Over the last 20 years, SIGN has published 132 guidelines. Of the 68 extant guidelines only 15 are under 3 years old. SIGN is committed to providing evidence based clinical practice guidelines to help accelerate the translation of new knowledge into action to meet our aim of reducing variations in practice, and improving patient-important outcomes.

SIGN has an established process of scoping, consulting on, prioritising and updating published guidelines. This process, however, is time and resource intensive and has been based heavily on the age of the guideline and the emergence of new evidence rather than on any real need from guideline users.

A full review of a guideline is equivalent to developing a new topic and takes 2–3 years. Some alternative approaches that SIGN has developed for keeping guidelines up to date in a more timely fashion include:

• a selective update based only on those key questions underpinning a guideline that are shown to identify new evidence that would change recommendations. This process takes around 15 months and topics are scoped and prioritised;

• a living guideline that is scoped and updated every year;

• a small change affecting one or two recommendations that is highlighted by a guideline user or initiated by a change in licensing, legislation or local healthcare policy. This process takes around 6 months, is more reactive and driven by guideline user need but may only be applicable to newer guidelines.

This presentation will describe the risks, benefits, success and challenges in adopting these approaches. The key lessons learned include the need to:

• clarify the need for the update

• scope the evidence base and define the breadth of the remit

• follow established processes and work within existing methodology

• manage guideline development group expectations.