Beyond Theatre Efficiency: Building the Patient Pipeline for High-Flow Cataract Surgery

The latest GIRFT Further Faster 20 update highlights a truth that resonates across specialties: theatre efficiency isn’t just about what happens on the day.

As the report makes clear, a persistent barrier to high-flow theatre lists is identifying enough suitable patients to fill them reliably. Without a steady stream of “fit and ready” patients, the best on-the-day workflows falter, theatres risk under-utilisation, and patients wait longer for treatment.

For cataract surgery - the NHS’s most common elective operation - this challenge is especially pressing. The surgery itself is relatively quick and standardised. What determines whether a list succeeds or stalls is how well the whole pathway works upstream: selecting the right patients, preparing them properly, and planning lists effectively. 

At Lutra Health, our solution brings these elements together - patient selection, preparation, and list planning - helping trusts embed the high-flow principles GIRFT champions.

1. Patient Selection: Building the Right List

The FF20 update emphasises the importance of clear patient selection criteria to avoid on-the-day cancellations. Lutra Health strengthens this process from the moment of referral.

Our platform captures cataract-specific clinical and patient-reported information, including:

• Cataract complexity grading
  
  
• Relevant comorbidities and allergies
  
  
• Symptoms and their impact on daily life and quality of vision
  
  
• Patient-reported outcome and experience measures (PROMs and PREMs)
  
  

Because information comes from both the optometrist and the patient, it provides a full picture from the outset. Crucially, diagnostic results recorded in community optometry  transfer seamlessly to ophthalmology teams, avoiding duplication and speeding up decisions.

Patients can be automatically triaged against criteria defined by both consultant teams and national guidance, ensuring decisions are consistent, safe, and transparent.

And this isn’t just about getting patients onto a list: Lutra also captures outcome data, including complications and post-operative PROMs/PREMs. That means trusts can benchmark performance against national standards and continuously improve their pathways.

2. Patient Preparation: Ensuring Patients are Ready

Even when patients are suitable, lists falter if they are not fully prepared. GIRFT stresses the importance of maintaining a pool of ‘fit and ready’ patients. Lutra supports this with proactive engagement:

• Digital pre-consent sent in advance
  
  
• Clear education materials explaining the procedure, preparation steps, and aftercare
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• Early flagging of comorbidities or risks, allowing pre-op teams to intervene before list day

This ensures patients arrive informed, confident, and ready. By reducing late cancellations and no-shows, preparation strengthens the chain that begins with good selection and ends in predictable flow.

3. List Planning: Turning Triage into a Virtual Clinic

The final link is translating selection and preparation into efficient scheduling. Because Lutra captures comprehensive referral and pre-op information, the referral itself acts as a virtual clinic. Up to 90% of cataract patients can be listed directly for surgery, without the need for an outpatient appointment.

In NHS Tayside, where this approach was piloted with 1,200 patients:

• 90% were directly listed
  
  
• 1,260 outpatient appointments were released
  
  
• 93% reduction in time to listing (182 → 13 days)
  
  
• 56% reduction in surgical wait times (304 → 134 days)
  
  

This freed significant clinic capacity and allowed schedulers to populate lists with confidence. Each high-flow session could be fully booked with appropriate patients maximising throughput.

Why This Matters

The FF20 cohort shows that high-flow lists can transform elective productivity. But their success relies on more than intraoperative processes. They depend on a steady pipeline of prepared and appropriate patients, underpinned by robust planning.

By digitising and aligning these three levers — selection, preparation, and planning — Lutra Health provides the infrastructure that high-flow lists need to succeed sustainably. This isn’t extra work for clinicians; it removes duplication, frees capacity, and ensures the right patients flow to the right lists at the right time.

Conclusion: Building on GIRFT's Vision

The GIRFT programme has rightly shone a light on the role of high-flow lists in elective recovery. Our experience strongly echoes their conclusion: efficiency is built upstream, not just on the day of surgery.

With cataract surgery, the NHS has the opportunity to embed these principles at scale. By pairing GIRFT’s surgical flow models with digital platforms like Lutra, high-flow cataract lists can move from pilots to business as usual - delivering shorter waits, more reliable lists, and better outcomes.

High-flow surgery needs high-flow data. By bringing these together, we can accelerate recovery and give thousands more patients back their sight, sooner.

Get in touch to learn how we’re supporting ICBs, provider collaboratives, and community optometry networks to deliver joined-up, modern eye care.