Verified progression milestones, the first Slime Shift window, and what to do when Slimebert enters the hospital.
Earlier versions of this guide treated Shift 7 as a fixed mode boundary. Current gameplay evidence shows continued story, Slime Shift, and Journal progression well beyond that point, so the guide now lists only reproducible milestones.
| Event | Timing | Best preparation |
|---|---|---|
| Ambulance | First at Shift 4; six patients; later every 5 shifts | Split critical care, admission, and treatment roles |
| Rainy Shift — standard | Usually around Shift 6 | Keep the lobby and treatment route clear while checking unusual patients |
| Rainy Shift — Skip Tutorial | Usually around Shift 3 | Prepare emergency tools earlier because the tutorial buffer is shorter |
| Slime Shift | Current table uses Shift 12–23; exact timing can vary | Continue the normal loop and route around Slimebert |
Two scripted normal patients teach check-in and treatment. The first uses Herbs for a stomach ache; the second uses Eye Drops for dried eyes.
Player task: Learn the treatment route. The shutters and cameras become available for later shifts.
Regular patients, anomalies, story characters, and enemies can now appear. The Emergency Wing and Supplies Shop unlock after the shift.
Player task: Start checking appearance, photos, and cameras before admitting patients.
The core loop continues while Dr. Harlow reinforces camera and photo checks. The Taser unlock follows this stage.
Player task: Stop treating the window check as visual-only; use every available information source.
Dr. Harlow reacts to an anomaly attack, a News Bunny broadcast appears, and the scripted Ambulance sequence sends six possible patients into the hospital.
Player task: Split admissions and treatment work so the sudden patient load does not collapse the run.
Dr. Harlow gives his last automatic shift briefing and warns that three animal deaths will fail the run.
Player task: Prioritize patient survival and sanity before optional interactions.
Shift 10 is the first late-run Journal reward. Liz can begin appearing around the Shift 11-12 stage with her UV Camera quest.
Player task: Check the Journal in the lobby and prepare for encounter-specific objectives.
The first Slime Shift can occur in this range. Slime spreads, Hazmat workers arrive, and Slimebert roams the hospital.
Player task: Route around Slimebert, use the Fire Extinguisher only for a temporary stun, and finish the shift.
The Journal awards 50, 100, and 250 Animal Coins for reaching Shifts 25, 50, and 100.
Player task: Use a coordinated team and treat these as long-run milestones, not new mode boundaries.
| Stage | What happens | Best response |
|---|---|---|
| Start window | First event occurs between Shifts 12 and 23 | Keep the run going; do not expect exactly Shift 12 |
| Environment | Slime appears on floors, walls, ceilings, and item cases | Watch movement routes and keep key work areas accessible |
| Hazmat team | Workers enter and clean slime until the shift ends | Let them work while your team continues hospital tasks |
| Slimebert | Roams the hospital and can eat players or patients | Keep distance; use the Fire Extinguisher only to create space |
| Completion | Slimebert and remaining slime disappear at shift end | Finish the shift instead of trying to defeat him |
| Afterward | Sam can arrive at check-in and costs $250 | Hire him for three shifts of cleanup support if needed |
The event does not replace the normal hospital loop. Continue checking and treating patients while the Hazmat workers handle slime.
Slimebert can eat patients and make them faint. Move around him and avoid leaving vulnerable patients in his path.
A Fire Extinguisher briefly stuns Slimebert. Use that opening to leave; it does not remove him from the shift.
When the shift ends, Slimebert, the Hazmat workers, and remaining slime leave. Sam may then appear at check-in.
There is no fixed final shift currently documented. Runs can continue beyond the tutorial and story milestones, with Journal rewards at Shifts 10, 25, 50, and 100.
The Slime Shift window is not a single universal trigger in every run. The current progression table uses the Shift 12–23 window; mode and version differences can move the first event, so follow the live shift state instead of forcing Shift 12.
Green slime spreads across the hospital, Hazmat workers arrive to clean it, and Slimebert enters and roams the halls. Complete the normal shift while avoiding him; remaining slime and Slimebert disappear when the shift ends.
Sam appears after the first Slime Shift. You can hire him for $250, and he helps with slime, Hiders, and room fires for three shifts.
No fixed Shift 7 transition is supported by the current progression evidence. The game continues through later story, event, Slime Shift, and Journal milestones.
Yes. You are not expected to kill him. Keep the hospital running until the shift completes, and he will leave automatically.
The first Ambulance Event is the Shift 4 sequence. It brings six patients, can include a critical patient timer, and later repeats every five shifts.
The standard flow usually reaches Rainy Shift around Shift 6, while Skip Tutorial runs can reach it around Shift 3. Treat the mode as a run-state event rather than a guaranteed single shift.
