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Patient safety in hospitals during nights and weekends has increasingly been recognized as a significant problem. The safety on weekends and nights tool was developed to assist health care leadership assess capabilities for care during off-hours and identify opportunities for improving outcomes. Eight categories of hospital-based services are detailed in the safety on weekends and nights tool that can assist clinical and administrative leaders in understanding services and processes of care that may eliminate differences in outcomes between day and night care. The implications of enhanced resources for off-hours care and future areas of study in this area of patient safety are discussed.