Frailsafe is a simple safety checklist offering the opportunity to improve safety and quality of care for frail older people while in hospital. It aims to increase key clinical assessments or practices on things like risk of falls, mobility and delirium, and to facilitate communication between staff. However, the relatively low completion rate highlights the need to understand how this approach can be better embedded in the complex care that is typical of services provided for older people. Comprehensive assessment of the frail older person in the emergency department is rarely feasible. Frailsafe was introduced in 12 NHS hospitals to help health professionals complete key frailty assessments and ultimately improve patient outcomes. Views on the checklist and completion rates were assessed through staff interviews and ward observations. The tool was mostly used by senior doctors, with a minimal challenge from junior staff and other healthcare disciplines. Most successes came when geriatricians were available in the acute setting to undertake the assessments. There appears need to consider organisational changes of geriatric services within hospitals before wider implementation of the checklist.