Despite extensive research, handoffs remain a leading concern in patient safety. This study examined handoffs from the emergency department to the inpatient unit, a transition known to be associated with adverse events. Investigators analyzed handoff communications before and after implementation of The Joint Commission's Targeted Solutions Tool, an online application to improve handoff communication, which includes the needed interventions and change management strategies to implement them. The rate of defective handoffs declined significantly after implementation of the tool. However, even after implementing the Targeted Solutions Tool approximately 12% of examined handoffs were defective, highlighting the challenge of achieving a zero error rate in patient safety.