Background: Checklists are increasingly proposed as a means to enhance safety and quality of care.
However, their use has been met with variable levels of success. The Frailsafe project focused on
introducing a checklist with the aim to increase completion of key clinical assessments and to
facilitate communication for the care of older patients in acute admissions.
Objectives: To examine use of the Frailsafe checklist, including potential to contribute to improved
safety, quality and reliability of care.
Methods: 110 qualitative interviews and group discussions with healthcare professionals and other
specialties, 172hrs of ethnographic observation in 12 UK hospitals and reporting of high-level
process data (completion of checklist and relevant frailty assessments). Qualitative analysis followed
a thematic and theory-driven approach.
Results: Through use of the checklist, hospital teams identified limitations in their existing
assessments (e.g. absence of delirium protocols) and practices (e.g. unnecessary catheter use). This
contributed to hospitals reporting just 24.02% of sampled patients as having received all clinical
assessments across key domains for this population for the duration of the project (1687/7021
checklists as fully completed). Staff perceptions and experiences of using the checklist varied
significantly, primarily driven by the extent to which the aims of this quality improvement project
aligned with local service priorities and pre-existing team communications styles.
Conclusions: The Frailsafe checklist highlighted limitations with frailty assessment in acute care and
motivated teams to review routine practices. Further work is needed to understand whether and
how checklists can be embedded in complex, multidisciplinary care.