Every year, almost all departments at PIH Health develop a PI (performance improvement) project plan that aims to improve patient care. Then, in late October, we attend a PI Fair to share with other departments the improvements we’ve made while striving to always put patients first. This year, FANS (Food and Nutrition Services) worked on improving the percentage of malnourished patients that are diagnosed. Our theme was Scooby Doo and during the fair we handed out clementines and Scooby snacks as we spoke with colleagues about our improvements and why we chose this PI project. This topic of malnutrition has been regularly discussed in recent years, and for good reason. Malnutrition diagnoses have the potential for bringing increased reimbursement for the organization. More than that, malnutrition has direct effects on patient outcomes. If there are not adequate stores in the body or adequate nutrition to maintain these stores, then patient outcomes tend to be poor. One might wonder how much muscle someone would lose while lying in bed all day, which can be similar to a stay in the hospital. Douglas Paddon-Jones has a particular interest regarding this topic- here are some of findings of the studies he has been involved with. Healthy, young adults lost 2% muscle mass after 28 days of bedrest, while healthy elders lost 10% in just 10 days. Elderly and ill patients lost 10% in a mere 3 days. These numbers seem intimidating, however when appropriate action is taken, patient outcomes have the potential to be improved upon. In the acute setting, action taken may only serve to delay the effects of malnutrition and give the patient and care team the knowledge of how to improve the patient’s malnourished status upon discharge from the hospital. To rebuild muscle mass, 25-30 grams of protein 3 times per day is adequate in many cases. The elderly and the young have the same muscle building capacity. Exercise and activity helps, however proper nutrition is still necessary. With a solid, supportive interdisciplinary approach, malnutrition can be addressed and resolved to benefit the patient. Of course, patient wishes must always be honored. We cannot force anyone to do anything, but we can encourage and arm those around us with evidence-based knowledge. Together we can put patients first by providing a level of care that supports the highest quality of life possible for each and every patient.