Developing service delivery guidelines on acute medical emergencies: challenges and solutions

Methods

The NHS is challenged by an ageing population and finite resources. Hospitals are approaching full capacity and the flow of patients through the system is compromised by various factors. NICE commissioned the National Guideline Centre (NGC) based at the Royal College of Physicians to develop a guideline on acute medical emergencies. This was unusual as it was one of the first NICE guidelines purely focused 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.

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.

Standard NICE methodology was followed but several adaptations to processes were needed. 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.