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 ({tau} = 0.50). Analyses were stratified into direct-access specialties and referral-required specialties. Results Non-standardized access was associated with shorter waiting times than standardized access. In adjusted median regression, non-standardized access was associated with a 3.2-day shorter median waiting time (95% CI -4.6 to -1.8). The difference was larger in direct-access specialties (-15.0 days, 95% CI -15.0 to -6.0) than in referral-required specialties (-5.0 days, 95% CI -5.0 to 0.0). Conclusion Among patients who attended a scheduled outpatient specialist consultation in Ecuadorian public hospitals, non-standardized access was associated with shorter waiting times, particularly in direct-access specialties. These findings suggest that, within routine outpatient care, parallel access pathways may shape timeliness and warrant greater transparency in appointment allocation and referral coordination.