Review – Dice Hospital (Alley Cat Games)

Stay Healthy, Stay Rolling


Dice Hospital is a medical-themed, worker placement, dice rolling game about managing hospitals and patients for 1-4 players. Dice Hospital is published by Alley Cat Games, from designers Stan Kordonskiy and Mike Nudd, with art by Sebastián Koziner and Sabrina Miramon.


In Dice Hospital, players must treat as many patients as possible, earning the highest reputation to appease the local authorities. The dice are the patients in hospitals. During each round, players use their nurses to treat these patients, where low scores indicate low health. Throughout the game, players may improve their hospitals by hiring Specialists and adding departments to assist with treating their patients. Each round, players will score points for every patient they discharge. After 8 rounds, players adjust their score, deducting for any fatalities in their morgue. The player with the most points has the highest reputation and wins the game.


The game plays over a series of 8 rounds. Each round consists of the following 6 Phases: Patient Intake, Hospital Improvement, Hospital Activation, Neglected Patients, Discharged Patients, and Shift Change. At the end of each round, rotate the round marker one step clockwise and a new round begins.


Include a specific number of dice according to the number of players. Each player is dealt with two Hospital Administrator cards, choosing one, and placing it face up next to their hospital. Starting with the First Player and moving clockwise, each player draws 3 random dice from the bag as starting patients. These dice must be set to the values 3, 4, and 5 – the player can decide which dice are set to which values, then place them the untreated spaces (top row) in one of the player’s wards.

Patient Intake

For each ambulance in play, the active player draws 3 dice from the bag and rolls them. Dice with values 1 or 6 are rerolled until the values are set to 3, 4, and 5. The dice are placed on the ambulances in order from lowest to highest. The lowest value dice represent the sickest patients and will be placed on the lowest number of ambulance. If there are multiple dice of the same value but different colors, the player to the right of the active player decides their placement in the ambulances.

The active player then chooses one ambulance and places it in front of them. They may not select the ambulance numbered ‘1’, because they cannot be the first player for two consecutive rounds. The player who claimed the lowest-value ambulance takes a bonus Blood bag token from the supply and also takes the First Player token.

Dice Hospital player board
Dice Hospital player board

Players then move the patients into any empty untreated spaces in the wards of their hospital. Actual ward a patient is in does not matter. If there are insufficient ward spaces for patient intake, players must remove existing patients (which become fatalities) to accommodate this round’s new intake.

Hospital Improvement

In ambulance number order, (starting with the lowest number taken), players may take 1 hospital improvement. New Department tiles will heal a specific color and/or value of the patient. New Specialist cards add staff to a player’s hospital. A corresponding meeple is added to the player’s pool. Each Specialist has a special healing effect.

At this time, each player may return one improvement (including the one they just took) to gain 1 Blood bag token. Only one improvement can be discarded per player per round in this way. Additionally, some hospital improvements may also allow players to gain Blood bag tokens in other ways.

Blood bag tokens are valuable, as a player may discard one token during hospital activation to heal any patient one step, or to temporarily change the color of one patient die until the end of the round. Additionally, unused Blood bag tokens are worth 1 point at the end of the game.

Hospital Activation

Simultaneously, players heal and discharge as many patients as possible. A patient is healed by placing an available nurse or Specialist meeple into an empty department of the hospital, triggering the action shown in that department. Each meeple can only be placed once each round. Each department can only be activated once each round.

Patient Intake
Patient Intake

Meeples are placed one at a time into hospital departments, with its effect being resolved before placing another meeple. The department effect is always resolved before the Specialist effect, and it is not mandatory to use a Specialist’s effect on the turn. If it is not possible to resolve the effect of the department in full, that department cannot be activated. For example, the Renal Medicine department heals exactly three different yellow patients of the same values (e.g. 3, 3, 3) one step each. If a player does not have three yellow patients of the same values, they cannot activate this department. If it is not possible to resolve the effect of a Specialist, that effect is ignored for the round. The Specialist meeple is treated just like a regular white nurse meeple.

Each time a patient die is healed, it is increased in value by one step, and then moved from the untreated space in the ward it currently occupies, to the corresponding treated space directly below it in the ward. Treated patients can be healed again later in the round by other healing effects, and are left in the same treated space in the ward. When a patient’s healing increases their value to 7 or more, they are fully healed and immediately discharged from the hospital. Place the patient die in the discharge lounge until the end of the round.

Neglected Patients

Once players complete all hospital activations, check for untreated patients in the wards. Each untreated patient left in the top row of spaces in a ward has its value lowered by one step due to neglect. If any patient’s value 1 is reduced to 0, that patient becomes a fatality. The player takes a Fatality token from the supply, which is worth 1 negative point at the end of the game. The patient’s die is also returned to the dice bag.

Hospital Improvements
Hospital Improvements

Discharged Patients

Players then count the number of patients in their discharge lounge and scores points based on the number of patients discharged. Track scores on the scoreboard. There is a special scoring bonus for any player that ends the round with all four of their wards completely empty, scoring them an additional 5 points. After scoring, return all discharged patients to the dice bag.

Shift Change

The Shift Change Phase marks the end of the game round, and players will perform steps to prepare the game for the next round. During the Shift Change, players return all nurse meeples back to the Nurses’ station and all specialist meeples back to their respective Specialist cards. Shift all treated patients to the untreated areas of their wards. Return all ambulances to the middle of the table. Rotate the round marker on the scoreboard to the next round number. Randomly return any unclaimed departments and Specialists to the bottom of their respective piles. Replenish the face-up department tiles and Specialists as newly available Hospital Improvements for the next round.

End of Game

The game ends after the 8th round is complete. Tally points to determine the winner. Each player subtracts 2 points for every Fatality token in their morgue and adds 1 point for each Blood bag token they still have. The player with the most points is the winner. If there is a tie, there are conditions that determine which of the tied players is the winner.


The Ins and Outs of Dice Hospital


In general, I am not a fan of dice games. I want my games to have thinking and strategy behind the gameplay. But I am finding that I am enjoying dice drafting and dice manipulation games. It is not just luck of the roll. There is some strategic thinking behind each move. Granted, there are some elements of luck that come into play. But, your success in the game does not ultimately depend on a dice roll.

Because the gameplay is fairly straightforward, it is pretty easy to teach this game to a wide audience. At first, it might seem intimidating, especially with all of the different Specialists and departments. But the rulebook includes a nice reference section that summarizes starting hospital departments, department improvements, Specialist improvements, and Hospital Administrator abilities. The pages are large, easy to read and summarize these effects well.


Dice Hospital integrates the hospital and medical theme well. The cute nurse and Specialist meeples treat your dice patients in the hospital that you have improved on during each round. Each Specialist has an ability that will heal these patients with an end goal of discharging them. While the departments and Specialists available are medically accurate in name, the effects are arbitrary. It may have been fun to go deeper with the theme and assign ailments, treatments, and so forth that aligned with the colors of the dice. But, keeping it with a lighter theme works too.


Dice and Trays
Dice and Trays

The components of the game are of mixed quality. The hospital boards and department tiles are of nice heavy cardstock and should hold up well over time. However, the cards are of average weight and may start to show wear over time. The ones of most concern are the ambulances. These are represented by small cards that you place the dice on. The dice can easily fall off when moving the ambulances in front of the player.

The dice are ordinary colored dice, nothing special. But the one component that really bugs me is the dice bag. It is white and made of thin velvet material. First, it is so thin that it is pretty much see through. You can almost see through it enough to differentiate the color of the dice that you are selecting. Second, the white material is a dirt magnet. It’s cute, and the white goes well with the hospital theme. But it’s going to get dirty pretty quick.

There is a deluxe add-on pack that includes 3D ambulances (which will solve the issue that I mention above), an experimental medicine mini-expansion pack, wooden tokens for the blood bags and fatality tokens, and a hospital-themed dice tower. But it is a little pricey for what you get.


The game scales well by adding more ambulances, dice patients, and hospital improvements based on the number of players. There are also optional rules for increased variety and difficulty.

Event Cards

The game includes a special deck of Event cards. Starting with round 2, and at the start of each round after that (before Patient Intake), reveal the top Event card from the deck and apply its effect. Some Event cards have a one-off effect to apply immediately. Other Event cards have an ongoing effect which applies for the duration of the round.


Dice Hospital solo mode
Dice Hospital solo mode

Experienced players may adjust the difficulty of the game using one of the variants. Opening Crisis is a variant where players take 5 patient dice from the bag instead of the usual 3. In the Nationwide Epidemic variant, when a player takes an ambulance during Patient Intake (Phase 1), they must also draw one additional die at random from the bag (rolling for a 2, 3, 4 or 5 value). In the Resistant Superbug variant, during Phase 4 (Neglected Patients), each patient that has not been treated this round deteriorates 2 steps instead of one. These variants sound super fun!

Solo Mode

There is also a solo mode! I am a big fan of solo variants in games. It shows that the game designer put a little more thought and effort into the design to accommodate a varying range in player count. The gameplay is similar to the multiplayer game with a few adjustments. The solo mode doesn’t use ambulances or a Hospital Administrator card. The player reveals six of the Medical Report cards, completing them for additional points. Any incomplete Medical Report cards reduce your points by the value of the card at the end of the game. Players keep the record of their final score and play to beat their previous scores in subsequent games.


Final Thoughts

Medical Report cards
Medical Report cards

Dice Hospital is a fun game and one that my friends enjoy playing. However, it is on my shelf of games to trade. Why? Because it is very similar to another dice rolling game that I own and love: Roll Player. When I play each of these games, I have similar fun and enjoyment. Which is why I can’t justify keeping both games. It really comes down to theme for me. Would I rather play a game with a hospital theme or one with a fantasy adventure theme? Fantasy adventure is going to win out every time.

That being said, I do not think Dice Hospital is a bad game, nor would I discourage anyone from getting it. I think it would be a great purchase for a gamer that works in or has an interest in the medical field. I just felt that it did not add anything new to my (bulging at the seams) game collection. So, I don’t feel that it needs to stay there.

Game Statistics

  • Release Date: 2018
  • MSRP: $54.99
  • Playing Time: 45-90 minutes
  • Age Range: 10+
  • Player Count: 1-4


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