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One million patients a year experience a handoff when residents who provide primary care graduate. These handoffs are a risky time and lead to care delays, missed results, and ER visits and hospitalizations. We created a multifaceted project to improve care during these handoffs. We created a standardized sign-out process and improved scheduling coordination. We created teaching videos and provided education to residents. We performed safety audits to ensure all patients were scheduled with a new PCP. We scheduled time for residents to establish care in telephone visits. We also interviewed patients over the phone and incorporated their patient-identified solutions by creating a transition packet and a patient comic to improve patient notification, education and engagement. We have improved patients lost to follow-up at 6 months, the number of patients seeing the correct PCP, test follow-up and reduced acute visits in the ER and hospital 3 months after the handoff.