Considerable resources are being expended internationally on the development of clinical practice guidelines. Although consensus is increasing about methods for developing evidence-based guidelines, less attention has been paid to the process for assessing when guidelines should be updated. The most common advice is for guidelines to include a scheduled review date. This could result in wasted resources, however, if a full update is undertaken prematurely in a slowly evolving field, or in guidelines in a rapidly evolving field becoming out of date before the scheduled review. Some guidelines state that they should be updated when new information becomes available. It is unclear, however, how this should be done, and we are unaware of any systematic attempts to devise a method. In this paper we propose a set of principles and a pragmatic model for assessing whether guidelines need to be updated.
Reprinted with permission from British Medical Journal, Vol. 323, No. 7305, July 21, 2001, pp. 155-157. Copyright © 2001 British Medical Journal Publishing Group.