Abstract Aim To describe methodology of the quality improvement programme. To assess outcomes and balancing measures. Methods This paper describes how Kotter’s 8-step improvement model was applied in a District General Hospital. The primary outcome (negative appendicectomy rate) was assessed using GIRFT data over 6 years. Reducing negative appendicectomies might conceivably result in delayed surgery (with a potentially increased incidence of perforated/gangrenous appendicitis), increased length of stay (LOS) and increased readmissions due to delay-related complications. These were assessed by a retrospective audit of appendicectomies performed over the same 8-week period in 2016 and 2019. Results The negative appendicectomy rate in children fell from 16% in 2016-2017 (England average 12%) to 4% in 2017-2018. The improvement was sustained at 6% in 2018-2019 (England average 11%). The incidence of perforated/gangrenous appendicitis decreased by 6% from 23% in 2016 to 16% in 2019. Average LOS decreased from 4 days in 2016 to 3 days in 2019. There was 1 (3%) readmission within 7 days in 2016, and 2 (6%) in 2019. Reasons for readmission were postoperative small bowel obstruction due to omental band adhesion(1) and persistent pain (2). None were caused by delayed operation. Conclusions A sustained improvement in negative appendicectomy rate can be achieved by adopting a systematic quality improvement approach. Against expectations, the reduction in negative appendicectomy rate was associated with a slight decrease in average LOS and reduced frequency of perforated/gangrenous appendicitis. There was no significant increase in readmissions, and none were due to delayed operations.