From other comments here, it sounds like there really hasn't been a lot of experimentation or innovation in the "sign-off" process. It seems like things like body cameras and audio recordings could help with the transfer of knowledge between two people about a specific patient. So could telepresence, IMO, if the off shift doctors weren't trying to recover for their next marathon.

> a solution that they know works

For what definition of works? My (thankfully few) trips to the hospital have not exactly inspired a lot of confidence in the hospital system. Duplicated questions, minimized interaction with an actual doctor, being kept in the dark about what's going on, waiting for hours between human interactions, empty IV bags which hang for hours... This is questionable definition of "works".