Background: Malnutrition negatively affects growth, immune system function, emotions, cognitive development, and is known to be poorly recognized in hospitalized children. Under diagnosing malnutrition also negatively impacts assessment of medical complexity and estimates for hospital resourcing needs. In our facility, prior hospital screening only triggered dietitian assessment for patients if unintentional weight loss greater than 10 pounds was identified. Goal: Improve hospital screening to identify pediatric patients at risk for malnutrition, measured as a change in codable malnutrition diagnoses upon hospital discharge. Methodology: A 4-week pilot study was performed to determine feasibility for success with implementation of the Paediatric Yorkhll Malnutrition Score (PYMS) tool for all patients admitted to a regular nursing unit. It was used to determine how many patients would have consults based on the PYMS screening compared to how many patients were actually ordered dietitian consults. From the pilot study, potential for 45-105% increased dietitian consultation volume was estimated. With nursing and dietitian support, the PYMS tool was implemented on all non-intensive care units. PDSA cycles were performed monthly for 6 months, evaluating dietitian consult volume, documentation of malnutrition, and post-discharge coded malnutrition diagnoses. Project adjustments were made with each PDSA, with the project continuing after 6 months to be monitored in maintenance. Outcomes: The screening process resulted in approval of the PYMS tool as an official hospital form, completed for every non-intensive care patient. For patient reaching threshold score, a dietitian consult is ordered by the admitting nurse. If the dietitian makes a diagnosis of malnutrition, including degree of severity, both the primary physician team and the clinical documentation improvement (CDI) team are notified. The CDI team monitors patient progress notes to insure the primary team is documenting malnutrition, and a query is placed if not present. The quarter prior to project implementation, 109 malnutrition diagnoses were made. During the project, malnutrition diagnoses made were: quarter 1 = 130, quarter 2 = 166, quarter 3 = 157, quarter 4 = 179. During the first year of the project (2018), malnutrition diagnoses increased 22% compared to the year prior (2017). Comparison of severity of diagnoses (2017 vs 2018) were: Severe 187 vs 267, Moderate 159 vs 192, Mild 102 vs 128, Unspecified 71 vs 50. Discussion: Hospitalized children with malnutrition are at increased risk for comorbid conditions and require more care. Clinicians should be aware that a diagnosis of malnutrition also increases a patient’s overall severity of illness and risk of mortality (Severe SOI/ROM 4/3, Moderate SOI/ROM 3/2, Mild SOI/ROM 2/1). With improved screening and diagnosis of malnutrition, clinicians will better assess and treat the most vulnerable patients, while also improving their facility reimbursement through truer reflection of medical complexity.