• Chrysanthi Papoutsi, Alan Poots, Jake Clements, Zoe Wyrko, Natalie Offord, and Julie E Reed.
• Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
• Age Ageing. 2018 Mar 1; 47 (2): 311-317.

Backgroundchecklists 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.Objectivesto examine the use of the Frailsafe checklist, including potential to contribute to improved safety, quality and reliability of care.Methods110 qualitative interviews and group discussions with healthcare professionals and other specialties, 172 h 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.Resultsthrough 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 24.0% of sampled patients as having received all clinical assessments across key domains for this population for the duration of the project (1,687/7,021 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.Conclusionsthe 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.© The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.

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