Introduction: Pediatric palliative care (PPC) seeks longitudinal relationships with patients facing life threatening conditions. Optimal PPC navigates between both inpatient and outpatient domains thus making the patient’s primary care physician (PCP) an integral member of the PPC care team. However, PPC to PCP communication is often lacking. This project sought to improve the communication between PPC teams and primary care providers through quality improvement (QI) techniques. Methods: PCP interviews revealed that they preferred a letter that outlines the patient’s care plan by palliative domains. PPC QI team members then crafted a PPC domain based letter through an iterative process. The aim of the project was to increase compliance in discharge letter completion for discharged high acuity PPC patients from 0 to 80% by July 2018 and to sustain for 6 months (Figure 1). The process measure was full compliance with the templated note when completed. The balancing measure was to survey PCP satisfaction with the letter. Interventions to improve compliance included modification of the previous PPC discharge EMR documentation process and creating an EMR letter template that can pre-populate from the PPC EMR discharge note. Results: The project’s outcome measure was to increase the compliance in letter completion for discharged high acuity PPC patients from 0 to 80% by July 2018 and sustain for 6 months. As of April 12, 2018 56 patient discharges met criteria with 51% having a completed letter. March data reveals an average completion rate of 83% (Figure 2). Conclusions: Using QI methodology, communication between PPC and PCPs was improved by the creation of and increased compliance in the completion of a discharge note to PCPs for high acuity PPC patients at discharge. This project could be used as a model for other PPC teams to increase communication with outpatient providers.