SafeLLM: Extraction as a Hallucination-Resistant Alternative to Rewriting in Safety-Critical Settings

Large language models (LLMs) are increasingly used to access organisational documentation, including standard operating procedures (SOPs), HR policies and institutional guidelines. However, retrieval-augmented generation (RAG) systems that rely on free-form rewriting can introduce hallucinations and unstable trade-offs between completeness and conciseness, particularly in safety- and compliance-critical settings. Objectives: To evaluate extraction as a hallucination-resistant alternative to rewriting-based RAG and compare strategies that balance precision, recall and safety across document types and model scales. Methods: We compare multiple prompting strategies, including line-number-based source selection, extraction of relevant guideline sentences with explicit safety annotations, and a multi-stage pipeline that refines draft answers using supporting evidence from source guidelines. Experiments are conducted on documents of varying length and structure, including local NHS acute care and oncology guidelines and UK-wide NICE guidelines, using both frontier-scale and locally deployable models. Performance is assessed using automatic metrics and human expert evaluation of relevance and completeness. Results: Line-number selection achieves the strongest results, outperforming direct copying and safety-focused strategies across both large and small models while maintaining high term recall (up to 95%) and close alignment with source text. Safety-oriented approaches improve precision but introduce systematic omissions, while multi-stage filtering further amplifies this trade-off. Performance varies with document structure: line-based extraction excels in protocol-like content, whereas alternative strategies perform better on more verbose documents (up to 97% term recall).

Clean & Clear: Feasibility of Safe LLM Clinical Guidance

Background: Clinical guidelines are central to safe evidence-based medicine in modern healthcare, providing diagnostic criteria, treatment options and monitoring advice for a wide range of illnesses. LLM-empowered chatbots have shown great promise in Healthcare Q&A tasks, offering the potential to provide quick and accurate responses to medical inquiries. Our main objective was the development and preliminary assessment of an LLM-empowered chatbot software capable of reliably answering clinical guideline questions using University College London Hospital (UCLH) clinical guidelines. Methods: We used the open-weight Llama-3.1-8B LLM to extract relevant information from the UCLH guidelines to answer questions. Our approach highlights the safety and reliability of referencing information over its interpretation and response generation. Seven doctors from the ward assessed the chatbot's performance by comparing its answers to the gold standard. Results: Our chatbot demonstrates promising performance in terms of relevance, with ~73% of its responses rated as very relevant, showcasing a strong understanding of the clinical context. Importantly, our chatbot achieves a recall of 0.98 for extracted guideline lines, substantially minimising the risk of missing critical information. Approximately 78% of responses were rated satisfactory in terms of completeness. A small portion (~14.5%) contained minor unnecessary information, indicating occasional lapses in precision. The chatbot' showed high efficiency, with an average completion time of 10 seconds, compared to 30 seconds for human respondents. Evaluation of clinical reasoning showed that 72% of the chatbot's responses were without flaws. Our chatbot demonstrates significant potential to speed up and improve the process of accessing locally relevant clinical information for healthcare professionals.