When I was appointed at Manchester Royal Infirmary in 1997, I was the first consultant in anaesthesia with a specialist interest in emergency work. Over the following 17 years, I have been actively involved in audit and service improvement initiatives in emergency surgical care which have included expanding the infrastructure of our Emergency Theatre Service, developing policy, and trying to audit and improve processes. We have been developing a pathway of care for patients presenting with an acute abdomen since 2010. The key elements in this are early surgical review, assessment of risk using integrated criteria, rapid CT scanning and reporting, a timely decision to operate, consultant delivered care, goal-directed haemodynamic therapy in the perioperative period, and admission to critical care for high risk patients. To support implementation we are collected detailed risk-adjusted data concerning all aspects of the pathway. I joined the Steering Group of the Emergency Laparotomy Network in 2010 and I am a member of the Clinical Reference Group for the National Emergency Laparotomy Audit.
� Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ; UK Emergency Laparotomy Network. Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. Br J Anaesth. 2012 Sep;109(3):368-75.
� E Barrow, I D Anderson, S Varley, A C Pichel, C J Peden, D I Saunders, D Murray. Current UK practice in emergency laparotomy. Annals of The Royal College of Surgeons of England 11/2013; 95(8):599-603.