OR

Browse By

Professor Ian Scott

Professor Clinical Decision-making

Princess Alexandra Hospital Southside Clinical Unit
Faculty of Medicine
i.scott@uq.edu.au
+61 7 3176 7355

Overview

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.

Research Interests

  • 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
  • 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
  • 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.
  • 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
  • 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.
  • 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.

Qualifications

  • Master of Education, The University of Queensland
  • Grad Cert Education, The University of Queensland
  • Master of Health Administration, University of New South Wales
  • Fellow, Royal Australasian College of Physicians
  • MBBS, The University of Queensland

Publications

View all Publications

Grants

View all Grants

Supervision

View all Supervision

Publications

Book Chapter

  • Pharmacotherapy and deprescribing

    Reeve, Emily, Hilmer, Sarah N. and Scott, Ian (2019). Pharmacotherapy and deprescribing. Encyclopedia of Pharmacy Practice and Clinical Pharmacy. (pp. 117-128) London, United Kingdom: Academic Press. doi: 10.1016/B978-0-128-12735-3.00083-2

  • Embedding evidence-based practice into routine clinical care

    Scott, Ian, Del Mar, Chris, Hoffmann, Tammy and Bennett, Sally (2017). Embedding evidence-based practice into routine clinical care. Evidence-based practice across the health professions. (pp. 409-427) edited by Tammy Hoffmann, Sally Bennett and Chris Del Mar. Chatswood, NSW, Australia: Elsevier.

  • Embedding evidence-based practice into routine clinical care

    Scott, Ian, Del Mar, Chris, Hoffmann, Tammy and Bennett, Sally (2013). Embedding evidence-based practice into routine clinical care. Evidence-based practice across the health professions. (pp. 391-405) edited by Tammy Hoffmann, Sally Bennett and Chris Del Mar. Sydney, NSW, Australia: Elsevier.

Journal Article

Conference Publication

PhD and MPhil Supervision

Current Supervision

Completed Supervision

For Media assistance please contact The Office of Marketing and Communications, (07) 3365 1120

Links

ResearcherID: F-1482-2011

ORCID: 0000-0002-7596-0837

Scopus ID: 7202832264

Unit Links
Other Media

Related Resources

Similar Staff
Researchers in Associated Units
Fields of Research