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
2022
Journal Article
Using information technology to reduce diagnostic error: still a bridge too far?
Scott, Ian A. (2022). Using information technology to reduce diagnostic error: still a bridge too far?. Internal Medicine Journal, 52 (6), 908-911. doi: 10.1111/imj.15804
2022
Journal Article
Impact of pharmacist and physician collaborations in primary care on reducing readmission to hospital: A systematic review and meta-analysis
Foot, Holly, Scott, Ian, Sturman, Nancy, Whitty, Jennifer A., Rixon, Kylie, Connelly, Luke, Williams, Ian and Freeman, Christopher (2022). Impact of pharmacist and physician collaborations in primary care on reducing readmission to hospital: A systematic review and meta-analysis. Research in Social and Administrative Pharmacy, 18 (6), 2922-2943. doi: 10.1016/j.sapharm.2021.07.015
2022
Journal Article
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). Scoping review of studies evaluating frailty and its association with medication harm. Drugs and Aging, 39 (5), 333-353. doi: 10.1007/s40266-022-00940-3
2022
Journal Article
Health literacy assessment in the clinic: benefits, pitfalls and practicalities
Ellender, Claire M., Boyde, Mary and Scott, Ian A. (2022). Health literacy assessment in the clinic: benefits, pitfalls and practicalities. Australian Journal of Primary Health, 28 (5), 365-370. doi: 10.1071/py22015
2022
Journal Article
Diagnostic features, management and prognosis of type 2 myocardial infarction compared to type 1 myocardial infarction: a systematic review and meta-analysis
White, Kyle, Kinarivala, Mansey and Scott, Ian (2022). Diagnostic features, management and prognosis of type 2 myocardial infarction compared to type 1 myocardial infarction: a systematic review and meta-analysis. BMJ Open, 12 (2) e055755, e055755. doi: 10.1136/bmjopen-2021-055755
2021
Conference Publication
Validation and updating of the adverse inpatient medication event (AIME) model
Falconer, N., Scott, I., Abdel-Hafez, A., Snoswell, C., Cottrell, N., Morris, C., Lam, J. and Barras, M. (2021). Validation and updating of the adverse inpatient medication event (AIME) model. Australasian Pharmaceutical Science Association (APS) Conference, Online, 6-8 December 2021. Adelaide, SA, Australia: Bellberry.
2021
Journal Article
Exploring stakeholder attitudes towards AI in clinical practice
Scott, Ian A, Carter, Stacy M and Coiera, Enrico (2021). Exploring stakeholder attitudes towards AI in clinical practice. BMJ Health and Care Informatics, 28 (1) e100450, e100450. doi: 10.1136/bmjhci-2021-100450
2021
Journal Article
Systematic review of machine learning models for personalised dosing of heparin
Falconer, Nazanin, Abdel-Hafez, Ahmad, Scott, Ian A., Marxen, Sven, Canaris, Stephen and Barras, Michael (2021). Systematic review of machine learning models for personalised dosing of heparin. British Journal of Clinical Pharmacology, 87 (11) bcp.14852, 4124-4139. doi: 10.1111/bcp.14852
2021
Journal Article
Demystifying machine learning: a primer for physicians
Scott, Ian A. (2021). Demystifying machine learning: a primer for physicians. Internal Medicine Journal, 51 (9), 1388-1400. doi: 10.1111/imj.15200
2021
Journal Article
Patient harm from cardiovascular medications
Paradissis, Chariclia, Cottrell, Neil, Coombes, Ian, Scott, Ian, Wang, William and Barras, Michael (2021). Patient harm from cardiovascular medications. Therapeutic Advances in Drug Safety, 12, 204209862110274. doi: 10.1177/20420986211027451
2021
Journal Article
What is needed to mainstream artificial intelligence in health care?
Scott, Ian A., Abdel-Hafez, Ahmad, Barras, Michael and Canaris, Stephen (2021). What is needed to mainstream artificial intelligence in health care?. Australian Health Review, 45 (5), 591-596. doi: 10.1071/ah21034
2021
Journal Article
Developing critical thinking skills for delivering optimal care
Scott, Ian A., Hubbard, Ruth E., Crock, Carmel, Campbell, Thomas and Perera, Michael (2021). Developing critical thinking skills for delivering optimal care. Internal Medicine Journal, 51 (4), 488-493. doi: 10.1111/imj.15272
2021
Journal Article
Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
Moynihan, Ray, Sanders, Sharon, Michaleff, Zoe A., Scott, Anna Mae, Clark, Justin, To, Emma J., Jones, Mark, Kitchener, Eliza, Fox, Melissa, Johansson, Minna, Lang, Eddy, Duggan, Anne, Scott, Ian and Albarqouni, Loai (2021). Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open, 11 (3) e045343, e045343. doi: 10.1136/bmjopen-2020-045343
2021
Journal Article
Sociocognitive approach to behaviour change for reducing low-value care
Scott, Ian A. and McPhail, Steven M. (2021). Sociocognitive approach to behaviour change for reducing low-value care. Australian Health Review, 45 (2), 173-177. doi: 10.1071/AH20209
2021
Journal Article
Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial
Freeman, Christopher R., Scott, Ian A., Hemming, Karla, Connelly, Luke B., Kirkpatrick, Carl M., Coombes, Ian, Whitty, Jennifer, Martin, James, Cottrell, Neil, Sturman, Nancy, Russell, Grant M., Williams, Ian, Nicholson, Caroline, Kirsa, Sue and Foot, Holly (2021). Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial. The Medical Journal of Australia, 214 (5), 212-217. doi: 10.5694/mja2.50942
2021
Journal Article
Clinician checklist for assessing suitability of machine learning applications in healthcare
Scott, Ian, Carter, Stacey and Coiera, Enrico (2021). Clinician checklist for assessing suitability of machine learning applications in healthcare. BMJ Health and Care Informatics, 28 (1) e100251, 1-8. doi: 10.1136/bmjhci-2020-100251
2021
Journal Article
Frequency, trends and institutional variation in 30-day all-cause mortality and unplanned readmissions following hospitalisation for heart failure in Australia and New Zealand
Labrosciano, Clementine, Horton, Dennis, Air, Tracy, Tavella, Rosanna, Beltrame, John F., Zeitz, Christopher J., Krumholz, Harlan M., Adams, Robert J. T., Scott, Ian A., Gallagher, Martin, Hossain, Sadia, Hariharaputhiran, Saranya and Ranasinghe, Isuru (2021). Frequency, trends and institutional variation in 30-day all-cause mortality and unplanned readmissions following hospitalisation for heart failure in Australia and New Zealand. European Journal of Heart Failure, 23 (1), 31-40. doi: 10.1002/ejhf.2030
2021
Journal Article
Development and dissemination of the national strategic action plan for reducing inappropriate polypharmacy in older Australians
Kouladjian O'Donnell, Lisa, Reeve, Emily, Cumming, Anne, Scott, Ian A. and Hilmer, Sarah N. (2021). Development and dissemination of the national strategic action plan for reducing inappropriate polypharmacy in older Australians. Internal Medicine Journal, 51 (1), 111-115. doi: 10.1111/imj.15155
2021
Journal Article
Effectiveness and sustainability of deprescribing for hospitalized older patients near end of life: a systematic review
Cardona, Magnolia, Stehlik, Paulina, Fawzy, Peter, Byambasuren, Oyungerel, Anderson, Jarrah, Clark, Justin, Sun, Shelley and Scott, Ian (2021). Effectiveness and sustainability of deprescribing for hospitalized older patients near end of life: a systematic review. Expert Opinion on Drug Safety, 20 (1), 81-91. doi: 10.1080/14740338.2021.1853704
2021
Journal Article
Low value care is a health hazard that calls for patient empowerment
Scott, Ian A., Elshaug, Adam G. and Fox, Melissa (2021). Low value care is a health hazard that calls for patient empowerment. Medical Journal of Australia, 215 (3), 101-103.e1. doi: 10.5694/mja2.51168
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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