With the start of the first national perioperative audit - The Australian and New Zealand National Emergency Laparotomy Audit (ANZELA), Dr Jonathan Nicholson discusses the project with Dr Tom Poulton, an anaesthesiologist and research fellow with the National Institute of Academic Anaesthesia (NIAA) and Health Services Research Centre (HSRC) in the UK who was involved in the UK NELA project. He discusses the experience learnt from this quality assurance project and the results of the nationwide quality improvement research project (EPOCH) that was published in the Lancet earlier this year that trialed the introduction of a pathway for patients requiring an Emergency Laparotomy.