Magical Girl ER has 11 endings, according to the Steam store page. Your choices decide which one you reach: who you admit or refuse, how you treat each patient, whether patients live or die, and how much the hospital’s reputation grows or drops. As of October 28, 2026, I found no source that lists all 11 endings, names the true ending or gives exact unlock requirements. Therefore, this guide covers the confirmed systems and a practical way to chase every ending.
Summary: Magical Girl ER Endings
- Endings: 11, per the Steam page.
- Release: October 26, 2026 on Steam.
- Price: $4.99, with a launch discount to $4.49 until November 2.
- Run length: about 20 to 40 minutes per playthrough.
- Drivers: patient survival, hospital trust and your treatment choices.
- Not confirmed: the full ending list, the true ending and exact requirements.
What Magical Girl ER Is
Magical Girl ER is a medical sim and visual novel from noranuco, a Japanese illustrator who both developed and published it. You run an emergency hospital for magical girls hurt in kaiju attacks. According to the Automaton write-up, you serve as the temporary head and have one week.
| Item | Detail |
|---|---|
| Developer | noranuco |
| Release | October 26, 2026 |
| Platform | Windows, on Steam |
| Price | $4.99, or $4.49 until November 2 |
| Genre | Medical sim, visual novel, horror |
| Run length | About 20 to 40 minutes |
| Endings | 11 |
| Languages | English and Japanese text, no full audio |
The store page warns about injury, blood, death and psychological horror. Because runs are short, you can replay the game several times in one evening.
How Your Choices Shape the Endings
The store page says your decisions affect three things: whether patients live or die, the hospital’s reputation and which of the 11 endings you reach. Here is how the main systems work.
| Item | Detail |
|---|---|
| Admit or refuse | The hospital has limited rooms, so you choose who gets a bed |
| Examination | You use tools such as a thermometer and a stethoscope |
| Diagnosis | Each patient has a hidden condition you must infer |
| Treatment | Options range from a bandage to surgery |
| Resources | Beds and stamina limit what you can do |
| Reputation | Patient outcomes raise or lower hospital trust |
Before you admit someone, the game shows their mortality rate, registration category, arrival date and fame. As a result, every admission is a trade-off between risk and reputation.
Hospital Reputation and Fame Ratings
Fame matters because it links patients to the hospital’s standing. The Automaton write-up explains the rule: famous patients who survive raise the hospital’s reputation, and famous patients who die lower it. Therefore, a famous patient is both an opportunity and a danger.
| Item | Detail |
|---|---|
| Famous patient survives | Reputation rises |
| Famous patient dies | Reputation falls |
| Malpractice | Can hurt the hospital’s reputation |
| Correct treatment | Does not prove the diagnosis was right |
That last point is important. Because the game separates treatment from diagnosis, a procedure can succeed on paper while you have misread the condition. Meanwhile, the reputation hit may still land, so check your reasoning before you act.
I found no source that names a fame rating threshold for any ending. Therefore, I will not give numbers.
The 11 Endings: What Is Known
The store page confirms the count and says the endings depend on your choices. It does not name them. Automaton adds that lore also comes through patient conversations, newspaper articles and the endings themselves, which encourages replaying.
| Item | Detail |
|---|---|
| Total endings | 11 |
| Ending names | Not found |
| True ending | Not confirmed |
| Bad ending triggers | Not confirmed |
| Unlock requirements | Not confirmed |
Because the game launched on October 26, guides and community lists may still be forming. Still, I will not invent names or triggers. Instead, the next sections show how to uncover them yourself.
How to Chase Every Ending
Short runs make a systematic approach practical. Follow these steps.
- Play once without a plan. Your first run shows the basic loop.
- Note every key decision. Write down who you admitted and who you refused.
- Replay with one change. Change a single choice, then compare the ending.
- Aim for different outcomes. Try a run where nobody famous dies, then one where several do.
- Check Steam Achievements. The page lists achievements, and they often track endings.
- Keep a simple log. Record the ending name, your choices and the reputation result.
Because a run lasts only 20 to 40 minutes, you can test one variable per run. As a result, you can map all 11 endings in roughly four to eight hours of play.
If you enjoy other recent horror games, our Mimic Alert Mimic Queen guide covers one that launched this season.
Treatment Mistakes That Likely Lead to Bad Endings
The sources do not name a bad ending trigger. However, they do point to the risks. These are my inferences, not confirmed triggers.
- Misdiagnosing a patient. The game says a correct treatment does not guarantee a correct diagnosis.
- Letting famous patients die. The reputation drop could push you toward a worse result.
- Treating too many patients. Beds and stamina run out fast.
- Ignoring documents and dialogue. The hidden condition comes from tests, talk, appearance and documents.
- Refusing without checking mortality. A refused patient may not survive.
Therefore, slow down on each case. Check every clue before you commit to a treatment.
Tips for a Strong Hospital Reputation
These tips follow from the confirmed rules. Still, they are my advice, so test them yourself.
- Prioritize famous patients you can save. Their survival raises trust.
- Check mortality before you admit. A high-risk famous patient may cost you reputation.
- Use every examination tool. More clues mean fewer misdiagnoses.
- Save stamina for hard cases. Easy cases can wait.
- Read the newspapers. They give lore and hints about how the city sees you.
- Do not rush the clock. You have one week in the story, and each choice counts.
About the True Ending
Your keywords mention a true ending and a fame rating. I found no source that confirms either. The store page says only that your choices lead to one of 11 endings. If a true ending exists, it likely needs strong survival and reputation results, but that is a guess and not a fact. As of October 28, 2026, I will not promise a recipe.
Common Mistakes to Avoid
- Trusting an unsourced ending list. No source confirms the names.
- Chasing a “true ending” recipe. No source confirms one.
- Assuming a fix equals a correct diagnosis. The game treats them separately.
- Letting famous patients die without a plan. It hurts reputation.
- Playing only once. The game encourages replays.
- Skipping the log. Without notes, you cannot compare runs.
Conclusion
Magical Girl ER has 11 endings, and your admissions, diagnoses, treatments and hospital reputation decide which one you get. No source I found lists the endings, names the true ending or gives exact requirements. The fastest path is a short replay loop with one change per run and a simple log. Everything here is accurate as of October 28, 2026, and I will update it when verified ending data appears.
FAQs
How many endings does Magical Girl ER have?
Eleven, according to the Steam store page.
What is the true ending?
Not confirmed. I found no source that names it.
How do I unlock the bad endings?
Not confirmed. Misdiagnosis and famous patient deaths look risky, but no source names a trigger.
How does fame work?
Famous patients who survive raise hospital reputation, and famous patients who die lower it.
How long is one playthrough?
About 20 to 40 minutes, per the store page.
How much does the game cost?
$4.99, or $4.49 with the launch discount until November 2.
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