This chapter presents the early results of an ongoing study of coordination and hand-offs across a group of fellows in a pediatric intensive care unit (PICU). The safety of PICU patients relies on the quality of care and the speed with which it is administered, and any breakdown in communication directly affects patients' health. Conversation analysis has been used in healthcare research to better understand the doctor–patient relationship by examining patient counseling, and the use of medical records. Intensive Care Units are hospital units that are equipped and staffed to provide specialized care for the most critically ill patients. Pediatric intensive care treats children, although patient ages in the unit can range from newborn to early twenties. The complex nature of interventions and the possibility of rapid deterioration in patient conditions make communication between caregivers essential in order to ensure continuous, efficient, and effective patient care.