Peden CJ, et al. - In this stepped-wedge cluster-randomised trial, researchers examined the efficacy of national quality improvement (QI) programme to implement a care pathway for patients (aged 40 years or older) undergoing emergency open major abdominal surgery to improve their survival. Between March 3, 2014, and October 19, 2015, treatment took place. The authors concluded that there was no survival benefit for patients undergoing emergency abdominal surgery from this QI program to implement a care pathway. Future QI programmes should ensure that teams have the time and resources necessary for improving patient care.