Hospital wayfinding: the cost of getting lost and the QR fix

A patient who cannot find the consulting room arrives late, asks three employees on the way and walks in tired. The cost of that walk appears in no budget, yet it can be measured: in staff minutes, in delayed appointments and in stress. This article gathers the verifiable figures, compares signage and digital options and describes how to build, in a single building, a system of QR codes that open a web page with the route drawn on the floor plan, with no app and no hardware.

What getting lost costs

The most quoted figure comes from a 1990 Georgia Institute of Technology report written by Craig Zimring for Emory University Hospital. The report is not publicly available online, so we give it as cited in the peer-reviewed literature: according to Majerova et al. (PLOS ONE, 2022), in a 604-bed tertiary hospital the annual cost of wayfinding problems was estimated at more than USD 220,000, much of it the hidden cost of directions given by staff other than information desk employees, which took up more than 4,500 staff hours. The figure is 36 years old and should be read as an order of magnitude, not a budget line.

The most detailed recent measurement is also by Majerova et al., at Vítkovice Hospital in Ostrava (Czech Republic). Of 785 employees, 173 answered a questionnaire on the time they spend each day giving directions. Doctors reported 8 minutes a day, nurses 16.4 minutes, non-medical staff 7.6 minutes. At the 2021 average hourly wage, the annual cost came to CZK 2.67 million: roughly USD 14,500 for doctors, USD 100,000 for nurses and USD 5,000 for non-medical staff, at the 22 CZK/USD rate used by the authors.

On the patient side, a representative survey of 1,041 respondents published in Design for Health (Zbiejczuk Suchá et al., 2025) found that 47% experience minor or major difficulties navigating hospitals, with older adults and people with lower educational attainment disproportionately affected. In the survey of 928 patients and visitors at Vítkovice Hospital (Ženka et al., 2021), roughly two thirds said a newcomer may face serious difficulties finding their way.

The third component is the late or missed appointment. No study separates the no-shows caused by getting lost from the rest, but the order of magnitude of the phenomenon is known: according to NHS Digital, in 2023-24 hospitals in England had 135.4 million outpatient appointments, of which 8.0 million (5.9%) were did-not-attends. The Department of Health wayfinding guidance (2005) lists explicitly, among the indirect costs a good system reduces, the time wasted when people are late for appointments and the time spent with people who are anxious because they had difficulty finding their way.

Other percentages of visitors who get lost circulate without an identifiable primary source; we do not use them.

What works in the building: signage principles

Before any digital solution, the building has to be legible. The Department of Health guidance (NHS Estates, 2005) starts from a written wayfinding strategy, not from buying signs. A few rules with numbers:

• No more than four or five destinations on a directional sign. More cannot be read while walking.
• One terminology. The name on the sign, in the appointment letter and in the mouths of staff must match. A case study in the guidance describes a hospital that renamed its buildings while staff kept sending patients to "C-Block" and internal signs never mentioned the new names.
• Colour coding, in moderation. Two out of three people did not notice colour coding at healthcare sites that had it. People can remember at most five colours, only eight colours have a generally agreed name, and around 8% of men and 1% of women have impaired colour vision. Code areas of the building, not departments, because departments move.
• Landmarks. An atrium, a piece of art, a café, a visible staircase: reference points that people notice and remember, especially where the architecture is repetitive.
• Bold type, large x-height, strong contrast. The guidance gives the viewing distances of the standard NHS typeface for normal vision and for partially sighted people.

The same 15 mm letters, legible from 7.5 m with normal vision, can be read from no more than 0.5 m by a registered partially sighted person (6/60 acuity), according to the same table. This is the limit of physical signs: they cannot be enlarged indefinitely, cannot be in every language and cannot be updated the day after a clinic moves.

Physical signage remains the backbone. Digital tools complete it for those who cannot read it, do not understand it, or need a route rather than an arrow.

Digital options, compared

Four families of solutions appear in hospitals. The differences lie in the hardware, in what the patient has to do and in who maintains the system.

Bluetooth beacons and an app. Beacons are small transmitters stuck to walls, from which the phone computes its position. According to Grönroos et al. (2017), who installed such a system in Finnish hospital units, a beacon typically costs USD 10-30, runs for over a year on a coin-cell battery and gives room-level accuracy. A large building needs hundreds of them, each with a battery to replace, and the patient has to install an app.

Dedicated mobile app. The map and the route live in the app; positioning may come from beacons or be absent. The problem is adoption: in the Ženka et al. (2021) survey, only 35.2% of men and 29% of women would use a smartphone navigation app in the hospital, and 61.4% of respondents over 60 had or used no smartphone.

Interactive kiosks. Screens at the entrance and at corridor junctions. They need no phone, so they also serve people without a smartphone, but they carry equipment and replacement costs: in the Vítkovice project, Majerova et al. budget the replacement of kiosks, tablets and frames after five years at CZK 131,000.

QR codes that open a web page with the route. A code printed on a poster, at the entrance and on each floor, encodes a link. On an iPhone the Camera app reads it directly, with nothing to install, according to Apple's documentation; on Android the feature depends on the manufacturer and should be checked on staff phones before printing. The page knows where the code is, so it knows where the patient is, and draws the route on the floor plan to the chosen destination. There is no hardware in the walls and no battery. Salins et al. (2025) built such a system for a tertiary hospital in India, with 5 floors, 52 destinations and 758 routes, in HTML, JavaScript and the open-source Leaflet.js library, hosted statically at no cost. The Vítkovice system uses the same principle, QR codes "in clearly visible places" as position fixes.

Option	Hardware in the building	What the patient does	Maintenance	Who is left out
Signs and landmarks	Physical signs	Reads and follows the arrow	Reprinting at every clinic move	Low vision, other languages, complex routes
Beacons + app	Hundreds of beacons at USD 10-30 each (Grönroos et al., 2017)	Installs the app, grants permissions	Batteries after a year or more (Grönroos et al., 2017), app updates	People without a smartphone, those who refuse to install
Kiosks	Screens at entrances and junctions	Searches the destination on screen	Equipment replacement after 5 years: CZK 131,000 (Majerova et al., 2022)	Those who leave the kiosk without remembering the way
QR code + web page	Printed posters	Scans with the camera, picks a destination	Content updated online, reprinting only when a location changes	People without a smartphone (needs a kiosk or staff)

The Vítkovice project combines QR codes, kiosks and a web application, and its cost-benefit analysis gave a benefit-cost ratio of 5.27, a net present value of CZK 19.4 million over 2020-2031 and a payback period of under one year, with maintenance of CZK 12,000 a year from 2023. The main cost was the time of the team that developed the system, not the equipment.

Accessibility: who we design for

A wayfinding system is judged by its most vulnerable user. Four concrete requirements:

1. Contrast and size. WCAG 2.2 (Web Content Accessibility Guidelines, success criterion 1.4.3) requires a contrast of at least 4.5:1 between text and background for normal text and 3:1 for large text, defined as at least 18 point or 14 point bold. A wayfinding page meets these thresholds and allows the text to be enlarged.
2. Step-by-step instructions, in text. A map is useless to someone who cannot see it. The page also offers a list: "Leave the lift on floor 2. Turn right. Third door on the left, room 214." The text can be read aloud by the phone's screen reader, enlarged or sent to a companion.
3. Languages. The Department of Health guidance notes that multilingual signs become large and confusing and recommends other ways of helping people who do not read the local language. A web page switches language with one tap. For Romania and Moldova the minimum set is Romanian, Russian and English.
4. The legal obligation. Directive (EU) 2016/2102 requires the websites and mobile applications of public sector bodies to be accessible, following the European standard EN 301 549, with a published accessibility statement and a mechanism for users to report problems. A public hospital that publishes a wayfinding page publishes a public sector website.

People without a smartphone will not scan any code. For them, signs, staff and, where the budget allows, a kiosk at the entrance remain.

How a QR wayfinding system is built

The chain has six parts. Each can be tested on its own.

1. Floor plans. The existing architectural drawings, simplified: walls, doors, corridors, lifts, stairs, toilets. Salins et al. used Adobe Illustrator for 5 floors.
2. Points of interest. Every consulting room, laboratory, cashier, toilet and exit gets a unique name, identical to the one on the door and in the appointment letters.
3. Routes. Corridors become a graph of nodes and links, with lifts and stairs connecting floors. From 52 destinations, 758 routes resulted in the Indian study. Step-free routes are marked separately.
4. QR points. At every entrance and on every floor, next to the lift and at the main junctions, a poster with the code and a short line. Each code leads to a different address, which tells the page where the route starts.
5. Content management. When a clinic moves or changes its hours, someone in the hospital edits the record and every page updates at once. The Vítkovice system has this function.
6. Data protection. The page asks for no account, name or phone number. To count scans, a server-side counter is enough, with no cookies and no device identifiers, in line with Article 5(1)(c) of the GDPR (General Data Protection Regulation), which requires the data processed to be limited to what is necessary.

These results are self-reported, from a single hospital, and do not measure minutes saved; they do show that a simple page opened from a QR code is accepted by the people who try it.

How to measure success

Four indicators, all cheap:

• Scans per QR point, per day. The server counter shows which entrances and floors generate requests and which codes nobody sees.
• Questions at the front desk and to staff. The Majerova method: a short staff questionnaire on minutes spent daily giving directions, before launch and three months after. The difference, multiplied by headcount and hourly cost, is the saving.
• Time to destination. Measured by an observer for a sample of first-time visitors, before and after, or asked of the patient at the end, as in the Indian study.
• Late arrivals and no-shows. From the scheduling system: the share of patients arriving after their slot and the did-not-attend rate, by clinic, against the baseline month. The English benchmark is 5.9% (NHS Digital, 2023-24).

What this means for a hospital in Romania or Moldova

According to Romania's National Institute of Statistics, in 2023 the country had 554 hospitals and 717 hospitals and assimilated units in total, 355 of them with more than 100 beds; they treated 3.7 million inpatients and 5.3 million day cases. Large hospitals are typically pavilion campuses, extended in stages, with inherited building names: the profile in which wayfinding costs.

A plan for one building in four weeks (a planning example, not a real case):

1. Week 1, measurement. An employee accompanies ten first-time visitors and notes the time and the stops. The front desk counts wayfinding questions per day. Staff fill in the minutes-per-day questionnaire.
2. Week 2, plans and destinations. Floor plans are simplified and the single list of destinations is fixed. Contradictory signs are corrected now: no more than five destinations per sign, bold type, strong contrast.
3. Week 3, routes and the page. The route graph and the web page are built, in Romanian, Russian and English, with map and text instructions. They are tested with ten people, at least two over 65 and one with low vision.
4. Week 4, launch. QR posters are printed, the front desk points patients to the code, and the four measurements start. After three months the staff questionnaire is repeated and the extension is decided.

Questions for a vendor, whatever the solution:

• What does the patient have to install? If the answer is "an app", ask how many of your patients over 60 will do it.
• What hardware goes into the walls, how many units, with what battery, and who replaces them?
• Who updates the content when a clinic moves, and how fast does the change appear?
• What patient data does the page or app collect, and where is it stored?
• Does the page meet WCAG 2.2 and Directive 2016/2102, and what report do you receive: scans per point, destinations searched, languages used?

A QR code does not replace a good sign. It extends it to the consulting room door, in the patient's language, in letters as large as they need.

Consdinamic builds software and AI to order, with its deepest specialisation in healthcare, and its portfolio includes a QR wayfinding system alongside a voice assistant for appointments and an FAQ chatbot, with products available in Romanian, Russian and English; its own products are used daily in the Gral Medical private medical network in Romania, across 29 locations.

Conclusion

The cost of getting lost in a hospital is real and measurable: 8 minutes a day for a doctor and 16.4 for a nurse in the Ostrava measurement, more than 4,500 hours a year in Zimring's classic estimate, 47% of patients with wayfinding difficulties in the 2025 survey. Good physical signage solves the first part of the problem: few destinations per sign, one name per destination, colour only where it makes sense, large letters and contrast. The second part, the personal route, in the patient's language, updated the day after a move, is solved most cheaply by a web page opened from a QR code: no app, no beacons, no batteries, with a benefit-cost ratio of 5.27 in the Ostrava economic analysis. The conditions: clean plans, unique names, text instructions for those who cannot see the map, zero personal data and four indicators measured before and after.