What The Pitt Gets Right About ER Chaos And How To Get Safer Care

Forbes

07-05-2025

The U.S. could save an estimated $4.4 billion each year by shifting avoidable ER visits to ... More lower-cost options like urgent care centers. Newsday via Getty Images
When lives hang in the balance, there's no script. The Pitt captures the controlled chaos of emergency medicine, with detailed accuracy and documentary-level hyperrealism. Like 24 , this Max series unfolds in real time, set in the frenetic, unforgiving realm of a Pittsburgh ER — affectionately called "The Pitt." Here, the staff pivots from crisis to crisis — each case different, each urgent and life-threatening, coupled with important societal issues such as drug use, violence, family dynamics and facing the challenges of death and dying. But it doesn't have to be this way. For patients and families, understanding how the system works — and how to advocate within it — can mean the difference between chaos and clarity.
If you think The Pitt is Hollywood hyperbole, it's not. Based on my years running emergency departments, I can tell you: real emergency rooms are even more unforgiving. Seconds matter. Resources are stretched thin. Hospital administrators are exerting pressure to improve Press Ganey (patient satisfaction) scores and manage costs. Noah Wyle's character, Dr. Robinavitch, reveals the grim truth when he instructs his residents that 'beds are a very precious commodity around here, so please be quick and efficient in your workups.' Which means cardiac arrest patients are tended to in hallways when there's no room. And there's rarely enough room. Due to the lack of beds, care is often initiated in the waiting room, which is far from optimal.
The controlled chaos of emergency departments is well known to healthcare insiders — and to patients, whether through firsthand experience or pop culture stand-ins like ER . In fact, ER physicians are interrupted by communication events 13.8 times per hour, or once every 4.3 minutes. To add to this chaos, for the patient, approximately 75% of their time in a care area is spent not interacting with providers. That means patients who believe they need emergency care — regardless of whether they're right — wait. And wait.
Is there a way to "hack" the ER and improve your chances of getting better, faster care if you or a loved one ends up there? Surprisingly, the answer is yes. A few smart strategies can make the emergency room experience more manageable — and in some cases, safer. Here's how to be better prepared when every minute counts.
On average, 13% of patients who come into the ER need to be admitted. It's possible that some of the care received in the ER can be arranged in other settings. ERs focus their resources on the sickest patients, so it's important that patients get to the right place for the right treatment at the right time. In New York State, nearly 48% of ER visits are for routine, non-emergency care that could be addressed by community health providers or are otherwise preventable. The U.S. could save an estimated $4.4 billion each year by shifting avoidable ER visits to lower-cost options like urgent care centers, retail clinics or telemedicine.
Ambulance patients are usually prioritized higher upon arrival because their conditions are flagged as urgent. Ambulances alert the ER ahead of time. The hospital can prepare a trauma or stroke team to meet you at the door, often saving critical minutes. As opposed to having someone drive you to the hospital, ambulances can begin life-saving treatment before you even get to the hospital with oxygen, IVs, EKGs and medications. That said, arriving by ambulance doesn't guarantee immediate care. If your condition is not deemed life-threatening by triage staff, you may still wait behind more critical cases. Of course, if you are not sure which setting is best, always choose the higher level of care to ensure you receive timely treatment for your condition. Plan For The Unexpected
Nobody wakes up in the morning and plans to have a medical emergency, so always be ready. When an emergency hits, you won't have time to research your options. Know which hospitals near you have specialized ER programs — like trauma centers, stroke centers and burn units — and where you would go if the unexpected happens. A few minutes of preparation now can save precious time, lower costs and ensure you get the right care, right away. In an emergency, every second — and every decision — matters.
In the middle of a crisis, it's hard to remember every medication, allergy or past surgery. Having a one-page summary — printed out or saved on your phone — helps medical staff move faster and avoid dangerous mistakes. If you have known medical issues, make sure you bring the pertinent information.
For example, if you have a heart problem always have a copy of your last EKG so the ER team can compare it with your new one.
Why it's critical: Quick, accurate information can shave critical minutes off your treatment and prevent serious errors and facilitate the best care possible. Name a Healthcare Proxy
A healthcare proxy is someone legally authorized to make decisions if you can't speak for yourself. Choose someone you trust — and make sure they know your wishes.
Why it's critical: In emergencies, fast, clear decisions protect your health and your autonomy. Know Your Insurance Information
Keep your insurance card handy and know which local hospitals are in-network if possible.
Why it's critical: In non-life-threatening situations, going to an in-network hospital can help avoid surprise bills and higher costs. Bring an Advocate if You Can
If possible, have a family member or friend come with you to the ER. They can help monitor changes in your condition, speak up if your symptoms worsen and make sure important information is shared with the care team. In addition, while it is essential that you advocate for your care needs, it is important to balance any requests or demands with the reality that the staff is extremely busy. The ER staff appreciate being treated with respect and understanding as they deliver care under these challenging circumstances.
Why it's critical: In a crowded ER, polite but firm advocacy can make a difference in how quickly serious changes are noticed. Understanding the ER: What to Expect
The emergency room isn't designed for comfort or calm — it's built for speed, survival and split-second decisions. Knowing a little about how the system operates can help you stay grounded rather than panicked. It's normal to feel anxious, frustrated or helpless at times, but understanding the flow of the ER — and why things happen the way they do — can make a chaotic experience a little easier to navigate. Here are a few key things to keep in mind:
• Fast for some, slow for others: A gunshot victim will be seen immediately; a sprained wrist may wait hours.
• Constant triage: Every new patient arrival reshuffles priorities.
• Team-based care: You may interact with multiple nurses, doctors, techs and specialists — not just one provider. It is okay for patients and family members to request a specialist consultation or ask the care team to contact your PCP.
• Resource limitations: Beds, staff and equipment are often in short supply, especially in crowded urban hospitals.
• Documentation matters: Everything needs to be recorded for safety, insurance and legal reasons, which can create delays.
The Pitt gets the chaos right, but real life raises the stakes even higher. While you can't eliminate the unpredictability of a true emergency, you can be prepared if you need to visit the ER. Knowing your options, planning ahead and taking a few smart steps can turn a vulnerable moment into one in which you stay informed, protected and empowered. In a system built to move fast, the best thing you can do is stay one step ahead.