Overview
Background
Ian Scott is the Director of Internal Medicine and Clinical Epidemiology at the Princess Alexandra Hospital and a Professor with the Faculty of Medicine. He is a consultant general physician with clinical interests in in health services evaluation and improvement, clinical guidelines, clinical decision-making, evidence-based medicine, low value care, quality use of medicines, non-invasive cardiology, advance care planning, and older patient care. He currently chairs the Queensland Clinical Networks Executive, is the inaugural chair of the Australian Deprescribing Network, Metro South Clinical AI Working Group, and Queensland Health Sepsis AI Working Group and is a founding member of the Australian and New Zealand Affiliate of the US Society to Improve Diagnosis in Medicine (ANZA-SIDM). He is also a member of Queensland Health System Quality, Safety and Performance Management Committee and the Quality and Safety Committee and the Digital Health Advisory Group of the Royal Australasian College of Physicians (RACP). He is a past President of the Internal Medicine Society of Australia and New Zealand and past member of the MBS Review Taskforce for Cardiac Services. He has led multi-site quality improvement collaboratives in acute cardiac care including both hospitals and Divisions of General Practice. He has been involved at senior level on various high-level committees in establishing policies for Queensland Health and/or RACP on electronic discharge summaries, clinical handover, clinical indicators, evaluation of physician performance, chronic disease management, perioperative medicine, medical assessment and planning units, and patient flow through emergency departments. He has published over 270 peer-reviewed articles, presented to over 150 national and international meetings, and is a recipient of several NHMRC and government research grants.
Availability
- Professor Ian Scott is:
- Available for supervision
Fields of research
Qualifications
- Postgraduate Diploma in Education, The University of Queensland
- Masters (Coursework) of Education, The University of Queensland
- Royal Australasian College of Physicians, Royal Australasian College of Physicians
Research interests
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Clinical decision making
Investigation into how clinicians reason, the cognitive biases that may afflict that reasoning and ways for mitigating such bias, and the sociocognitive aspects of decision-making
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Low value care
Investigation into the drivers and manifestations of low value care (ie care that is ineffective, harmful or disproportionately costly for marginal benefit) and methods for reducing it
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Advance care planning
Investigation into how clinicians and patients can promote and participate in shared decision-making around end of life care which accounts for patient values and preferences and avoids unnecessary or unwanted invasive interventions in the last years of life.
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Evidence-informed clinical practice
Investigation into how clinicians can be assisted in ensuring their clinical practice aligns with best available research evidence of the effectiveness and safety of clinical interventions
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Diagnostic error
Investigation into the cognitive and system-related factors that predispose clinicians to making diagnostic error which currently affect around 1 in 10 diagnostic decisions, with potential to cause patient harm.
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Using artificial intelligence to improve clinical decision-making
Investigation into how predictive analytics using artificial intelligence, in particular machine learning, can be used to improve clinical decision-making.
Research impacts
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.
Works
Search Professor Ian Scott’s works on UQ eSpace
2023
Journal Article
Digital health competencies for the next generation of physicians
Scott, Ian A., Shaw, Tim, Slade, Christine, Wan, Tai T., Coorey, Craig, Johnson, Sandra L. J. and Sullivan, Clair M. (2023). Digital health competencies for the next generation of physicians. Internal Medicine Journal, 53 (6), 1042-1049. doi: 10.1111/imj.16122
2023
Journal Article
Implementation frameworks for end-to-end clinical AI: derivation of the SALIENT framework
van der Vegt, Anton H., Scott, Ian A., Dermawan, Krishna, Schnetler, Rudolf J., Kalke, Vikrant R. and Lane, Paul J. (2023). Implementation frameworks for end-to-end clinical AI: derivation of the SALIENT framework. Journal of the American Medical Informatics Association, 30 (9), 1503-1515. doi: 10.1093/jamia/ocad088
2023
Journal Article
Deployment of machine learning algorithms to predict sepsis: systematic review and application of the SALIENT clinical AI implementation framework
van der Vegt, Anton H., Scott, Ian A., Dermawan, Krishna, Schnetler, Rudolf J., Kalke, Vikrant R. and Lane, Paul J. (2023). Deployment of machine learning algorithms to predict sepsis: systematic review and application of the SALIENT clinical AI implementation framework. Journal of the American Medical Informatics Association, 30 (7), 1349-1361. doi: 10.1093/jamia/ocad075
2023
Journal Article
Coping with uncertainty in clinical practice: a narrative review
Scott, Ian A., Doust, Jenny A., Keijzers, Gerben B. and Wallis, Katharine A. (2023). Coping with uncertainty in clinical practice: a narrative review. Medical Journal of Australia, 218 (9), 418-425. doi: 10.5694/mja2.51925
2023
Journal Article
Appropriate use of transthoracic echocardiography in the investigation of general medicine patients presenting with syncope or presyncope
Simos, Peter and Scott, Ian (2023). Appropriate use of transthoracic echocardiography in the investigation of general medicine patients presenting with syncope or presyncope. Postgraduate Medical Journal, 99 (1170) postgradmedj-2021-141416, 279-285. doi: 10.1136/postgradmedj-2021-141416
2023
Journal Article
An organisational approach to improving diagnostic safety
Scott, Ian A. and Crock, Carmel (2023). An organisational approach to improving diagnostic safety. Australian Health Review, 47 (3), 261-267. doi: 10.1071/ah22287
2023
Journal Article
Recognition and management of hospital-acquired sepsis among older general medical inpatients: a multi-site retrospective study
Barker, Nicholas, Scott, Ian A., Seaton, Robert, Mehta, Naitik, Kalke, Vikrant R. and Redpath, Lyndell (2023). Recognition and management of hospital-acquired sepsis among older general medical inpatients: a multi-site retrospective study. International Journal of General Medicine, Volume 16, 1039-1046. doi: 10.2147/ijgm.s400839
2023
Book Chapter
Advance Care Planning
Scott, Ian (2023). Advance Care Planning. Beyond Evidence-Based Medicine. (pp. 107-109) Singapore: Springer. doi: 10.1007/978-981-99-4440-8_25
2023
Book Chapter
Overdiagnosis
Scott, Ian (2023). Overdiagnosis. Beyond Evidence-Based Medicine. (pp. 11-14) Singapore: Springer. doi: 10.1007/978-981-99-4440-8_3
2023
Book Chapter
Looking for Causes of Delirium
Scott, Ian (2023). Looking for Causes of Delirium. Beyond Evidence-Based Medicine. (pp. 85-88) Singapore: Springer. doi: 10.1007/978-981-99-4440-8_20
2023
Book Chapter
Investigation of Syncope
Scott, Ian (2023). Investigation of Syncope. Beyond Evidence-Based Medicine. (pp. 161-163) Singapore: Springer. doi: 10.1007/978-981-99-4440-8_38
2023
Book Chapter
Polypharmacy and Deprescribing
Scott, Ian (2023). Polypharmacy and Deprescribing. Beyond Evidence-Based Medicine. (pp. 7-10) Singapore: Springer. doi: 10.1007/978-981-99-4440-8_2
2022
Journal Article
Quality of observational studies of clinical interventions: a meta-epidemiological review
Grosman, Sergei and Scott, Ian A. (2022). Quality of observational studies of clinical interventions: a meta-epidemiological review. BMC Medical Research Methodology, 22 (1) 313, 1-14. doi: 10.1186/s12874-022-01797-1
2022
Journal Article
Guideline Concordance in Managing Community-Acquired Pneumonia: Room for Improvement
Tan, YG Alvin and Scott, Ian A (2022). Guideline Concordance in Managing Community-Acquired Pneumonia: Room for Improvement. Clinical Audit, Volume 14, 79-88. doi: 10.2147/ca.s377148
2022
Journal Article
A whole-of-health system approach to improving care of frail older persons
Whiting, Elizabeth, Scott, Ian A., Hines, Laureen, Ward, Tamara, Burkett, Ellen, Cranitch, Erin, Mudge, Alison, Reymond, Elizabeth, Taylor, Andrea and Hubbard, Ruth E. (2022). A whole-of-health system approach to improving care of frail older persons. Australian Health Review, 46 (5), 629-634. doi: 10.1071/AH22170
2022
Journal Article
Establishing the worth of deprescribing inappropriate medications: are we there yet?
Scott, Ian A., Reeve, Emily and Hilmer, Sarah N. (2022). Establishing the worth of deprescribing inappropriate medications: are we there yet?. Medical Journal of Australia, 217 (6), 283-286. doi: 10.5694/mja2.51686
2022
Journal Article
A whole-of-community program of advance care planning for end-of-life care
Scott, Ian A., Reymond, Liz, Sansome, Xanthe and Miller, Leyton (2022). A whole-of-community program of advance care planning for end-of-life care. Australian Health Review, 46 (4), 442-449. doi: 10.1071/AH22099
2022
Journal Article
Research activities in general medicine: a scoping survey by the Internal Medicine Society of Australia and New Zealand (IMSANZ)
Aung, Ar Kar, Pickles, Robert, Knight, Anne, Shannon, Leigh‐Anne, Bowers, Andrew, Donnelly, Sinead, Johnson, Douglas F., Scott, Ian A., Potter, Elizabeth L. and Internal Medicine Society of Australia and New Zealand Research Network (IMSANZ‐RN) working group (2022). Research activities in general medicine: a scoping survey by the Internal Medicine Society of Australia and New Zealand (IMSANZ). Internal Medicine Journal, 52 (9), 1505-1512. doi: 10.1111/imj.15866
2022
Journal Article
Predicting therapeutic response to unfractionated heparin therapy: a methodological pilot study using machine learning
Abdel-Hafez, Ahmad, Scott, Ian A., Falconer, Nazanin, Canaris, Stephen, Bonilla, Oscar, Marxen, Sven, Van Garderen, Aaron and Barras, Michael (2022). Predicting therapeutic response to unfractionated heparin therapy: a methodological pilot study using machine learning. Interactive Journal of Medical Research, 11 (2) e34533, e34533. doi: 10.2196/34533
2022
Journal Article
Correction to: Scoping Review of Studies Evaluating Frailty and Its Association with Medication Harm
Lam, Jonathan Yong Jie, Barras, Michael, Scott, Ian A., Long, Duncan, Shafiee Hanjani, Leila and Falconer, Nazanin (2022). Correction to: Scoping Review of Studies Evaluating Frailty and Its Association with Medication Harm. Drugs & Aging, 39 (8), 671-672. doi: 10.1007/s40266-022-00956-9
Funding
Current funding
Past funding
Supervision
Availability
- Professor Ian Scott is:
- Available for supervision
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Supervision history
Current supervision
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Doctor Philosophy
Methods for presenting clinical AI predictions to clinicians
Associate Advisor
Other advisors: Dr Maxime Cordeil, Mr Anton Van Der Vegt
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Doctor Philosophy
Development and Integration of a Medication Harm Prediction Tool within an Australian Digital Hospital
Associate Advisor
Other advisors: Professor Michael Barras, Dr Nazanin Ghahreman-Falconer
Completed supervision
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2018
Doctor Philosophy
Minimising potentially inappropriate polypharmacy in community living older people: A multi-phase, mixed methods study to develop and pilot a general practitioner-led deprescribing intervention in primary care
Principal Advisor
Other advisors: Associate Professor Chris Freeman
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2002
Doctor Philosophy
COMPARATIVE STUDIES ON THE DEVELOPMENT OF CLINICAL REASONING
Associate Advisor
Media
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