Tracking Day Shift Nurses' Work Patterns Using an Indoor Positioning System in an Internal Medicine Ward at a...

The increasing complexity of medical care and the shortened hospital stays mandated by Japan's Diagnosis Procedure Combination/Per-Diem Payment System (DPC/PDPS) necessitate the objective and efficient analysis of nursing workload. Given that traditional time-motion studies are resource-intensive, the use of an Indoor Positioning System (IPS) offers an unobtrusive and scalable solution for the continuous quantification of nurse activities.

This study aims to quantify day-shift nurses' location-based time-use using an IPS and to evaluate how staffing levels and weekday/weekend status relate to concentrated bedside care and total room presence in a DPC/PDPS ward.

A prospective time-motion study was conducted in a 51-bed internal medicine ward at a Japanese university hospital for 14 consecutive days between January and February 2025. A total of 153 day shift records were analyzed. Location and duration of stay were measured using smartphones and Bluetooth Low Energy (BLE) beacons. Data were analyzed using Mann-Whitney U tests and Spearman's ρ.

Nurses spent the largest proportions of time at the nurses' station (36%) and in patient rooms (30%). The median total patient-room time per nurse was 160.8 minutes (interquartile range (IQR): 111.1-197.2) on weekdays versus 214.5 minutes (147.0-236.2) on weekends (Mann-Whitney U, p = 0.0015). Break-room time was 14.3 minutes (8.3-20.3) on weekdays and 21.8 minutes (12.8-32.0) on weekends (p = 0.0034). At the day level, the number of nurses on duty correlated negatively with the median per-nurse room time (Spearman's ρ = -0.94, p = 7.2 × 10⁻⁷). Per-patient, bedside time (ward-level) was longer on weekdays than weekends (43.16 minutes (41.33-44.95) vs 28.14 minutes (27.08-28.98); Mann-Whitney U, p = 0.0020).

The IPS effectively quantified nurse location and workload patterns. The finding that total room presence was shorter while bedside time per patient was longer suggests that higher weekday staffing enables more focused and efficient task allocation. IPS technology demonstrates strong practical utility as a scalable, data-driven tool for objectively evaluating nursing efficiency and guiding staffing policy decisions under Japan's DPC/PDPS system.