One of Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) National Patient Safety Goals for 2006 involves implementation of a standardized approach to handoff communications. This study provides a literature review of patient handoffs and discusses the variability of existing systems in one internal medicine training program. The authors define handoffs as "any transfer of role and responsibility from one person to another." They discuss a broad number of barriers to effective handoffs, such as physical setting, social setting, language and communication barriers, and time and convenience. Their recommendations call for development of standard educational practices and incorporation of handoff tools into existing information technology systems.