In hospitals, wheelchairs are vital mobility aids that are used to move patients with restricted movement between departments. Wheelchairs must be made available on time and distributed effectively in order to provide high-quality patient care, reduce delays, and enhance operational workflows. However, manual wheelchair availability and location tracking frequently results in inefficiencies, resource misplacement, or underutilization. This paper presents the design and development of an IoT-based Smart Wheelchair Monitoring System intended for hospital environments. The primary objective of the system is to enhance patient care and optimize hospital resource management by enabling real-time detection of wheelchair occupancy, availability status, and location. The solution employs ESP32 microcontrollers integrated with pressure sensors to detect whether a wheelchair is in use or vacant and uses dedicated node identification to determine its room-level position within the facility. All detected data are transmitted in real time to a centralized cloud database using Firebase Realtime Database, enabling seamless data storage, monitoring, and retrieval. A web-based dashboard interface provides hospital staff with an intuitive view of each wheelchair’s current state and location, facilitating quicker decision-making and efficient resource allocation. Experimental validation in a controlled environment demonstrated the system’s ability to provide accurate occupancy status, reliable room identification, and stable cloud connectivity with minimal latency. The proposed solution offers a scalable and cost-effective approach to improving operational efficiency and patient service quality in healthcare institutions.