Waiting time for scheduled outpatient specialist consultations by access pathway in public hospitals in Ecuador

OBJECTIVE: To quantify waiting time in days for scheduled outpatient specialist consultations and to compare waiting time between standardized and non-standardized access pathways in Ecuadorian public hospitals. METHODS: We analyzed hospital-based survey data from Ecuadorian public hospitals, restricted to adults attending a scheduled outpatient specialist consultation (n = 4,436). Emergency care, unscheduled urgent visits, procedures, and follow-up visits were excluded by design. Access pathway was classified from participants' self-report as standardized (institutional or system-based) or non-standardized (informal or non-system-based). Waiting time, defined as the number of days between obtaining the appointment and attending the consultation, was compared using the Mann-Whitney U test. Sociodemographic correlates of non-standardized access were examined using adjusted logistic regression, and adjusted median differences were estimated using quantile regression (τ = 0.50). Effect modification by specialty referral requirement was assessed in a single median regression model using an interaction between access pathway and referral-requirement stratum. RESULTS: Non-standardized access was associated with shorter waiting times than standardized access. In median regression adjusted for sociodemographic covariates, specialty, and hospital, with hospital-clustered inference, non-standardized access was associated with a 3.6-day shorter conditional median waiting time (95% CI -6.2 to -1.0). Adjusted stratum-specific contrasts were -7.9 days (95% CI -13.7 to -2.1) in direct-access specialties and -3.1 days (95% CI -5.9 to -0.2) in referral-required specialties; however, the interaction between access pathway and referral-requirement stratum was not statistically significant (p = 0.136). CONCLUSION: Among patients who attended a scheduled outpatient specialist consultation in Ecuadorian public hospitals, non-standardized access was associated with shorter waiting times. Although the adjusted point estimate was larger in direct-access specialties, the formal interaction test did not provide clear evidence that the association differed according to specialty referral requirement. These findings suggest that, within routine outpatient care, parallel access pathways may shape timeliness and warrant greater transparency in appointment allocation and referral coordination.