With reductions in resident work hours, a greater number of communication failures have resulted, largely due to an increased number of "sign-outs" between providers. Despite the development of educational curricula, best practice guidelines, and computerized systems for sign-out, the patient care issues that remained around ineffective transfer of information elevated the issue into a National Patient Safety Goal. This prospective audiotape study analyzed more than 500 sign-outs and discovered omission of key information that potentially contributed to delays in diagnosis and treatment from covering providers, near misses, and several inefficiencies or redundancies in work. The authors also reported that failures to provide an accurate overall picture of the patient led to challenges with overnight decision-making. A past AHRQ WebM&M commentary discussed a sign-out–related error and the necessary systems to ensure safe and effective sign-outs.