# Pediatric Palliative Care Patient Transfers of Location at End-of-Life: A 7-Year Retrospective Study

## TL;DR

This study examines how often pediatric palliative care patients are moved between care locations in their final weeks, and why these transfers happen.

## Contribution

This is the first study to quantify and analyze transfers of pediatric patients at end-of-life in the last two weeks of life.

## Key findings

- 44.1% of patients had at least one care location change in the last two weeks of life.
- The most common reason for the final transfer was to receive a higher level of medical care due to sudden medical events.
- 37.8% of transfers involved moving patients to less medicalized settings.

## Abstract

Background/objectives: Transferring pediatric palliative care patients nearing the end of life (EOL) between care locations is clinically and logistically complex, potentially causing significant stress for families and patients. This study aimed to determine how frequently such transfers occurred in the last two weeks of life, noting the documented reasons for these changes. Methods: A retrospective medical record review was conducted for pediatric palliative care patients known to two palliative care services in Sydney, Australia, who died between January 2017 and May 2024. All medical records from the last two weeks of life were reviewed for any transfers that occurred, noting the reasons for these transfers. Results: Of 457 patients with available medical records, 44.1% of patients had at least one change in location of care in the last 2 weeks of life: 34.1% had one, 7.0% had two, and 3.1% had three or more changes in location. The most common reason for the final change in location was to receive a higher level of medical care (54.3%), often triggered by a sudden medical event. However, 37.8% of changes involved moving a patient to a less medicalized setting. A smaller proportion of transfers (8.0%) were due to psychosocial reasons. Conclusions: To our knowledge, this is the first study to quantify pediatric EOL transfers in the last 2 weeks of life, identifying reasons for these transfers. The findings offer valuable insights to improve planning, reduce unnecessary and potentially stressful transfers, and guide the management of necessary transfers.