An IoT BLE based system literature review of real time location monitoring and tracking to shorten patient wait times in Malaysian public hospitals

1.1 Defining real time patience location monitoring and tracking solution

Real-time location systems (RTLS) are designed to dynamically detect and map an individual’s location within enclosed spaces such as hospitals or other healthcare facilities in real time. These systems typically rely on wireless wearable tags attached to individuals or objects that emit signals picked up by fixed reference access points throughout the building. The collected data helps determine precise locations, enabling seamless tracking and monitoring of people and assets within the facility. Although Global Positioning Systems (GPS) are effective for outdoor real-time tracking, their accuracy and reliability degrade significantly indoors because of signal obstructions.⁷ To overcome these challenges, healthcare providers use a range of location awareness technologies to support indoor monitoring and ensure smooth operation within medical environments. The ability to monitor the movement of patients, staff, and equipment has numerous applications in healthcare, contributing to improved workflow, reduced wait times, and enhanced patient care. This study provides a simplified primer for real-time patient location monitoring and tracking solutions in healthcare settings. It discusses the variety of technologies and innovations involved, their practical applications, and their future benefits. These advantages include maintenance cost savings, improved operational workflow, and higher patient satisfaction. However, the success of an RTLS solution depends on the choice of the right technology for a specific application or problem.

The cornerstone of effective RTLS implementation is to align the appropriate technology with the desired application. For instance, BLE is well-suited for real-time patient monitoring, whereas UWB may be better for tracking essential equipment that requires accurate location information.⁸ Not aligning the technology with a particular operational requirement may lead to less-than-ideal results or the potential failure of the system. With healthcare facilities increasingly adopting digital transformation and intelligent healthcare technologies, RTLS will be crucial for enhancing operations and elevating service delivery. Future innovations in IoT and AI will significantly improve the functions of location-based systems, creating new opportunities for predictive analytics and personalized healthcare. In conclusion, the effectiveness of real-time patient location monitoring and tracking solutions depends on the choice of appropriate technology for a particular application. Careful evaluation of the operational requirements, technological alignment, and future objectives is crucial to guarantee that the solution yields significant outcomes. Through effective planning and implementation, RTLS can significantly improve patient outcomes and hospital efficiency, establishing it as a fundamental aspect of contemporary healthcare.

Real-time patient location monitoring and tracking solutions aim to pinpoint and track the exact whereabouts of individuals, mainly patients, in healthcare settings. These systems employ dedicated fixed receivers or readers (location sensors) that interact wirelessly with badges or tags worn by patients to pinpoint their precise location within the facility. These solutions provide immediate insight into patient movement, aiding workflow optimization, minimizing delays, and enhancing care delivery. Every wearable tag sends a distinct ID to the patient to which it is assigned. As patients progress through different locations such as the imaging department, MRI suite, or consultation rooms, tags consistently transmit their IDs. Receivers or access points positioned strategically across the hospital capture these signals and send the information to the central tracking system. The position of every patient is subsequently established based on the tag’s closeness to the designated sensors, with the system refreshing the patient locations in various zones in real time. Real-time patient location monitoring and tracking solutions are crucial assets for contemporary healthcare, offering insights into patient movements to optimize operations and improve care quality. Although they may not provide ongoing navigation or spatial awareness, these systems are still crucial for resource management, workflow improvement, and patient contentment. Upcoming developments in tracking technology, such as the incorporation of IoT- and AI-driven analytics, could ultimately address existing constraints,⁹ providing even more accurate and practical insights regarding patient movement and hospital functions.

1.2 Real time patience location monitoring and tracking solution components and technologies

The efficiency of a real-time patient location monitoring and tracking system in enhancing Patient Turnaround Time (PTAT) depends on smooth collaboration among its elements and technologies. The system combines different hardware and software components to constantly track patient locations and enhance workflow in healthcare settings. Tags are wearable gadgets (such as badges or wristbands) with unique IDs assigned to patients. Location Sensors are stationary receivers or access points deliberately placed around the facility to capture signals from tags. These sensors served as reference markers for identifying the precise locations of tagged individuals inside the hospital. The location engine serves as the main software tasked with determining the positions of tagged items or individuals. It gathers information from tags and location sensors and analyzes the signal intensity, closeness, or triangulation outcomes to identify the location of each patient. The engine guarantees that real-time tracking information is consistently accessible and refreshed as patients transition between various departments or areas.

The tools used by hospital personnel offer immediate visualization and oversight of patient placement and conditions. These systems enable administrators to monitor patient movements, organize appointments, optimize resource allocation, and address possible bottlenecks in patient flow.¹⁰ Applications can consist of mobile platforms, desktop interfaces, or notification systems, allowing the rapid retrieval of location information on various devices. A real-time patient location monitoring and tracking system depends on the collaboration of tags, sensors, location engines, middleware, and applications to enhance the patient turnaround efficiency. The middleware functions as a vital “sensor” between the hardware and software, guaranteeing that precise and usable data can move effectively through the system. When applied successfully, these solutions not only boost operational efficiency, but also elevate patient care and satisfaction, rendering them vital resources for contemporary healthcare institutions.

The variety of solutions for real-time patient location monitoring and tracking includes basic end-user interfaces and sophisticated integrations with large-scale systems, such as public hospital information networks. This variety emphasizes the adaptability and scalability of location-based systems, rendering them appropriate for both personal users and intricate organizational settings. On the one hand, user interfaces offer simple tools for instantly retrieving location information. These interfaces focus on user friendliness, allowing non-technical individuals, such as nurses, administrative personnel, or visitors, to effortlessly search for and access pertinent information without requiring specialized knowledge. These tools improve daily operations by providing a clear and user-friendly interface and reducing delays in finding patients, personnel, or tools. Conversely, these tracking solutions can be incorporated into larger enterprise systems such as hospital information management platforms. These advanced integrations enable location data to be aligned with electronic health records (EHRs),¹¹ patient-scheduling systems, and various business applications, offering an all-encompassing perspective on operations. This enhanced level of integration facilitates improved resource distribution, operational strategies, and instantaneous decision making. For instance, real-time location monitoring can activate automated alerts when patients are late, enabling staff to quickly step in to uphold service quality and reduce waiting periods.

By utilizing these adaptable solutions, healthcare organizations can meet various needs across diverse contexts and stakeholders. Basic, independent interfaces are designed for individual users wanting easy access to location information, whereas integrated solutions address the needs of hospital administrators and IT departments by overseeing intricate workflows. This wide-ranging applicability guarantees that the system remains pertinent across multiple departments, from outpatient services to emergency care, and facilitates long-term scalability as hospital operations expand. Finally, the range of solutions provides both operational ease and technical complexity, allowing hospitals to optimize patient flow, elevate care standards, and boost overall efficiency. Along with simple user interfaces, real-time patient location monitoring and tracking solutions also encompass intricate integrations with organizational networks, including public hospital information systems. These complex interactions facilitate smooth communication and data transfer between the tracking solution and hospital’s current infrastructure. By means of this interoperability, the tracking system can utilize current data sources, workflows, and scheduling systems to further optimize operations, boost coordination among departments, and enhance the overall effectiveness. For instance, the movement of patients can be aligned with scheduling systems, ensuring that staff are notified when patients are on their way or running late, which helps lessen interruptions and reduce waiting periods. The flexibility of these location-based solutions extends beyond user-interface convenience and technical connectivity. They are intended to function in a wide range of settings and user needs, making them relevant not only for healthcare facilities, but also for sectors such as manufacturing, logistics, and retail. This adaptability guarantees that organizations can utilize the technology in various settings, tackling both operational obstacles and specific industry issues. In hospitals, these systems can effectively manage patient movement, staff distribution, and resource use, assisting administrators in proactively addressing shifting circumstances.¹² Meanwhile, in different environments such as production facilities, comparable monitoring systems can monitor equipment usage and optimize workflows.

By applying solutions that span user-friendly interfaces to complex system integration, healthcare providers can customize the technology to meet specific challenges. Whether via a straightforward dashboard that assists nurses in finding a patient instantaneously or an intricate integration with electronic health record (EHR) systems for unified management, these tools enable healthcare professionals to make educated choices and provide prompt care. Ultimately, this adaptable and scalable method guarantees that organizations, regardless of their size or sector, can efficiently streamline operations and better address patient requirements while reducing delays and enhancing patient results.

2.1 Systematic literature review process

This research utilized a systematic literature review (SLR) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework¹³ to guarantee an organized and reproducible review procedure. The PRISMA framework has gained extensive acceptance in health related research, encompassing fields like telerehabilitation, confirming its relevance to studies on healthcare technology. In this study, the PRISMA flowchart¹⁴ was used, as shown in Figure 2. To improve the thoroughness of the review, various data sources have been examined. Alongside searches in formal academic databases, Google searches were conducted to include pertinent literature that could not be indexed in prominent journal repositories. This approach granted access to various sources, including books, book chapters, institutional websites, and gray literature, facilitating a more comprehensive review.

Figure 2. PRISMA guideline flowchart.

2.2 Database selection and search strategy

This systematic review focused on seven major academic databases specializing in healthcare, technology, and management. The title and abstract screening process was used to filter out irrelevant studies, with a focus on research exploring real-time monitoring and tracking systems specifically designed to reduce patient Turnaround Time (TAT) in hospital settings. Studies that did not align with the core criteria were excluded. Table 1 lists the databases included.

2.3 Inclusion and exclusion criteria

The inclusion criteria were designed to capture studies that:

Exclusion criteria eliminated:

2.4 Timeframe and scope

This review examines publications spanning 2017 to 2024, a timeframe selected to capture the rapid advancements and growing adoption of IoT technologies within the healthcare sector. This period reflects the evolution and integration of innovative Bluetooth low-energy (BLE)-based systems, which have significantly influenced hospital efficiency and patient care management. By focusing on this era of technological transformation, the review ensures the inclusion of cutting edge solutions and trends that align with Malaysia’s ongoing healthcare improvement initiatives. The primary objective of this systematic review is to synthesize existing research, providing a comprehensive analysis of the impact of IoT enabled systems on hospital operations. It highlights key findings, uncovers recurring themes, and identifies critical knowledge gaps that present opportunities for innovation. This study aimed to offer actionable insights into how BLE and IoT technologies can streamline workflows, enhance resource management, and optimize patient turnaround times in public hospitals.

Ultimately, this review contributes to the development of advanced hospital management systems that not only reduce operational inefficiencies, but also elevate the overall quality of healthcare delivery. By addressing existing challenges and paving the way for further innovation, the findings can guide policymakers, administrators, and technologists in building a connected, efficient, and patient-centered healthcare ecosystem.

3.1 Systematic literature review for absence of real time patient location monitoring and tracking solution in medical facilities

The SLR seeks to collect, examine, and integrate current research to offer comprehensive insight into the fundamental elements necessary for real-time patient location monitoring and tracking solutions. This analysis aimed to identify the essential factors that enhance patient turnaround times in healthcare settings. A Systematic Literature Review (SLR) offers a comprehensive analysis of current studies to identify best practices, technological advancements, and the main issues recognized by specialists in the domain. This examination provides an essential understanding of how real-time tracking systems can optimize patient movement, improve operational productivity, and elevate the overall service provision in healthcare settings. In addition to highlighting their strengths, the review reveals shortcomings in existing solutions, providing insights into the key features necessary to enhance or create these systems.¹⁵ This guarantees that the solutions correspond to the evolving requirements of public hospitals and medical institutions, tackling both current and upcoming issues.

The findings from the SLR contribute to a more informed understanding of the technical, organizational, and patient-centered factors that impact the effectiveness of real-time patient location monitoring and tracking solutions. This knowledge serves as the foundation for designing comprehensive solutions tailored to meet the evolving needs of healthcare operations. Integrating these insights with other components of the research will ensure a well-rounded approach, helping to achieve the study’s objectives and driving meaningful improvements in hospital performance and patient outcomes. The absence of a comprehensive framework may suggest that smaller, more specific indexes, such as those for real-time patient location monitoring and tracking solutions, are also unlikely to exist. Even if such solutions or frameworks exist, thorough research is still necessary to determine whether this segment has been adequately explored in the existing literature.

These two indicators (the Smart Healthcare definition and the Smart Healthcare Index) play a crucial role in assessing whether the foundational groundwork has been laid for real-time patient location monitoring and tracking solutions to emerge in academic and industry discussions. If these indicators are well-defined, they can serve as signposts, indicating that the topic is ready to be further explored. Conversely, the absence of these indicators highlights the need for further research and development before such solutions can gain wider acceptance or visibility. Following this, a direct investigation into the existence of a real-time patient location monitoring and tracking index will be conducted, even if the initial two indicators are not fully met. This ensures that no existing frameworks or research contributions are overlooked. This section provides an in-depth review of the literature on both the definition and index, as well as an extensive analysis of existing studies related to real-time patient location monitoring and tracking solutions. This combined approach offers a clear understanding of the current state of knowledge and identifies the gaps that need to be addressed for future development.

The two key indicators Smart Healthcare’s comprehensive definition and Smart Healthcare Index were absent in the literature, indicating that an index for real-time patient location monitoring and tracking solutions is also unlikely to exist. This conclusion was confirmed through searches of major academic journals, as summarized in Table 2. A Systematic Literature Review (SLR) was conducted to address objective (2) using two specific keywords: (1) real-time patient location monitoring and the tracking solution index. The keywords were chosen to ensure that potential research was captured, even if the solutions existed outside a “smart” environment framework. The search covered both smart and non-smart settings to provide a more comprehensive view.

3.2 Choice of database

In a Systematic Literature Review (SLR), a comprehensive search across multiple databases is essential to ensure the quality and depth of the review.¹⁶ Accessing major journal databases is crucial, as they provide peer-reviewed, high-quality studies relevant to specialized fields, such as healthcare, engineering, and information systems. For this study, searches were performed in the following key databases to gather relevant literature for developing a real-time patient location monitoring and tracking solution in healthcare facilities: Directory of Open Access Journals (DOAJ), ScienceDirect, SpringerLink, PubMed, IEEE Xplore, Emerald Insight, and Google Scholar. These databases ensure a broad coverage of both theoretical and practical studies and offer valuable insights needed to build an effective solution.

These databases were strategically selected for extensive coverage across disciplines relevant to this study. Each platform offers unique insights that are essential for developing real-time patient location monitoring and tracking solutions. DOAJ and PubMed focus on healthcare systems and patient care, providing valuable perspectives on clinical practices and patient-centered approaches. ScienceDirect and SpringerLink cover technological innovations and engineering solutions that are crucial for understanding the technical infrastructure behind real-time tracking systems. IEEE Xplore specializes in information and communication technology (ICT) applications, offering research on sensor networks, IoT devices, and real-time data transmission, which are all key components of patient monitoring solutions. Emerald Insight provides insights into healthcare management and operational efficiency, helping to explore how real-time tracking can optimize patient flow and reduce turnaround times. This diverse selection ensures a comprehensive review integrating technical, clinical, and management perspectives, which is essential for building an effective real-time patient tracking system.

By searching across this broad spectrum of databases, we ensured a well-rounded collection of resources that encompass both the technical and operational aspects of real-time patient location monitoring and tracking solutions. This comprehensive approach is expected to yield a significant number of high-quality studies that not only reflect current trends and challenges in healthcare technology, but also contribute valuable insights into the development and optimization of such systems in medical facilities. Additionally, this thorough search allowed us to identify potential research gaps, ensuring that the review offers both a solid foundation and innovative directions for future work in this field.

3.3 Search terms and eligibility criteria

For this study on real-time patient location monitoring and tracking solutions in healthcare facilities, two primary search terms were identified: “patient real-time location monitoring” and “tracking solutions in medical facilities.” These keywords were carefully chosen to align with the study’s core objectives, emphasizing the capabilities required for healthcare professionals to track and monitor patients in real-time within hospital settings. The search was conducted across multiple databases, and the initial results were screened by reviewing titles and abstracts to determine their relevance. Studies that did not meet predefined criteria were excluded to streamline the process. Only studies that met the eligibility requirements, specifically focusing on patient location monitoring systems, their implementation, and relevant tracking technologies, were included for further analysis. This approach ensured that the review remained focused and aligned with the objectives of the study.

In the subsequent stages, the selected studies were examined more closely, focusing on identifying key elements related to the functioning conditions, attributes, and operational environments of real-time patient location monitoring systems. Studies that demonstrated a strong connection to research focus, especially in terms of technological integration, patient care impact, and hospital operational efficiency, were subjected to deeper scrutiny. This in-depth review sought to uncover valuable insights into how these tracking solutions function in practical healthcare settings, the challenges they address, and the potential benefits they offer to improve patient flow, reduce turnaround times, and enhance the overall healthcare service quality. By applying this structured approach to search terms and literature selection, the study was able to avoid information overload while ensuring that only the most relevant and impactful studies were included in the review. This process not only narrowed the focus, but also enabled a thorough exploration of the key components that make real-time patient location monitoring and tracking solutions essential in medical facilities.