DESIGN DEVELOPMENT AND IMPLEMENTATION OF
WIRELESS NURSE CALL STATION
S.Aswin, N. Gopalakrishnan, Member, IEEE, S.Jeyender, R.Gnana Prasanna and S. Pravin Kumar*
Abstract: In this work, a nurse call system is designed
and developed which provides continuous monitoring
of patient’s status. The system helps in assisting
patients who are bedridden and have no other means
of communication with medical staffs in the absence
of their caretakers. The conventional nurse call
systems employ push button switches mounted near
hospital beds that facilitate patients to alert a
centralized base station for seeking the attention of
the nurses or other health care staffs. As and when
the call is initiated and attended the alert signal is
automatically turned on and off respectively. A radio
frequency based wireless communication is adopted
to address the additional wiring requirements in the
initial installation process. The designed system
provides the unique identification number of the
patient through voice messages and short messaging
service (SMS) messages to the base station. The call
can be initiated either by manual or automated
modes. In the automated mode, the physiological
parameters such as ECG, pulse rate, oxygen
saturation level, respiration rate are continuously
monitored and in case of any emergencies, voice
message and SMS is initiated automatically.
Keywords: Alert Devices, Health monitoring systems,
Nurse call system, Peripheral Interface Controller,
GSM Modem.
I. INTRODUCTION
Conventional Nurse Call Systems employ push
buttons located at the bed site of the patient. When
pressed by the patient, it alerts the center nurse
station by giving out an audible tone or light
flashes. A red and a green indicator lamp are
stationed outside the patient room together with a
switch to cancel the already registered call.
Whenever the red lamp is lit, it indicates that the
patient needs attention. On the other hand, the
green lamp when lit indicates that the call has been
acknowledged by the nurse. This prevents the same
patient from being attended by more than one nurse
[1]. These alert signals are turned off only if the
call is attended by the nurse. In case of delay
Manuscript received October 7, 2011. This work is being still
extended for automated triggering of the system based on bio-
signals and is under test in the laboratory.
S.Aswin, N.Gopalakrishnan, S.Jeyender and R.Gnana
Prasanna are final year students in Department of Biomedical
Engineering, SSN College of Engineering, Tamil Nadu.
S.Pravin Kumar is Assistant Professor in Department of
Biomedical Engineering, SSN College of Engineering, Tamil
Nadu. (Corresponding author: phone: 9994246503; e-mail:
pravinkumars@ ssn.edu.in).
caused for the nurse to attend the call registered by
the patient the light flash rate and the beeper sound
increases as preprogrammed. Also there is a
provision for two way voice communications
where only the nurse can initiate the voice
communication and not the patient. A layout plan
clearly outlining the ward, beds with bed numbers
together with the color coded lights is stationed at
the nurse’s station. In addition a central monitoring
panel is provided in the nursing director’s office.
Since the above mentioned system setup is a wired
communication, the installation cost and time
becomes factors of concern [2]. Also the layout
stationed at the nurse’s station becomes quite
difficult to interpret quickly as from which
ward/bed number the call is initialized, thereby
delaying the response time. However the system
proposed and designed helps in reducing the transit
time of physicians, nurse and medical staff by
providing the exact information of the patient who
pressed the button which is displayed through an
LCD module housed at the base station. Also the
same data is announced through speaker upon call
initialization. In addition, these text details are sent
to the medical staff's mobile as a short message
service. Hence even if the nurse is not available in
the center station the required details can be
obtained from the SMS. This feature especially
helps in emergency conditions where time is an
important factor.
As communication to the single central unit at the
base station is done wirelessly, it eliminates the
need of bulkier layout plans to be stationed at the
base. Also the system can be designed to transmit
the patient’s biological parameters say ECG
(ElectroCardioGram) automatically as and when
they turn abnormal along with his/her identification
number provided by the hospital.
II. METHODOLOGY
The system consists of four modules namely
transmitter and receiver module, Voice Module,
LCD module and GSM module.
A. Transmitter and Receiver Module
This section of the system which operates at
frequency-433.9MHz, transfers the call initiated by
the patient by pressing the switch available in the
vicinity of the bed to the center station. It consists
of a HT-12E encoder, HT-12D decoder, TWS BS3
transmitter and a RWS 317-6 receiver as shown in
Fig.1 & Fig.2.
1) Encoder
The encoder module HT-12E (HolTek
Semiconductor) is capable of encoding information
which consists of N address bits and 12-N data bits
[3], [4]. Whenever the trigger signal TE
(Transmission Enable) goes low, the programmed
address bits are transmitted along with data bits via
an RF transmitter and the cycle continues as along
as the trigger pin is held low. The programmable
address and data pins can be set to one of the two
logic levels "one" or "zero". Thus whenever a
switch is pressed by the patient the corresponding
data line (ADx) goes low and its status is
transmitted to the PIC microcontroller. The encoder
consumes lesser amount of current when operated
in standby mode when no trigger is applied [5].
2) Transmitter and Receiver Module
The transmitter and receiver modules has an
operating frequency of about 433.9Mhz and the
modulation mode employed is Amplitude shift
Keying, where whenever a "one " occurs at the data
input, the carrier signal is transmitted and no carrier
signal is transmitted for "zero" at the input . The
data is transmitted at the rate of 8 kilobits per
second and received at the same rate. The
transmitter/receiver unit of the Nurse Calling
Station functions like a normal transmitter receiver
unit whose block diagrams are as shown in Fig.1
and Fig.2. In this study, on the receiver end there is
an LED indicates the status of the decoded output
line as and when the corresponding push button is
pressed/released by the patient at the transmission
end. If a switch at the transmitter is in OFF state
there will be +5v at the corresponding decoded
output line of receiver section. Conversely if the
switch is in ON state the output will be 0v in the
decoded output line corresponding to the switch. In
addition a TC4051 multiplexer/demultiplexer is
proposed to be used to couple both the call register
switch status and the patients’ bio signal (in digital
form). Initially the inbuilt Analog to Digital
Convertor employed in the PIC converts the
applied input biosignal into an equivalent digital
value which is transmitted through the RF module.
The range of transmission extends to around a
kilometer.
SWITCH MICRO CONTROLLER
BATTERY ANTENNA ASK
Fig.1.Block Diagram: Transmitter
ANTENNA RECEIVER DECODER
BATTERY LED
Fig.2.Block diagram: Receiver
3) Decoder
The HT-12D (HolTek Semiconductor) series of
decoders receive the serial data that are transmitted
by an encoder and the first N bits of code period
are interpreted as addresses and the last 12-N bits
as data, where N is the number of address bits. The
above operation is done whenever a signal on the
DIN (Data IN) pin activates the oscillator [5]. In
order to eliminate unmatched codes or errors, the
decoders will check the received address three
times continuously. If the received address codes
all match the contents of the decoder's local address
which is preprogrammed , the 12-N bits of data are
decoded to activate the output pins and the
VT(Valid Transmission) pin is set high to indicate
a valid transmission. This will last unless the
address code is incorrect or no signal is received
[6]. Thus, whenever a patient (say patient no.1)
triggers the pushbutton, the corresponding output
line (line 1) of the decoder goes low. Also the
Receiver module can be coupled to a PIC that reads
the digital values transmitted along with the analog
waveform and recreates the Bio signal using
DAC0808. It is then followed by TC4051
demultiplexer to discriminate the patient details
from his/her bio signal.
B. Peripheral Interface Controller
PIC stands for Peripheral Interface Controller. It is
available as 28/40/44 pin packages. PIC 16F8A77A
is 40 pin microcontroller. The device with Reduced
Instruction Set Computer architecture (RISC) has a
10 bit 8 channel analog to digital convertor , an
analog comparator module, Synchronous Serial
Port (SSP), I2C (Master/Slave) and a Universal
Synchronous Asynchronous Receiver Transmitter
(USART) with 9-bit address detection. The CMOS
Technology employed permits wide operating
voltage range (2.0-5.5V) and facilitates low power
consumption. The device has five I/O ports
designated as A, B, C, D and E, where ports B, C
and D are 8bit bidirectional whereas port A is 6bit
bidirectional and port E has three pins that can be
configured either as input or output [7-9]. In this
system port C is configured as input and ports B
and D are configured as outputs by software code.
C. Voice Module
The APR9600 device offers true single-chip voice
recording, non-volatile storage, and playback
capability for 40 to 60 seconds. The device
supports both random and sequential access of
multiple messages. The device is ideal for use in
portable voice recorders. The APR9600 device
reproduces voice signals in their natural form. It
eliminates the need for encoding and compression,
which often introduce distortion. APR9600 consists
of a differential microphone amplifier, including
integrated AGC, an anti aliasing filter which
automatically adjusts its response according to the
sampling frequency selected thereby satisfying
Shannon’s sampling theorem. The block diagram
of voice module is as shown in Fig.3. After anti-
aliasing filtering is accomplished the signal is ready
to be clocked into the memory array. This storage
is accomplished through a combination of the
Sample and Hold circuit and the Analog
Write/Read circuit. These circuits are clocked by
either the Internal Oscillator or an external clock
source. When playback is desired the previously
stored recording is retrieved from memory, low
pass filtered, and amplified. The signal can be
heard by connecting a speaker to the SP+ and SP-
pins. The device supports five message
management modes defined by the MSEL1,
MSEL2 and /M8_OPTION pins, Random access
mode with 2, 4, or 8 fixed-duration messages Tape
mode, with multiple variable-duration messages.
Modes cannot be mixed. The length of each
message segment is the total recording length
available (as defined by the selected sampling rate)
divided by the total number of segments enabled.
VOICE RECORDER AMPLIFIER
PLAY BACK GAIN CONTROL
Fig.3. Flow diagram for Voice Module.
1) Recording
When actual recording begins the device responds
with a single beep at the speaker outputs to indicate
that it has started recording. Recording continues as
long as the message pin stays low. The rising edge
of the same message trigger pin during record stops
the recording operation (indicated with a single
beep).If the message trigger pin is held low beyond
the end of the maximum allocated duration,
recording stops automatically (indicated with two
beeps), regardless of the state of the message
trigger pin. The chip then enters low-power mode
until the message trigger pin returns high. After the
message trigger pin returns to high, the chip enters
standby mode. Any subsequent high to low
transition on the same message trigger pin will
initiate recording from the beginning of the same
message segment.
2) Playback
To playback, /CE must be set low to enable the
device and /RE must be set high to disable
recording & enable playback. Playback is initiated
by applying a high to low edge on the message
trigger pin. Playback will continue until the end of
the message is reached. If a high to low edge
occurs on the same message trigger pin during
playback, playback of the current message stops
immediately. If a different message trigger pin
pulses during playback, playback of the current
message stops immediately (indicated by one beep)
and playback of the new message segment begins.
Thus in record mode, the information to be
announced on the loudspeaker corresponding to
each patient is recorded in subsequent message
pins. Port lines D0-D7 of the PIC are connected to
these message input lines so that whenever a low
occurs at one of the decoder output pins which is
coupled to i/p port C , the corresponding port D pin
goes low as programmed by the software code.
Hence it triggers the required message to be played
back, say when M2 gets triggered message
corresponding to patient 2 is played back in the
loudspeaker.
D. LCD Module
A 16 Character x 2 line Alphanumeric Dot Matrix
LCD Module (JHD162A LCD) [10] used in this
system has 8 bit data lines with three backlight
coloration options whose block diagram is as
shown in Fig.4. Port B pins of the PIC are
configured as the output lines and are directed to
the data input lines of the LCD. Whenever the Read
enable pin is low instruction register is selected and
the stored command words for actions such as
display, clear and cursor shift, and address
information for display data RAM (DDRAM) and
character generator RAM (CGRAM) are taken as
commands and placed on the data bus . Whenever
RS pin goes high data register is selected and
information on data bus is the ASCII value of
respective character to be displayed on the LCD.
All the command and data words (text to be
displayed) are written from the PIC16F877A. This
pin of LCD is connected to RD (Read) pin of PIC.
Whenever R/W (Read/Write) pin goes high,
information is read from the LCD display RAM,
and when it goes low, information is written to the
LCD module. This pin is connected to WR (Write
pin) of PIC. The enable pin is used to enable the
LCD and it is connected to CS chip select pin of
PIC. The contrast of the LCD is adjusted by
varying the input voltage to the Vo pin of LCD by
the use of a potentiometer. The text data
corresponding to each patient is already
preprogrammed into PIC. It has 8Kx14-bits flash
program memory, 368 bytes of RAM whenever the
pin in the configured input port goes low,
corresponding text message will be sent serially to
LCD.
RECEIVER DECODER
LCD PIC
Fig.4. LCD Display.
E. GSM
The GSM (Global Systems for Mobile
Communications) is the widely accepted standard
for mobile communications whose flow is as
shown in Fig.5. These networks have an operating
range from 900 to 1800 MHz bands. The data rate
for transmission is around 270kilobits per second.
Subscriber Identity Module (SIM) is one of the key
components of GSM, where in the user information
is stored in a card. The information is retrieved on
switching on the handsets. The preprogrammed
data that is the text corresponding to individual
patient is transmitted to the GSM modem through
the serial port lines TX & RX of PIC.
RECEIVER MICRO CONTROLLER
GSM MAX 232 DRIVER
Fig.5.GSM Logic Flow Diagram
A MAX232 driver/convertor is used to convert the
TTL signals from PIC into PC signals and also to
restrict the operation of the circuit devices to 5V.
The MAX220–MAX249 family of line
drivers/receivers is intended for all
communications interfaces such as portable
computers, low power modems, multi drop RS-232
networks, particularly applications where ±12V is
not available. The text data corresponding to each
patient is already preprogrammed into the PIC. And
port C is configured as an input port by the
software code. So that whenever a pin in port C
goes low, say port C0 the text corresponding to
patient 1 is sent to the GSM modem through the
serial port whose setup is as shown in Fig.5. And if
port C1 goes low then text information
corresponding to patient 2 is sent via the serial port
and so on [11] [12]. The complete block diagram
with port distribution of PIC for various modules is
as shown in Fig.6.
III. RESULTS AND DISCUSSION
As per the schematic port D of microcontroller is
used for voice module, port B for LCD display and
serial port lines for interfacing with GSM and the
programming the PIC IC was done accordingly.
Programming is done using C language. Once the
system is set, whenever a patient (say patient no.1)
triggers the pushbutton, the corresponding output
line (line 1) of the decoder goes low which in turn
makes input port line of the PIC to go low. The
designed and developed transmitter and receiver
circuits are as shown in Fig.7 and Fig.8.
Hence the text information corresponding to
patient number 1 is sent via the serial port to GSM
modem along with the AT commands written in the
software code also the same information is placed
on the data bus of the LCD for display through
output port B which is as shown in Fig.9.
In addition corresponding output port line D0 goes
low thereby triggering the voice module to make
the announcement of message 1 corresponding to
patient number 1.
Thus as and when a particular switch number is
triggered, the call corresponding to that particular
number (i.e. the patient identification number) is
initialized. It provides efficient manpower planning
by providing nurses only to the beds where care is
needed and thereby reducing the nurse-to-bed ratio.
Further being operated in such a high frequency
range the distance of transmission offered to the
system by the transmitter is around 500m. Thus
with this wide range of transmission facilitates the
system can serve almost the entire critical care area
in the hospital environment & thereby reduces the
cost incurred in utilization of hundreds of meters of
conductor cables that is used in traditional systems.
 Fig.6.Complete Block Diagram

Fig.9. LCD module

Fig.7. Developed Transmitter Module

Fig.10.Setup for GSM module Developed

Fig.8. Developed Receiver Module

Upon call initialization all the above mentioned

modules are triggered within 2-3 seconds, hence
the transmission delay becomes negligible. Since
communication is done wirelessly, the design is
quite compact and it is less prone to interference.
The designed and developed GSM model is as
shown in Fig.10. The front and rear view of the
designed nurse call station kit with casing is as Fig.11. (a) Front View (b) Rear View of Nurse Call
shown in Fig.11. Station kit.
 IV. CONCLUSION
Thus the above mentioned nurse call system can
alert the base station upon call initialization. It
helps in timely management of nurses servicing the
Critical care patient’s thereby efficient human
resource management. It also reduces the nurse-to-
bed ratio and also has good credentials for
economic and functional planning in hospital
management. Since communication is done
wirelessly, the end product is quite compact in
design and thereby occupying much less space
without affecting the present structural and
functional plan on installation. This system also
replaces the conventional switch system which
requires very high installation cost. This
application design can be further enhanced by
employing a decimal two binary convertor, two
transmitter & receiver modules and then coupling
the outputs of the decoders before it is given to the
PIC. Thus the system can respond up to 2^8 = 256
patients
V. FUTURE ENHANCEMENT
Automated mode nurse calling system is being
developed. The call will be made when the
physiological parameters reaches the abnormal
value. For this, ECG is being transmitted and
received using multichannel transmitter and
receiver. The received signal is applied to Pan-
Tompkins algorithm [13] to determine the heart
rate. The heart rate determined using this algorithm
is set as the parameter for automatic nurse call
system. When the heart rate exceeds the normal
range, nurse call occurs automatically. In this mode
continuous monitoring occurs without patient
pressing the button and also helps in monitoring the
patient in unconscious state. Electro-oculography
(EOG) signal can also be acquired and transmitted
to detect the consciousness of the bedridden
patients [14]. EOG is a signal produced due to the
movement of the eyeball and this was found to be
appropriate parameter to be monitored for
consciousness [15].
REFERENCES
1. Tika Miller, “Nurse Call Systems: Impact on Nursing
Performance,” Journal of Nursing Care Quality, Vol.11, Issue 3,
Feb. 1997, pp. 36-43.
2. E. L. Bunting, “Nurse Call System Including a Coaxial
Conductor only connecting a plurality of signals,” US Patent
3,517,120, June 23, 1970.
3.. Kuo-Kai Shyu, “ Development of a Low-Cost FPGA-Based
SSVEP BCI Multimedia Control System,” IEEE Transactions
on Biomedical Circuits and Systems, Vol. 4, Issue 2, April 2010,
pp.125-132.
4. M. Farajmandi, “Internet Based Wireless Mobile Robot
Network,” IEEE Conference on Intelligent Automation, 2003,
pp.549-554.
5. B.Sklar, “Digital Communications Fundamentals and
Applications” 2nd Edition Pearson Education, 2007.
6. B.P.Lathi, “Modern Digital and Analog Communication
Systems”, 3rd edition, Oxford University Press, 2007.
7. Farooq, U, “Microcontroller Based Neural Network
Controlled Low Cost Autonomous Vehicle,” Second
International Conference on Machine Learning and Computing
(ICMLC), Feb. 2010, pp. 9-11.
8. Hashim, U, “Design of digital display system for ISFET pH
sensor by using PIC microcontroller Unit (MCU),” 1st Asia
Symposium on Quality Electronic Design, Kuala Lumpur, July
2009, pp. 15-16.
9. Wael M. El-Medany, “Implementation of GPRS-Based
Positioning System Using PIC Microcontroller,” Second
International Conference on Computational Intelligence,
Communication Systems and Networks (CICSyN), Liverpool,
United Kingdom, July 2010, pp.365-368.
10. Suraj G. Swami, “Wireless Quiz System using Low Power
Microcontrollers,” Proceedings of the IEEE South east
Conference, March 2010, pp.21-24.
11. Subramanian S, “Real time mailbox alert system via SMS or
email,” Asia-Pacific Conference on Applied Electromagnetics,
Dec. 2007, pp.1-4.
12. Al-Ali, A.R, “Embedded system-based mobile patient
monitoring device,” Proceedings of 16th IEEE Symposium
on Computer-Based Medical Systems, June 2003, pp.355.
13. R M Rangayyyan, “Pan-Tompkins algorithm to detect QRS
complex in ECG signal,” Biomedical Signal Analysis, IEEE
Press, 2002.
14) V. Mahesh, "Human Computer Interface for the Physically
Challenged Using Wireless Electro-Oculography," Proceedings
of International Conference on Power, Control and Embedded
Systems (ICPCES), Chennai, Dec 2010, pp. 434-437.
15) S.Pravin Kumar, “Implementation of Patient Interfaced
Nurse Call Station Using Bio-Signals,” has been accepted for
International Conference on Ergonomics and Human Factors
(HWWE 2011), IIT MADRAS, Tamil Nadu, Dec 2011.