Emergency laparotomy is relatively common, high risk surgery which is carried out on between 30-50,000 cases annually in England. An evidence-based bundle of interventions and measures was initially developed by the Royal Surrey County Hospital to reduce mortality, length of stay and complications. The Emergency Laparotomy Collaborative expanded to cover the whole country as one of seven national programmes for spread and adoption coordinated through all 15 AHSNs (Now Health Innovation Networks) in 2018-20.