Background: Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for the provision of timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy.Methods: The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a documented preoperative risk score for patients undergoing an emergency laparotomy at each site.Results: The percentage of patients undergoing emergency laparotomy who received perioperative risk scoring increased from 0-11% during the exploratory phase to 35-100% during the full implementation phase. This change was consistently maintained throughout the full implementation phase of the programme.Conclusions: A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, suggesting that such an approach may be feasible for improving patient outcomes and care delivery performance.