This is the first season to feature Alexis Floyd, Harry Shum Jr., Adelaide Kane, Midori Francis, and Niko Terho as series regulars.

[2] A thunderstorm hits Seattle, sending several patients to Grey Sloan, including Jonathan, a TV reporter whose helicopter was struck by lightning.

After watching Teddy save Jonathan's life, Owen suggests that she apply for the open Chief of Surgery position now that Meredith is leaving.

Elsewhere, Lucas and Simone get closer, culminating in a kiss, as do Benson and Jules; and Jo, Bailey, and Carina open up a new reproductive health care clinic.

Krista Vernoff, who serves as the showrunner and an executive producer of Grey's Anatomy and spin-off Station 19 signed a two-year deal with ABC in 2021 to remain on both series through a potential nineteenth season.

[47] Network executives at ABC were interested in a nineteenth season due to its status as the longest-running primetime medical drama, high viewing figures, and profit generation.

[51] Kim Raver, Camilla Luddington, and Kevin McKidd each signed a three-year contract in July 2020 keeping them attached to the series through a potential nineteenth season to portray Dr. Teddy Altman, Dr. Jo Wilson, and Dr. Owen Hunt, respectively.

[53] On August 3, 2022, it was announced that Pompeo would be scaling back her work on the series, only appearing in a "limited capacity" in the first 7 episodes, as well as the season finale.

[26] Alexis Floyd, who previously starred Inventing Anna, another Shondaland series; was the first of the five to be announced, and is set to play Simone Griffith.

[66] ABC later confirmed that Kelly McCreary, Anthony Hill, Chris Carmack, and Jake Borelli would also be returning to the main cast.

[27] Scott Speedman, who joined as a series regular in the previous season with a one-year contract, was set to be demoted to the recurring cast,[68] but continued to receive main billing.