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Lessons from the Field
Making every test count: Insights from a test kit efficiency audit
Submitted: 17 September 2025 | Published: 23 July 2026
About the author(s)
Amy O. Strydom, School of Pathology, Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Department of Chemical Pathology, National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South AfricaMpho R. Maphayi, School of Pathology, Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Department of Chemical Pathology, National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
Chemedzai Chikomba, School of Pathology, Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Department of Chemical Pathology, National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
Abstract
Background: Clinical laboratories face increasing demand for testing while operating within constrained budgets, necessitating efficient resource utilisation. Test kit efficiency, a key parameter in automated laboratories, refers to the appropriate use of reagent kits in a manner that minimises non-billable tests per kit.
Intervention: Manufacturer-supplied monthly test kit efficiency data for 96 chemistry analytes, collected between 01 April and 30 September 2023, were assessed retrospectively and compared with their respective benchmark efficiencies. The findings were further compared to those from a previous audit to assess for an improvement or decline in efficiency. Under-performing analytes identified included total protein in cerebrospinal fluid, alkaline phosphatase, glucose, ferritin, direct bilirubin and vancomycin. Root cause analysis and targeted interventions led to improvements in test kit efficiency of 12.6% – 37.7% for each analyte.
Lessons learnt: Auditing test kit efficiency data revealed inefficiencies, allowing targeted interventions to optimise kit use and reduce costs without compromising quality. Efficiency was influenced by analytical performance, test kit size and batching practices, underscoring the importance of data-driven decision-making for workflow optimisation and resource management. The audit revealed challenges with inherently inefficient tests, highlighting the need for tailored solutions based on the population served, reagent stability and sample stability.
Recommendations: We recommend regular test kit efficiency audits to reduce wastage, optimise workflow and drive quality improvement. Efficiency data can support identification of problematic assays and guide kit size adjustment and batching strategies, while ensuring initiatives remain patient-centred. However, the lack of standardised regulatory guidelines on test kit utilisation remains a key limitation that requires attention.
What this study adds: There is limited published evidence on the use of test kit efficiency data to drive quality improvement in clinical chemistry laboratories. This study demonstrates how systematic auditing can identify modifiable inefficiencies and support evidence-based resource optimisation.
Keywords
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