Waiting Times and Patient Flow in Outpatient Clinics at Ten Public Hospitals in Paraguay: A Multicenter Cross-Sectional Study
Abstract
Introduction: Waiting time is a temporal and organizational component of healthcare access. Direct observation of the patient journey can identify delays not captured in administrative records. Objective: To characterize the time elapsed from hospital entry to the start and completion of the medical consultation, and its variation across facilities and outpatient services at ten public hospitals in Paraguay. Methodology: Multicenter, observational, descriptive, cross-sectional study based on secondary analysis of institutional records collected from March to July 2019. Using COPE Client Flow Analysis, consecutive users were accompanied from entry into the building until completion of the medical consultation. Times were summarized using the median, interquartile range, 90th percentile, mean, and standard deviation. Results: Of 636 observed journeys, 610 had complete and consistent timestamps. Median time from entry to consultation start was 201.0 min (IQR: 154.0-263.5; P90: 345.0); the consultation lasted 8.0 min (IQR: 5.0-12.0), and time to consultation completion was 210.5 min (IQR: 162.2-271.8; P90: 360.1). Median time outside recorded contacts in registration, pre-consultation, and medical consultation was 198.0 min (IQR: 149.0-257.0). Median time to consultation ranged from 76.5 to 306.0 min across facilities. Conclusion: Patient journeys showed prolonged and heterogeneous waits before medical consultation. The findings provide a historical baseline and support facility-specific process measurement and redesign.
Keywords:
Outpatient Clinics, Hospital, Time Factors, Efficiency, OrganizationalDownloads
References
1. Cu A, Meister S, Lefebvre B, Ridde V. Assessing healthcare access using the Levesque's conceptual framework: a scoping review. Int J Equity Health. 2021;20(1):116. https://doi.org/10.1186/s12939-021-01416-3
2. McIntyre D, Chow CK. Waiting time as an indicator for health services under strain: a narrative review. Inquiry. 2020;57:46958020910305. https://doi.org/10.1177/0046958020910305
3. García-Corchero JD, Jiménez-Rubio D. Waiting times in healthcare: equal treatment for equal need? Int J Equity Health. 2022;21(1):184. https://doi.org/10.1186/s12939-022-01799-x
4. Lewis TP, Kassa M, Kapoor NR, Arsenault C, Bazua-Lobato R, Dayalu R, et al. User-reported quality of care: findings from the first round of the People's Voice Survey in 14 countries. Lancet Glob Health. 2024;12(1):e112-e122. https://doi.org/10.1016/S2214-109X(23)00495-3
5. Zhang H, Ma W, Zhou S, Zhu J, Wang L, Gong K. Effect of waiting time on patient satisfaction in outpatient: an empirical investigation. Medicine (Baltimore). 2023;102(40):e35184. https://doi.org/10.1097/MD.0000000000035184
6. Biya M, Gezahagn M, Birhanu B, Yitbarek K, Getachew N, Beyene W. Waiting time and its associated factors in patients presenting to outpatient departments at public hospitals of Jimma Zone, Southwest Ethiopia. BMC Health Serv Res. 2022;22(1):107. https://doi.org/10.1186/s12913-022-07502-8
7. Manderson K, Taylor NF, Lewis A, Harding KE. Service-level interventions to reduce waiting time in outpatient and community health settings may be sustained: a systematic review. BMJ Open Qual. 2025;14(1):e003235. https://doi.org/10.1136/bmjoq-2024-003235
8. Flores-Alatorre JF, Giménez-Caballero ED, Caballero-García CR, Peralta-Garay N. Perception of quality of care among adult patients in a university hospital in Asunción, Paraguay. Univ Odontol. 2023;42. https://doi.org/10.11144/Javeriana.uo42.pqca
9. EngenderHealth. COPE handbook: a process for improving quality in health services. Revised ed. New York: EngenderHealth; 2003. https://www.engenderhealth.org/resource/cope-handbook-a-process-for-improving-quality-in-health-services
10. Villegas AC, Saylor D, Kvalsund M, Atadzhanov M, Chiluba C, Chishimba L, et al. Task-shifting to optimize outpatient neurological care in Zambia. Hum Resour Health. 2021;19(1):88. https://doi.org/10.1186/s12960-021-00619-7
11. Cortés-Ramírez R, Ruíz-Velasco CB, González-Ojeda A, Ramírez-Aguado RA, Barrera-López NG, Gómez-Mejía E, et al. Calidad de la consulta externa urológica en un hospital público de tercer nivel en México. Actas Urol Esp. 2024;48(4):289-294. https://doi.org/10.1016/j.acuro.2023.10.009
12. Armijos JC, Núñez Mondaca A. Indicadores de gestión para evaluar el desempeño de hospitales públicos: un caso de estudio en Chile y Ecuador. Rev Med Chil. 2020;148(5):626-643. https://doi.org/10.4067/S0034-98872020000500626
13. Antonacci G, Lennox L, Barlow J, Evans L, Reed J. Process mapping in healthcare: a systematic review. BMC Health Serv Res. 2021;21(1):342. https://doi.org/10.1186/s12913-021-06254-1
14. Bernal Lara P, Savedoff WD, García Agudelo MF, Bernal C, Goyeneche L, Sorio R, et al. Disruption of non-COVID-19 health care in Latin America during the pandemic: effects on health, lessons for policy. Health Aff (Millwood). 2023;42(12):1657-1666. https://doi.org/10.1377/hlthaff.2023.00720
15. Ministerio de Salud Pública y Bienestar Social. Transformación digital en salud: 347 establecimientos ya cuentan con el HIS. Asunción: MSPBS; 2024. https://www.mspbs.gov.py/portal/29431/transformacion-digital-en-salud-347-establecimientos-ya-cuentan-con-el-his.html
16. Ministerio de Salud Pública y Bienestar Social. Alertas y respuestas a enfermedades respiratorias. Asunción: MSPBS; 2020. https://www.mspbs.gov.py/portal/20950/alertas-y-respuestas-a-enfermedades-respiratorias.html
Downloads
Article history
Received
Accepted
Published
Data Availability Statement
La base de datos se encuentra disponible al lector, en el repositorio de acceso abierto de la Unión Europea y el CERN (Organización Europea para la Investigación Nuclear); Zenodo, en el siguiente enlace; DOI 10.5281/zenodo.21729474
Issue
Section
License
Copyright (c) 2026 Edgar Tullo Gómez, Víctor Gómez Bareiro, María Graciela Gamarra, Angel Ricardo Rolón Ruiz Diaz
This work is licensed under a Creative Commons Attribution 4.0 International License.
