Cognizant of a possible Hawthorne bias, long-term assessment was conducted 2 years after protocol implementation (July-August 2011). Informed consent was obtained from parents and their children who were involved in videotaping of the handover. The clinicians were not aware of the exact time when they were being videotaped, although, as per ethics requirements, they were briefed a priori that some handover events would be recorded. We also conducted an anonymous survey among PICU and cardiac OR staff involved in handovers to assess their experience and acceptance of the process (questionnaire available on request).A total of 20 handovers were videotaped by one of the QI leaders unobtrusively to avoid distracting the teams. Nineteen were of sufficient quality and were evaluated and scored independently by 2 QI experts using the 7 defects categories (see Supplemental Digital Content, Table, available at: http://links.lww.com/JNCQ/A139); one of whom had been involved in the 2009 observation stage. Evaluators' coding were compared and discrepancies resolved by discussion or, if needed, the intervention of a third party. These results were then compared with the previous ones gathered 2 years earlier using the Mann-Whitney U nonparametric rank sum test for statistical comparison.The survey of PICU and OR handover teams gathered demographic information and assessed knowledge of the handover process as well as handover protocol acceptance. To test the participants' knowledge of the sequence of steps in the handover process, participants were presented with a list of handover elements in random order and asked to arrange the elements in the proper sequence in which they should occur. Opinions of the current handover process were assessed by a series of questions using a Likert-type response scale with 5 options from “poor” to “excellent,” with additional open-ended questions. Data were analyzed with descriptive statistics, and graphic representations (box-plot) were used to communicate results to the teams.