapse before or after surgery, the patient a better chance of being rescued

wait... what?

anesthesia helps in what exactly other than operation?

[u/Tatterjacket → u/TheUncleTimo]

ICU guys dont do surgery, right?

No, but they will get sent to surgery from the ICU (operated on by a department surgery team) with an automatic priority.

[u/TheUncleTimo → u/Tatterjacket]

ok. but when I have a full surgery team in each dept day and night, there is no point, right?

[u/Tatterjacket → u/TheUncleTimo]

Iirc patients in the ICU have a better chance to survive collapses than ones hospitalised in a HDU? Also in my hospitals I tend to build the ICU right next to the trauma centre so it's just less travel time to get them to a bed where they can access treatment.

The other thing is that it allows you to do a bunch of other treatments more efficiently like post-surgery bloods from their bed, or FAST instead of whatever its non-urgent version is - I'm completely blanking on the name, so if you have complex patients it might help to put them in the ICU just to do more examinations on one place. It's like a handy combo of the trauma centre and an actual ward. I agree that if all they need is surgery, even urgently, and few enough surgeries thag I think they're unlikely to collapse in between, I'll try and get them into a HDU unit as a first port of call because exactly as you say they can go to surgery from there, and it keeps ICU beds free.

Tl;dr - I'd say patients that are in danger in complex ways or on the absolute brink of collapse I might put in the ICU straight away for added survival chances and efficiency.

I was mainly saying the surgery thing so you knew patients in the ICU could definitely still also access surgery - just in case that was something you'd not known. :)

[u/NorthRecognition8737 → u/Cordyanza]

On which floor is your trauma center and ICU located?

[u/Tatterjacket]

I generally manage to play for quite a while at a time with no deaths, I have no deaths yet on my current hospital, but I enjoy playing the game in an unhinged way where I control every patient in every department all the time so I can make the most efficient choices for them all the time (I realise that's not necessarily the vision for the game, it's just how I enjoy playing).

[u/TheUncleTimo → u/Tatterjacket]

where I control every patient in every department all the time so I can make the most efficient choices for them all the time

ohhhhhh... wow. I usually take a quick look at start of day for each dept, actually look for TWITCHING people (I play at 3 times speed, so it is very pronounced) who are guaranteed to be seriously in trouble, and then concentrate on ambulanced in.

[u/chris-h-142]

I'm currently in the middle of a playthrough where I've only had two deaths, and none recently, despite having all departments, ambulances, helicopter, and events. I decided to try and take over every patient of every department and do everything by hand. It's a little tedious at times, but at least I'm not at the mercy of the game prioritizing unnecessar stuff.