Shifting Hematologic and Solid Tumor Units to Progressive Care Models

Cedars-Sinai Medical Center transitioned its 63-bed hematology-oncology unit to a progressive care model between 2023 and 2024, demonstrating the ability to use a structured nursing education framework to enhance monitoring and preserve continuity of specialized care for select patients with cancer, according to a presentation given at the 51st Annual Oncology Nursing Society (ONS) Congress.

Main data

The implementation of the progressive care model at Cedars-Sinai resulted in a substantial increase in specialized nursing expertise across the specialty unit. Quantitative results demonstrated that the percentage of progressive care unit (PCU)–trained nurses rose from 30% (n = 57) in 2023 to 65% (n = 94) in 2024. This growth in professional capability allowed the unit to treat higher-acuity populations more effectively within their primary oncology home.

The increase in trained staff directly impacted hospital operations by reducing the volume of unnecessary transfers to non-specialized PCU environments. By maintaining patients within the hematology-oncology unit, the multidisciplinary team ensured that oncology-specific treatments and monitoring continued without interruption. Furthermore, the investigators observed that the improved balance in workload, which accounted for the higher acuity levels of the patients, led to a positive impact on staff morale. These findings suggested that a systematic approach to education and unit designation could successfully bridge the gap between acute oncology care and intensive monitoring.

“The key takeaways are leadership alignment and data tracking, [which] help sustain ongoing change; implementing systemic approaches to education kept transparency of our registered nurse [RN] progression. Then, our oncology nurses [were able to] manage the [safety] of PCU patients,” Herson Portillo, MSN, RN, TCTCN, assistant nurse manager and oncology nurse at Cedars-Sinai Medical Center, stated in the presentation. “Structuring PCU training, enhancing oncology nurses' capabilities, and [giving] specialty progressive care provides distinguished oncology treatment. Their patients are kept on their floor, and [the patients] receive the best care that they can from the oncology nurses because they're the experts.”

Trial details

The project was designed as a systematic transition of a specialty oncology unit to a PCU model. The process began with an update to the RN job description and a series of mandatory educational requirements. All participating nurses were required to upgrade their Basic Life Support (BLS) certification to Advanced Cardiovascular Life Support (ACLS) and complete a telemetry foundation course, which included passing an annual telemetry test. To further formalize the role, the institution required nurses to obtain relevant certifications within 2 years of employment and established a new position for a Nurse Professional Development Practitioner (NPD-P) to oversee the transition.

The education timeline for the RNs was structured to ensure a steady progression of skills. Within the first 2 weeks, staff completed telemetry training. Between 3 and 6 months, nurses received training in the administration and management of chemotherapy and immunotherapy. The 6-to-12-month window focused on transplant and cellular therapy, and by the 1-to-2-year mark, nurses completed the formal progressive care training. This training included a mandatory 8-hour Progressive Care Class led by educators from specialty units such as heart failure, neurology, and lung transplant. The curriculum utilized a head-to-toe format to review indications for higher levels of care, nursing assessments, associated interventions, and standardized documentation. Additionally, nurses completed two 12-hour orientation shifts on the Cardiac Progressive Care Unit to gain hands-on experience with high-alert medications and respiratory devices.

The initiative focused on patients within a 63-bed acute inpatient setting at Cedars-Sinai Medical Center. The patient population was diverse, encompassing individuals with solid tumors and various hematologic malignancies. A significant portion of the population included those undergoing high-acuity treatments such as stem cell transplants and cellular therapies, including CAR T-cell therapy and tumor-infiltrating lymphocytes (TILs). The investigators noted that this population experienced a rise in rapid response activations, increasing from 159 in 2023 to 230 in 2024. This increase in acuity highlighted the necessity of a PCU model, as these patients often required higher-level monitoring that traditional acute care units could not provide, leading to delays in specialized oncology-specific interventions when patients were transferred to non-oncology units.

Main objectives

The primary objectives of this project were the improvement of patient safety on the specialty hematology-oncology unit and the preservation of oncology care continuity for patients who were unstable. The investigators sought to expand the institution's progressive care capacity by developing a PCU model specifically tailored to oncology needs. Success was measured by the significant rise in the percentage of PCU-trained nurses and the subsequent reduction in transfers to non-specialized units. Additionally, the project evaluated the progression of nursing education and the ability of the staff to manage high-acuity interventions––such as respiratory device management and high-alert medication administration––within the oncology setting.

Safety

The primary driver for this transition was the identification of safety challenges associated with rising patient acuity. Prior to the intervention, patients with cancer were often transferred to cardiac-specific units, where the staff lacked specialized oncology training, potentially resulting in delays for individualized cancer interventions. By implementing the progressive care model, Cedars-Sinai ensured that patients remained in an environment where staff could expertly manage oncologic adverse effects while providing continuous telemetry and higher-level monitoring.

The structured training program prioritized safety through mandatory ACLS certification and specialized competency highlights in high-alert medications and standardized documentation. Regular bi-weekly meetings between the NPD-P and Assistant Nurse Managers were held to review the progress of all registered nurses and ensure that education milestones were met.

Reference

Portillo H, Desvignes K, Hernandez V, et al. From crisis to capability: Transitioning a hematology-oncology unit to progressive care to improve safety and continuity. Presented at: 51st Annual Oncology Nursing Society (ONS) Congress; May 13-17, 2026; San Antonio, TX.