Strategies for ensuring safe transfers of patient care have been developed by analyzing handoff strategies in other high-risk industries. The integral components of an effective signout include providing accurate and updated information, interactive communications, limited interruptions, and a process for verifying data. Unfortunately, this mixed-methods study found that most resident handoffs did not include these key elements. In particular, few residents reported being able to sign out without interruptions. This study demonstrates that despite attempts to translate learnings from high-reliability organizations (organizations with a superior culture of safety) to health care, implementation of these strategies remains difficult in practice.