Discontinuity between providers is a well-known source of errors, with problems arising from handoffs and signouts both in hospital and at hospital discharge. This quality improvement initiative aimed to enhance handoffs in 23 children's hospitals over a 12-month period. Following introduction of a structured handoff tool, handoff-related care failures declined and provider satisfaction with handoffs increased. Handoff-related care failures were defined as insufficient information transfer that affected the patient, such as reporting inaccurate test results or miscommunication that led to duplicated medications. This study is the largest to date of a standardized handoff approach, and these results are consistent with prior smaller studies. A past AHRQ WebM&M commentary describes pitfalls of handoffs.