Background Lack of sufficient clinical expert and stakeholder involvement in the routine updating of guidance on new and emerging medical interventions can lead to inefficient use of resources and inadvertently create unnecessary barriers to implementation.

Context An evidence services unit within a large health care organisation developed a stakeholder-centred process for rapid updating and implementation of guidance related to the use of breast magnetic resonance imaging (MRI).

Description of Best Practice The process focused on the following: 1) asking clinical stakeholders to identify the indications for which use of breast MRI remained unresolved or controversial; 2) conducting a search for high-quality systematic reviews and clinical trials for the specific indications, and contacting well-known external content experts to identify unpublished evidence; 3) obtaining data on the organisation’s current breast MRI utilisation and practice variation; 4) engaging experts/stakeholders in guidance development and revision based on current utilisation/practice variation compared to findings from the evidence review; 5) obtaining endorsement of guidance and commitment to implementation efforts from clinical opinion leaders and other stakeholders; and 6) initiating routine monitoring and feedback on breast MRI use.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users Limiting evidence updates to controversial or unresolved areas of clinical practice, engaging stakeholders in guidance development based on a review of current utilisation data and scientific evidence, and engaging key opinion leaders and stakeholders in implementation and performance monitoring leads to more efficient use of resources, stronger implementation and improved performance.