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Patients with limited English proficiency (LEP) face communication barriers that can impact clinical assessment, prolong triage and affect diagnostic decision-making. Our Canadian community teaching hospital serves a linguistically diverse population and sought to understand the operational impact of LEP on emergency department (ED) workflow and resource use.We conducted a prospective observational controlled study (LEPED2) involving adult patients presenting to the ED with chest pain. 31 patients with LEP, identified as needing professional interpreter services, were compared with 43 patients with non-LEP. All patients with LEP received interpretation via a virtual video device. The primary outcome was triage time. Secondary outcomes included the utilisation of CT scans and hospital admission rates. Statistical analyses included one-tailed t-tests and χ2 tests.Patients with LEP required significantly more time for triage (mean 7.76 min) than patients with non-LEP (5.41 min), representing a 43% increase (p=0.0003). Although differences in CT utilisation and admission rates were not statistically significant, a trend towards increased diagnostic testing among patients with LEP was observed.