Purpose It is currently unknown to what extent recommendations from evidence-based guidelines for the management of acute pancreatitis (AP) have been adopted in Aotearoa New Zealand (AoNZ). This study aimed to determine compliance with evidence-based quality performance indicators (QPIs) for AP management. Methodology A multicentre, national prospective cohort study of consecutive patients with AP was performed by STRATA, a trainee-led collaborative, June to October 2024. QPIs for each management domain were based on a review of guidelines and expert consensus. Results Overall, 620 patients (age 57 [IQR 37-71] years; 55% female) were recruited from 19 hospitals. The incidence of pancreatic necrosis was 6.1% (n=36); organ failure 7.1% (n=43); and mortality 2.1% (n=13). The most common discrepancies between clinical practice and QPIs included early fluid management (10.3% meeting QPI), severity prediction (22%), and nutrition supplementation (40%). Adherence to QPIs varied significantly between hospitals (p<0.01). Adherence to a greater number of QPIs was significantly associated with reduced mortality (OR 0.55, 95% CI 0.31–0.95, p=0.031). Among individual QPIs, use of prophylactic or treatment-dose enoxaparin, was associated with a significant reduction in 30 day mortality (OR 0.21 CI 0.07–0.68, p=0.009). Conclusion There was significant hospital-level variation in adherence to QPIs; and increased adherence was associated with reduced mortality. A national harmonising protocol may therefore improve outcomes. Further, anticoagulation represents a promising avenue for future therapeutic research in AP.