Scripted, but real: What "The Pitt" gets right about design and emergency medicine

Not surprisingly, executive producer, Joe Sachs, MD, is a board-certified emergency medicine (EM) physician, and has deployed a bevy of practicing EM physicians on set during filming to ensure medical terminology, clinical decision-making and procedural performances are accurate, adding to the show’s authenticity.

EM clinicians and staff work in an environment unlike most others in medicine. The acuity and complexity of patients and conditions they provide care for encompasses all aspects of medicine, and life-or-death situations are common. Beyond emergency care, the ED acts as a safety net for those without access to primary, preventative, specialty or mental health care and frequently provides connections to vital social and community services needed to provide holistic, whole-person healthcare. It is not hyperbole to say EM clinicians need to be ready for anything, at any time.

Beyond being a medical drama, “The Pitt” highlights how healthcare planning and design impact patient outcomes, staff efficiency and safety and hospital resilience. Many of the challenges portrayed on screen — overcrowding, bottlenecks, stress— are not just clinical or operational issues. They’re design challenges too.

A system pushed to the brink

The series, where each episode represents one hour of one shift, highlights the fast pace of the emergency department, where crowded hallways and busy triage zones make clear the need for effective design. Efficient use of space in EDs is crucial to guide patients from crisis to care without causing delays. Properly designed EDs help reduce waiting times, decrease clinician fatigue, and improve throughput and patient outcomes—concepts “The Pitt” illustrates with precision.

In the background of the show, there are often patients in beds or wheelchairs lining the halls of the ED. There are also plenty of conversations between doctors and nurses about the inability to transfer patients to different inpatient parts of the hospital, such as cardiology, the ICU or even surgery. The lack of available rooms combined with an overflow of patients is known as “boarding,” where patients stay in the ED even after being admitted to the hospital because there are no beds available in the hospital where they need to continue their inpatient care.

Through the eyes of exhausted yet dedicated healthcare professionals, “The Pitt” exposes the cracks in an overburdened system. The challenges of finding available beds and treating patients in improvised spaces emphasize the importance of adaptable and future-ready healthcare environments that can handle increases in demand.

The COVID-19 pandemic especially highlighted this necessity and forced many EDs to implement flexible spaces, but it is important to recognize that overcrowding and resource strain are common issues faced by many hospitals on a regular basis.

The silent power of collaboration

Behind every life saved is a seamless dance of doctors, nurses, and support staff working in concert. The show reveals how design can either foster or hinder this teamwork, from strategically placed workstations to a large, centralized staff hub equipped with computers where clinicians are discussing diagnoses and care plans, charting or interfacing with other members of the care team.

These various types of workstations are common in EDs, as they allow visibility into the majority of patient areas and localize some of the “administrative” parts of medicine predominantly in one place of the often chaotic environment.

In the best hospitals, architecture supports efficiency — not just by reducing travel distances for patients and staff within the facility, but by creating intuitive spaces where teams can communicate, collaborate, and decompress when needed.

Saving lives while feeling unsafe

“The Pitt” also draws attention to a major issue plaguing EDs of all sizes — staff safety. Nurses and doctors are seen getting yelled at, berated and even assaulted by patients or their family members. The pandemic only increased these incidents, causing EDs to implement stationed security guards, metal detectors, cameras and duress buttons located around the unit or on their person. These safety issues have contributed to a significant exodus of emergency medicine staff out of the profession, putting even more pressure and burden on their colleagues left behind.

The emotional strain on caregivers is evident in the show. Nurses and doctors of all experience levels in “The Pitt” show instances of fatigue, with silent breakdowns in secluded corridors highlighting the burden of life-or-death decision making.

This unacknowledged responsibility emphasizes the necessity for environments that support not only patients, but also the healthcare professionals committed to their care. Well-designed hospitals incorporate areas for respite, natural lighting and quiet moments of recovery amidst the demanding atmosphere. But as seen in the show, even as charge nurse Dana sought a break outside in the ambulance bay, she ended up being assaulted by an angry waiting room patient. “The Pitt” presents a crucial question: are we designing spaces that prioritize the well-being and safety of those who care for us?

The waiting room dilemma

When the show’s doctors and nurses venture out into the waiting room to assess patients and take vitals, it is filled to the brim with people waiting to be seen. Tempers are running high, there are exhausted parents, and most of the people with less severe conditions or injuries are left waiting hours. Some of this issue stems back to boarding, but it’s also caused by the reality that many older facilities can’t handle the growing number of patients who rely on the ED for care.

The overcrowded waiting area is more than just an inconvenience — it’s a daily struggle for patients, families, and healthcare staff. Tension builds up as individuals sit shoulder to shoulder, sometimes on the floor, awaiting news or medical attention. Every moment feels longer in a space that is stretched beyond capacity, offering little solace during already stressful times.

ED waiting rooms are also the first impression of a healthcare facility for many patients, some who have been transferred or traveled a long distance for special care. Being greeted with a full and chaotic room does not instill confidence or put the institution’s best foot forward. EM clinicians are often practicing “waiting room medicine,” triaging patients in the waiting room, obtaining vitals and administering medications while they wait for a room to open.

When emotions run high, prolonged waits and packed spaces can turn volatile in an instant. Thoughtful design must ensure clear sightlines, controlled access and a layout that fosters both safety and reassurance.

In recent years, hospitals have had to incorporate security screenings at ED entrances to protect those inside. This presents a significant challenge: how can we design a waiting environment that strikes a balance between comfort and the presence of security measures?

Part of this can be resolved by incorporating family or privacy rooms for delivering difficult news. Throughout the show, many family members are brought into a separate room, with a mural on the wall, to receive difficult news about their loved ones. This room is more than walls and chairs, it's a refuge.

Thoughtful design for these spaces– privacy, soft seating, calming tones — offer dignity in fragile moments. They are often placed near the entrance of the ED, so there are multiple accessible ways to control an emotional situation that gets out of hand. If such a room doesn’t exist, clinicians try their best to use a consult room so they are not delivering bad news in a curtained area where other staff or patients could overhear.

More than just a gripping television drama, “The Pitt” holds up a mirror to the realities of emergency care, challenging architects and planners to rethink how they design, build, and support these spaces. Seeing the amazing medicine being practiced in EDs brought to life amidst the chaos on the TV show is a call to action for those who can help make their jobs a little easier by making their workplace the best it can be — a reminder that architecture and planning are not just about blueprints and budgets, but about lives.

Ben Bassin, MD, is a practicing emergency medicine physician at the University of Michigan Health System and Director of the Massey Family Foundation Emergency Critical Care Center, the first ED-based ICU in the country. He is also a Vice President and an Innovation Fellow with Blue Cottage of CannonDesign. Purvashri Hatkar is a Vice President and healthcare planner and designer at CannonDesign, with 15 years of experience in designing emergency departments and other healthcare spaces.