Abstract— An efficient discharge workflow with objective to minimize the turnaround time upon discharge of a patient in a typical hospital environment is proposed. The implemented workflow, which relies on a near-field-communication (NFC)-based patient discharge event, triggers a sequence of notifications and actions both by the nurses and housekeepers till the bed is cleared for occupancy by the next patient. The notifications are automated through Telegram Bot API. Android-based mobile applications are developed for both nurses and housekeepers. The mobile apps allow for follow-up actions and the status of the bed to be captured and sent to the cloud. Key functionalities of the system include immediate notification send to the housekeepers when a patient leaves the hospital, simple sending of cleaning requests and viewing of bed status. Click Here The system has been deployed in a hospital and evaluation is carried out in terms of improvement in the turnaround time of hospital beds. Keywords—NFC Tags, Hospital Discharge Process, Workflow Optimization, Mobile Applications
III.BED MANAGEMENT SYSTEM
The various elements of the automated workflow is implemented and integrated into a single bed management system. The three key elements of the bed management system are: a) mobile application for the nurse; b) Raspberry Pi with NFC reader that connects to the internet; c) mobile application for the housekeeper; and d) other required software component used to integrate with the system. A.Nurse’s Mobile Application The mobile application used by the nurse is built on Android. The main functionality is 1) to assign NFC cards to a patient’s bed number to allow patient to drop the NFC card into the box embedded with the Raspberry Pi and NFC reader; 2) to view bed status, such as whether a room is to be cleaned, in the process of cleaning or have been cleaned; 3) to send manual cleaning requests that are non-discharge related requests, such as mopping the floor and cleaning of toilet when it is dirty. The mobile application comprises of three major pages as shown in Fig. 5. The “Card Management” page allows a nurse to assign/reassign/unassigned NFC cards.This corresponds to the insert, update or delete operations on the online database hosted in a remote server. The NFC card chosen was a type A NFC which is also known as ISO14443-3A. Although type A NFC card has a lower memory size compared to other types, the objective of the NFC card is to get its unique serial number and store it in the database. Thus, the memory size is not a factor to be considered. Moreover, type A NFC card has a lower cost compared to the other types of NFC cards. The “SG Ward Room Status” page retrieves records from the database. The “Manual Cleaning Request” page inserts a record to the database and sends a Firebase automated notification to the housekeeper’s application to inform the housekeepers of the bed number and the type of cleaning requests.
B.Rasberry-Pi Raspberry Pi3 model B was used because of its faster processor and built-in Wi-Fi modules which can communicate with the remote server without the need of an additional USB wireless dongle. The NFC card reader is connected to the Raspberry Pi through a USB. The Raspberry Pi is setup to run a web-based application having the main functionality of 1) reading the NFC cards; and 2) send automated notification to the housekeepers when the NFC card is detected. The web application hosted by the Raspberry Pi only consists of a single textbox to read assigned NFC cards deposited by the patients. The status of the bed in the database will be updated once the web application reads the serial number of the NFC cards. Besides that, the system also sends an automated Firebase notification to the housekeeper’s mobile application with the bed number of the discharge patient. The components in the application are shown in Fig. 6. Lastly, the round-trip time of the remote server to update the database when the NFC card detected is less than two seconds. Thus, it is unlikely that the reader fails to read a subsequent NFC card deposit by the next patient. C.Housekeeper’s Mobile Application The housekeeper mobile application is also built on Android. The main functionality is 1) to obtain notification automatically when NFC cards are detected; 2) update bed status easily by pressing the “start” and “end” button; 3) send automated notification to the Admissions Office and nurses when cleaning request was completed. The components of the application are shown in Fig. 7. When viewing bed status, the records from the database are retrieved. When updating bed status, the bed status of the database record is updated. Besides that, when the bed status has been updated to “cleaned”, an automated Telegram message is sent to the nurse’s and Admissions Office’s Telegram chat group through the Telegram Bot API. The housekeeper mobile application consists of two pages: 1) list of beds to be cleaned; and 2) status of all the beds. The screenshots of the housekeeper mobile application are shown in Fig. 8. The status is color-coded for easy visual identification. D.Other Required Software Component The automated notification sent to the housekeeper’s mobile application and Admissions Office Telegram chat group uses Firebase Cloud Messaging and Telegram Bot API respectively. Both components have a HTTP-based interface. Thus, upon NFC card detection or completed cleaning, the remote server will send an HTTP request to the respective users. The automated notification sent to the housekeeper’s mobile application and Admissions Office Telegram chat group uses Firebase Cloud Messaging and Telegram Bot API respectively. Both components have a HTTP-based interface. Thus, upon NFC card detection or completed cleaning, the remote server will send an HTTP request to the respective users. Fig. 9 shows the database schema design. It consists of a “card” table and a “bed” table. The card table stores the unique serial number of the NFC card and a “bedid”, foreign key reference to the bed table “id”. When a NFC card was assigned with a specified bed, a record will be added both tables. However, once a NFC card has been deposited by the patient, the “status” field in the bed table will updated while the card table record will be deleted. This allows the NFC card to be reusable immediately.