Failure mode and effects analysis of fuel and LPG shortage impacts on hospital operations: a framework for healthcare resilience in conflict-related supply disruptions.

Abstract

To conduct a proactive failure mode and effects analysis (FMEA) of patient safety risks arising from acute fuel and liquefied petroleum gas (LPG) shortage at a quaternary-care hospital in a modelled geopolitical conflict scenario and to produce a tiered preparedness framework. Proactive process FMEA using the Institute for Healthcare Improvement (IHI) Healthcare FMEA framework. Risk priority numbers (RPNs) were computed as severity (S)×occurrence (O)×detection (D), each scored 1-10. A 455-bed quaternary-care hospital in South India. A multidisciplinary team (infectious diseases, quality, engineering, dietetics, nursing, pharmacy) mapped 10 hospital departments across six structured sessions. The hazard scenario modelled a US-Iran war causing Strait of Hormuz closure and acute national fuel and LPG supply shock. Each failure mode was scored on S, O and D; RPN risk bands were defined as Critical (≥200), High (150-199), Medium (100-149) and Low (<100). 62 failure modes were identified across 10 departments (RPN range 70-252; mean 143.3). 5 failure modes were Critical, 17 High, 34 Medium and 6 Low. The Generator/Power Backup department recorded the highest mean RPN (171.0), functioning as a systemic root-cause amplifier propagating risk across seven other departments. Laundry Services contained the highest-scoring individual failure mode (operating theatre/intensive care unit linen sterilisation failure, RPN 240); Kitchen Services-entirely LPG-dependent-recorded a mean RPN of 163.4. Critical clinical consequences, including ventilator failure, haemodialysis shutdown and emergency surgical cancellation, were traceable upstream to generator dependency. Fuel and LPG shortage in a conflict scenario generates cascading, multisystem patient safety failures. Generator continuity is the paramount mitigation target. Kitchen and laundry services carry infection-control risks comparable in magnitude to clinical departments. A proactively constructed, RPN-stratified response framework is essential for hospital resilience in geopolitical emergencies.