How to Get an Excellent Rating in Animal Hospital

At the end of every shift in Animal Hospital (Anomaly), a chime plays and a shift report appears: patients treated, visitors admitted, anomalies prevented, and animal deaths, capped by a Hospital Performance score. That score is not cosmetic — the amount of money and Animal Coins you receive is based on it, with Excellent paying the most and Critical the least. Here is exactly how the grade is calculated and how to lock in Excellent every shift.

The four scores and their exact conditions

The wiki documents the grading rules directly:

Critical is the floor — it cannot get worse on paper, though at three animal deaths you are also brushing against Dr. Harlow’s shift 6 warning that three deaths mean failure.

Exact payout amounts per grade are not documented on the wiki (the Shifts page itself is flagged as a stub for “shift score money calculations”). The documented reference points: shift 1 always pays $63 and 5 Animal Coins for treating both tutorial patients, and the minimum possible payout is 1 money and 1 coin.

Rule 1: reject every anomaly

A single admitted anomaly caps you at Good, even with a flawless treatment record. Before letting anyone in, run the checks covered in the how to play guide: look for appearance abnormalities, watch behavior at the window, snap a polaroid with the photo camera (any difference in the photo means a guaranteed anomaly), check the security cameras, or spend a Scanner charge on suspicious cases. Note that the “reject all anomalies” credit comes from turning them away at the check-in window — anomalies prevented is its own line on the report and pays 0.5 Animal Coins each.

Visitors count too. An anomaly slipping in as a visitor downgrades the score the same as a patient.

Rule 2: zero animal deaths

One dead animal drops you two ranks worth of pay. The documented ways patients die, so you can avoid all of them:

• Wrong treatment. Giving a patient a remedy that is not on their prescription kills them. Read the room computer, then double-check the item in hand against the treatments table.
• Wrong item interaction. The game does not verify you are holding a treatment at all — interacting with a patient while holding any non-prescribed item can kill them, and the “Treat From Inventory” upgrade makes an empty prescription slot instantly lethal.
• Critical patient timers. Some patients arrive with a countdown; treat them first or they die when it runs out.
• Suffocating patients. Hunched-over patients need their oxygen minigame pumped or the meter empties.
• Tasing or shooting a normal patient. It also costs 15 sanity per tase.
• Anomaly attacks. Mimics and roaming monsters can kill patients you have already admitted — respond fast when a camera or scream tips you off.

One useful asymmetry: an anomaly dying is rewarded, not penalized. Only normal animals count against you.

Rule 3: do not cheese with the taser

Ending a shift by tasing all patients instead of treating them is explicitly graded Poor. The taser is for anomalies (+2 sanity per zap), not for clearing the queue.

Does Excellent matter long-term?

Yes — money buys the Supplies Shop tools (scanner $150, deployable camera $600, gun $400, teddy bear revive $1000) that make later shifts survivable, and since shifts are endless, your rating streak is effectively your income curve. If your scores keep landing on Good, the fix is detection; if they land on Poor or Critical, the fix is treatment discipline — the beginner guide covers both habits.