User-centred innovation to advance safe surgery at the point of need: report on development of the SurgiField system

© Author(s) (or their employer(s)) 2022. Reuse permitted under CC BY. Published by BMJ. INTRODUCTION In conditions ranging from pneumothorax to acute compartment syndrome to fractures to traumatic and degenerative joint disease to appendicitis to obstructed labour to postpartum haemorrhage; safe, timely surgical intervention is the deciding factor among recovery, mortality or longterm disability. Consequently, access to quality surgical care is a global priority across the resource spectrum. Yet despite this, an estimated 18 million people die annually from conditions that safe surgery could address. Even more experience permanent disability from delayed, inaccessible, or unsafe surgery, generating a gross domestic product loss of US$820 billion from lost annual productivity. Far from requiring resourceintensive, sophisticated surgeries, the vast majority of surgical needs globally are captured by the simple, socalled bellwether surgical procedures. Surgical care has traditionally relied on consistent availability of three resource categories: (1) functional equipment and materials, (2) appropriate facility space and (3) medical staff. 4 Given the practical challenges of disseminating these resources consistently in many austere settings, including but not limited to conflict settings, disaster zones, lowtomiddleincome countries and rural regions; surgical care availability is often limited to centralised referral settings. Even higherresource settings regard costcontainment and quality improvement as ongoing challenges to care equity and sustainability. For instance, Californian operating theatres cost an average of US$37 per minute to run. High equipment and facility costs are driven in part by maintaining the sterility WHAT ARE THE NEW FINDINGS