Understanding how a tap on/tap off system supports clinical work in an emergency department: a qualitative study

Single sign-on (SSO), tap-on-tap-off (TOTO) and virtual desktops (VD) are increasingly being used in hospitals to reduce the burden and risks of password management, but we know little about how these systems are used in practice. We aimed to understand whether, and if so, how and why a TOTO and VD solution supported clinical work in an emergency department (ED).

Qualitative descriptive design comprising interviews (n = 17) and work observations (~ 7 h) with doctors and nurses in an Australian ED. Data collection and analysis were informed by the unified theory of acceptance and use of technology (UTAUT).

Some participants perceived the TOTO-VD system as useful, however, most questioned the value of the system for ED work. Time to login was relatively long for the needs of the ED, which contributed to the system not being used as intended. Workarounds led to users being automatically logged out mid-task, which further contributed to clinicians' negative experience with the system. There appeared to be limited use for, and potentially new risks introduced with a VD solution, where ED clinicians perceived there to be redundant control of access to computers.

The ED work context presented barriers to TOTO-VD adoption. The system did not support clinical work in an ED and so was worked around by clinicians. We recommend examining and understanding clinician work, including when and how computers are used and what systems are accessed, prior to implementation of any technological solution.

Not applicable.