Ian Scott

I have investigated several quality anfd safety improvement (QSI) topics with publications influencing clinical and policy decisions, cited in 93 countries by 160 institutions (including Harvard, Stanford, Johns Hopkins Universities), 23 publications receiving 41 mentions in policy documents, 11 in top 5% of all outputs (Altmetric 2019). I was lead author of the first systematic review of effectiveness of acute medical units (AMU) and co-authored the first operational standards for AMUs in 2006 (with regular updates), both initiatives prompting many Australian hospitals to establish such units. I co-authored the first Cochrane review of early invasive versus conservative strategies for non-ST-elevation acute coronary syndromes in the stent era in 2016, wrote the first evidence-based Australian guide in perioperative medicine, and reported a case-control study suggesting increased cardiac risk with perioperative use of angiotensin antagonists (now being investigated in the first randomised trial). I have led and researched major QSI reforms within a large tertiary hospital which, within 12 months, increased percentage of patients with ED length of stay of <4 hours from 32% (worst in the country) to 62% (near top), decreased in-hospital mortality from 2.3% to 1.7%, and identified novel predictors of better outcomes. We undertook a study, with Health Roundtable and CSIRO, of 11 million acute presentations which validated a national emregency access target of 82%, which was then adopted by QH and subsequently by other states.

In response to the growing problem of potentially inappropriate polypharmacy (PIP) in older patients, I co-authored two literature reviews and four prevalence studies, and established the multidisciplinary Australian Deprescribing Network (ADeN) in 2014 (currently >400 colleagues). In 2015 we published a sentinel paper (560 citations to date, top 1% cited paper worldwide), detailing a method (CEASE protocol) for ceasing or dose reducing inappropriate medications – a process called deprescribing - which has been accepted as the international standard. I have co-authored a systematic review of enablers and barriers to deprescribing by clinicians and published papers that prove the efficacy of CEASE in hospital and primary care settings, the latter in a successful controlled trial involving 5 general practices (world first). In addition to Australian authorities (Aust Medicines Handbook), CEASE has been adopted by US advocates (Lown Institute among others), New Zealand (NZ Health), UK (NHS), Taiwan and Singapore (respective health ministries), and China (Guangdong Pharmaceutical Association). I have recently published a review of EMR-enabled tools for minimising polypharmacy, and am now researching means for identifying patients at high risk of medication harm and machine learning methods to predict better drug dosing.

I have proposed clinician-led strategies for minimising low value care (LVC) later endorsed by the Productivity Commission and the Australian Medical Association. I have researched the extent of LVC in Australian hospitals and, in a landmark paper, exposed the cognitive biases underpinning it, which has informed QH Value-based Care group and NSW Health. I have authored reviews of advance care planning (ACP) detailing its process and benefits, evaluated ACP implementation in a tertiary hospital, and assessed integration into nursing homes.

I have co-authored a review of the impacts of electronic medical records (EMR) in hospital practice and formulated an evidence-based EMR implementation checklist that is assisting other hospitals in their digital transformation (344 reads). More recently, I have established two clinical working groups targeting machine learning models aimed at early detection of sepsis and optimising drug dosing.