Background: Guideline development is time consuming and costly. Once published, guidelines may become rapidly outdated. SIGN has adopted a variety of approaches to ensuring that guidelines remain up to date and relevant. Despite this, very old guidelines remain a concern because the content could be out of date and the questions which the guideline addressed may no longer be relevant.

Objectives: We reviewed the current methods of updating guidelines to decide how to manage old guidelines.

Methods: We undertook several methods to keep guidelines up to date. We scrutinised and accepted appropriate requests for new versions of a guidelines. We undertook refreshes, selective updates or updated entire guidelines depending on the extent of the change required. We also used a process of rolling updates to a living guideline. We also introduced rapid formal reviews at 3 years. Despite this, some guidelines still reached 10 years with no recent changes and uncertain value. We therefore decided that as we could no longer guarantee that the contents of these guidelines were current that they should be withdrawn. When the guidelines were removed from the website we informed the relevant stakeholders via our normal communication channels. We then responded to the reaction of guideline users.

Results: We received a several general comments of disappointment that guidelines that were still of value were now missed. We also received some adverse criticism from users in clinical networks who used these guidelines as the definitive guides to management and standards. We met with these groups and worked with them to develop new proposals for more focused guidelines in key areas of uncertainty where new guidance would have the most impact.

Conclusions: Withdrawing guidelines at 10 years received a surprisingly low level of adverse comment but, where significant concerns were raised, we worked with these groups to produce requests for new, shorter, more-focused, 3-question guidelines which are now in our programme.