Language Barriers And Clinic Efficiency In Cataract Services: A Time-In-Motion Study At Moorfields

Efficient patient flow is essential in cataract clinics where patients move through multiple assessment stages. An audit at Moorfields, Stratford, showed only 53% of cataract clinic patients had English as their preferred language. Patients with limited English proficiency (LEP) often require professional interpreter support, which may increase visit duration and time spent by staff. Understanding this impact is important for service planning and resource allocation.

This study aims to quantify and compare total in-room time, idle time (periods when the practitioner was not carrying out expected clinical tasks), and touch time within each stage of cataract clinics for patients who require interpreting services versus those who do not.

This prospective time in motion study in cataract clinics at the Moorfields at Stratford site in London. This study has been registered as a service improvement project.

Data was collected between 14th January and 11th February, 2026. New and follow-up patients were observed throughout each stage of the patient journey – check-in, vision assessment, imaging, clinician consultation, and surgical pre-assessment. For each stage, in-room time and idle time were timed and recorded onto a proforma along with English proficiency and the type of interpreter used (if any). Covariates collected include age, gender, mobility, and relevant hearing and cognitive impairment. Median times are compared using the Mann–Whitney U test.

34 patients were observed: 19 follow-up, 15 new. 15 patients (44.1%) were classified as LEP, speaking 8 different languages including Bengali, Urdu, Albanian, and Vietnamese. Among follow-up patients, LEP individuals (n=10) spent a median 32 minutes in clinic versus 26 minutes for English-proficient patients (n=9), representing a 23% increase in visit duration (p<0.05). Touch time efficiency (touch time as a proportion of in-room time) was also reduced in LEP patients (88.5% vs 92.4% respectively). Notably, 100% of interpreter support was provided informally by relatives rather than professional services. 7 of the 15 LEP patients (46.7%) required rebooking due to language barriers, whilst no English-proficient patients required rebooking. 

This time in motion study quantitatively demonstrates the impact of language barriers on clinical flow in cataract clinics. Patients with LEP spent longer in clinic than English-proficient patients, with high rebooking rates due to unavailable telephone interpreters and need for language-concordant clinicians, significantly affecting workflow efficiency. 

These findings highlight opportunities for service improvement: identifying LEP patients at the point of booking would allow proactive arrangement of professional interpreting services, reducing rebooking rates and improving clinic efficiency. Additionally, scheduling longer appointment slots for patients requiring interpreters could support more realistic workflow planning.