Operational efficiency and practical utility of real-time location systems: a hospital-based case study during the COVID-19 outbreak

Effective contact tracing is a core strategy for infectious disease control. Conventional contact tracing methods rely on retrospective reviews of multiple data sources, including interviews, hospital records, closed-circuit television (CCTV) footage, and visitor logs, making the process labor-intensive and time-consuming. Bluetooth Low Energy (BLE)-based real-time location systems (RTLS) have therefore emerged as an efficient alternative. This study analyzed the technical evolution and operational implications of implementing a BLE-based RTLS at Yongin Severance Hospital during the third wave of the coronavirus disease 2019 (COVID-19) pandemic and quantitatively evaluated its impact on contact tracing efficiency. A BLE-based RTLS was progressively implemented beginning in 2019 through phases of initial deployment, institutional transition, and system enhancement. These phases included technical refinements to the RTLS, expanded functionality, and improved compliance with BLE tag use among hospital staff, reaching 92.8%. We retrospectively analyzed nine confirmed COVID-19 cases among hospital staff and compared contact tracing performance using CCTV alone, CCTV combined with RTLS, and RTLS alone. Outcomes included tracing time per case and per location. Internal hospital documents and operational records were reviewed to identify key technical and operational changes throughout the implementation process. Following RTLS implementation, contact tracing time was reduced from more than 12 hours using CCTV alone (381 contacts in 770 minutes) to 10 minutes for 918 contacts using RTLS alone. Efficiency, expressed as person-minutes per contact, improved from 10.1 to 0.02, representing a 99.8% reduction in labor required for contact tracing. A BLE-based RTLS substantially improved the efficiency of in-hospital contact tracing, supporting its potential role in hospital infection control. Future studies should evaluate the long-term economic sustainability and ethical considerations associated with wider RTLS implementation.