Production designer Nina Ruscio has significantly expanded the emergency room set for the second season of HBO's "The Pitt," adding new locations and practical lighting to make the Pittsburgh Trauma Medical Center feel larger and more immersive without losing the look established in Season 1. The changes were designed to be felt rather than seen, giving cast and crew greater freedom of movement while ensuring the set never appeared to end, reflecting Ruscio's aim to mirror the emotional intensity of the show through its physical environment.

The redesigned set now covers more than 24,000 square feet and includes new areas such as a karaoke bar, a patient wing and a parking garage, alongside an extended ambulance drop-off zone. Ruscio, who earned an Outstanding Production Design nomination for the season finale as part of the show's record 25 nominations, described meticulous attention to detail throughout, from neon lighting effects to accurate medical paperwork and X-rays created with input from real physicians, reinforcing the emergency department's role as a character in its own right.