Peden CJ, et al. - Through a stepped-wedge cluster-randomized trial, researchers intended to implement a care pathway to improve survival for emergency abdominal surgery (EPOCH) patients and study the effectiveness of national quality improvement (QI) programme. An abundant volume was organized into 15 geographical clusters and commenced the QI programme of emergency abdominal surgery cases and analyses were carried out on an intention-to-treat basis. QI program was observed having no survival benefit for EPOCH patients. Time and resources are needed to improve patient care were suggested for future QI programmes.