Background:The NHS in England is challenged by an aging population and limited funding. Hospitals are nearly full and the flow of patients through the system is compromised by various factors. The National Institute for Health and Care Excellence (NICE) in the UK commissioned the National Guideline Centre (NGC) to develop a guideline on Acute Medical Emergencies. This was one of the first NICE guidelines purely focussed on service delivery. Clinical questions on acute care have been covered by many other previous NICE guidelines. It was also probably the largest guideline that NICE has commissioned, approximately three times the size of a standard NICE guideline.

Objectives:The guideline aimed to produce evidence based recommendations on the delivery of care for patients with acute medical emergencies in England. There was an acknowledgement from the outset that it was important to look at the whole pathway of patient care from initial contact with healthcare through to discharge from hospital and beyond. The challenge was twofold: to produce a service guideline applicable to the UK context using global evidence and to produce a guideline much bigger than a standard guideline.

Methods:Standard NICE methodology was followed but several adaptations were needed to processes. A guideline committee was convened to work alongside the technical team at the NGC. Work was needed to determine which key issues were most important and what evidence should be included in terms of applicability to the UK context. We also needed to be mindful of policy developments in this fast moving political area.

Results:We found that we needed to work with our stakeholders and committee members in new ways and particularly make decisions about the applicability of evidence to the UK context. The guideline is due for publication in October 2017.

Conclusions:From this experience, the NGC have developed new ways of working efficiently to develop very large guidelines and methods for working on service delivery topics, particularly in relation to keeping the evidence applicable to the national political context. This presentation will summarise our key learning points.