feature: Trend Detection & Alert Suppression Windows
This commit is contained in:
voltsrage
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using FluentAssertions;
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using Microsoft.EntityFrameworkCore;
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using Microsoft.Extensions.DependencyInjection;
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using StackExchange.Redis;
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[Collection("Integration")]
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public class AlertSuppressionTests : IAsyncLifetime
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{
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private readonly ApiFixture _fixture;
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private Guid _patientId;
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private Guid _encounterId;
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public AlertSuppressionTests(ApiFixture fixture) => _fixture = fixture;
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public async Task InitializeAsync() => await ResetAndSeedThresholdAsync();
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public Task DisposeAsync() => Task.CompletedTask;
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private async Task ResetAndSeedThresholdAsync()
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{
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await DbResetHelper.ResetAsync(db);
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var patient = new Patient
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{
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Id = Guid.NewGuid(), Mrn = "MRN-SUP-001", FirstName = "Suppress", LastName = "Test",
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DateOfBirth = new DateOnly(1982, 8, 10), Gender = "M", CreatedAt = DateTimeOffset.UtcNow
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};
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var encounter = new Encounter
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{
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Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
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Status = EncounterStatus.Active, Department = Department.Icu,
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AttendingPhysician = "Dr. Suppress", AdmittedAt = DateTimeOffset.UtcNow,
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CreatedAt = DateTimeOffset.UtcNow
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};
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db.Patients.Add(patient);
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db.Encounters.Add(encounter);
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db.AlertThresholds.Add(new AlertThreshold
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{
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Id = Guid.NewGuid(), ObservationCode = "HEART_RATE",
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DisplayName = "Heart Rate", Unit = "bpm",
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CriticalLow = 30, WarningLow = 50, WarningHigh = 100, CriticalHigh = 150,
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CreatedAt = DateTimeOffset.UtcNow
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});
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await db.SaveChangesAsync();
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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await redis.GetDatabase().StringSetAsync("threshold:HEART_RATE",
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"""{"ObservationCode":"HEART_RATE","CriticalLow":30,"WarningLow":50,"WarningHigh":100,"CriticalHigh":150}""");
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_patientId = patient.Id;
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_encounterId = encounter.Id;
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}
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[Fact]
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public async Task AcknowledgeWarning_SetsSuppressionKey()
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{
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await ResetAndSeedThresholdAsync();
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var alertId = await SeedAlertAsync(AlertType.WarningHeartRate, AlertSeverity.Warning);
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using var scope = _fixture.Services.CreateScope();
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var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("nurse-1", "monitoring"));
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var key = AlertSuppressionService.SuppressionKey(_encounterId, AlertType.WarningHeartRate);
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(await redis.GetDatabase().KeyExistsAsync(key)).Should().BeTrue();
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}
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[Fact]
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public async Task SuppressedWarning_SkipsAlertCreation()
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{
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await ResetAndSeedThresholdAsync();
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var alertId = await SeedAlertAsync(AlertType.WarningHeartRate, AlertSeverity.Warning);
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using var scope = _fixture.Services.CreateScope();
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var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
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var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("nurse-1", "monitoring"));
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await alerts.ResolveAsync(alertId);
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var created = await evaluator.EvaluateAsync(
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Guid.NewGuid(), _encounterId, _patientId, "HEART_RATE", 105m);
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created.Should().BeFalse();
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(await db.ClinicalAlerts.CountAsync()).Should().Be(1,
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"suppressed warning must not create a new alert after resolve");
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}
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[Fact]
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public async Task CriticalAlert_NotSuppressible()
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{
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await ResetAndSeedThresholdAsync();
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var alertId = await SeedAlertAsync(AlertType.CriticalHeartRate, AlertSeverity.Critical);
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using var scope = _fixture.Services.CreateScope();
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var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("dr-1", "treating"));
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var key = AlertSuppressionService.SuppressionKey(_encounterId, AlertType.CriticalHeartRate);
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(await redis.GetDatabase().KeyExistsAsync(key)).Should().BeFalse();
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}
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[Fact]
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public async Task News2Emergency_NotSuppressible()
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{
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await ResetAndSeedThresholdAsync();
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var alertId = await SeedAlertAsync(AlertType.News2Emergency, AlertSeverity.Critical);
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using var scope = _fixture.Services.CreateScope();
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var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("dr-1", "reviewed"));
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var key = AlertSuppressionService.SuppressionKey(_encounterId, AlertType.News2Emergency);
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(await redis.GetDatabase().KeyExistsAsync(key)).Should().BeFalse();
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}
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[Fact]
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public async Task News2Warning_Suppressible()
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{
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await ResetAndSeedThresholdAsync();
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var alertId = await SeedAlertAsync(AlertType.News2Warning, AlertSeverity.Warning);
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using var scope = _fixture.Services.CreateScope();
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var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("nurse-1", "monitoring"));
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var key = AlertSuppressionService.SuppressionKey(_encounterId, AlertType.News2Warning);
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(await redis.GetDatabase().KeyExistsAsync(key)).Should().BeTrue();
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}
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[Fact]
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public async Task SuppressionExpires_AllowsNewAlert()
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{
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await ResetAndSeedThresholdAsync();
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using var scope = _fixture.Services.CreateScope();
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var suppression = scope.ServiceProvider.GetRequiredService<IAlertSuppressionService>();
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var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await suppression.SetSuppressionAsync(
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_encounterId, AlertType.WarningHeartRate, TimeSpan.FromSeconds(1));
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var blocked = await evaluator.EvaluateAsync(
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Guid.NewGuid(), _encounterId, _patientId, "HEART_RATE", 105m);
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blocked.Should().BeFalse();
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await Task.Delay(1500);
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var created = await evaluator.EvaluateAsync(
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Guid.NewGuid(), _encounterId, _patientId, "HEART_RATE", 105m);
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created.Should().BeTrue();
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.WarningHeartRate);
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}
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private async Task<Guid> SeedAlertAsync(AlertType alertType, AlertSeverity severity)
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{
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = new ClinicalAlert
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{
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Id = Guid.NewGuid(),
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EncounterId = _encounterId,
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PatientId = _patientId,
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AlertType = alertType,
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Severity = severity,
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Details = $"Test {alertType.ToDbString()} alert.",
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Status = AlertStatus.Open,
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TriggeredAt = DateTimeOffset.UtcNow
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};
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db.ClinicalAlerts.Add(alert);
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await db.SaveChangesAsync();
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return alert.Id;
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}
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}
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@@ -32,12 +32,17 @@ public class ApiFixture : WebApplicationFactory<Program>, IAsyncLifetime
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public async Task InitializeAsync()
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{
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// Apply migrations against the test database on first run
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// Apply migrations before the host starts — background services such as
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// ThresholdCacheLoader query the database during StartAsync.
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var connectionString = "Host=localhost;Port=5436;Database=vigilcare_test;Username=postgres;Password=password";
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var options = new DbContextOptionsBuilder<AppDbContext>()
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.UseNpgsql(connectionString)
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.Options;
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await using (var migrateDb = new AppDbContext(options))
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await migrateDb.Database.MigrateAsync();
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using var scope = Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await db.Database.MigrateAsync();
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// Flush the test Redis database (db=1) to avoid cross-test cache pollution
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var server = redis.GetServer(redis.GetEndPoints().First());
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await server.FlushDatabaseAsync(1);
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@@ -0,0 +1,58 @@
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using FluentAssertions;
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public class TrendCalculatorTests
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{
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private static readonly DateTimeOffset BaseTime =
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new(2026, 6, 18, 12, 0, 0, TimeSpan.Zero);
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[Fact]
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public void ComputeRatePerMinute_TwoEntries_ReturnsCorrectRate()
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{
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var entries = new List<TrendHistoryEntry>
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{
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new(72m, BaseTime),
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new(95m, BaseTime.AddMinutes(10))
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};
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var rate = TrendCalculator.ComputeRatePerMinute(entries, windowMinutes: 30);
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rate.Should().Be(2.3m);
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}
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[Fact]
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public void ComputeRatePerMinute_SingleEntry_ReturnsNull()
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{
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var entries = new List<TrendHistoryEntry> { new(72m, BaseTime) };
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TrendCalculator.ComputeRatePerMinute(entries, windowMinutes: 30)
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.Should().BeNull();
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}
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[Fact]
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public void ExceedsThreshold_HeartRateRise_ReturnsTrue()
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{
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TrendCalculator.ExceedsThreshold("HEART_RATE", 0.6m, 0.5m).Should().BeTrue();
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}
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[Fact]
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public void ExceedsThreshold_Spo2Decline_ReturnsTrue()
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{
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TrendCalculator.ExceedsThreshold("SPO2", -0.3m, 0.2m).Should().BeTrue();
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}
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[Fact]
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public void ExceedsThreshold_StableRate_ReturnsFalse()
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{
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TrendCalculator.ExceedsThreshold("HEART_RATE", 0.3m, 0.5m).Should().BeFalse();
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}
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[Fact]
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public void DescribeTrend_FormatsCorrectly()
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{
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TrendCalculator.DescribeTrend("HEART_RATE", 0.77m, 95m)
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.Should().Be("Rapid rise: HEART_RATE rising at 0.77/min (current 95)");
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TrendCalculator.DescribeTrend("SPO2", -0.25m, 92m)
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.Should().Be("Rapid decline: SPO2 falling at 0.25/min (current 92)");
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}
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}
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@@ -0,0 +1,147 @@
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using FluentAssertions;
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using Microsoft.EntityFrameworkCore;
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using Microsoft.Extensions.DependencyInjection;
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using StackExchange.Redis;
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[Collection("Integration")]
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public class TrendDetectorTests : IAsyncLifetime
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{
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private readonly ApiFixture _fixture;
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private Guid _encounterId;
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private Guid _patientId;
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private static readonly DateTimeOffset BaseTime =
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new(2026, 6, 18, 10, 0, 0, TimeSpan.Zero);
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public TrendDetectorTests(ApiFixture fixture) => _fixture = fixture;
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public async Task InitializeAsync()
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{
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await DbResetHelper.ResetAsync(db);
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var patient = new Patient
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{
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Id = Guid.NewGuid(), Mrn = "MRN-TREND-001", FirstName = "Trend", LastName = "Test",
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DateOfBirth = new DateOnly(1970, 3, 1), Gender = "F",
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CreatedAt = DateTimeOffset.UtcNow
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};
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var encounter = new Encounter
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{
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Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
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Status = EncounterStatus.Active, Department = Department.Icu,
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AttendingPhysician = "Dr. Trend", AdmittedAt = DateTimeOffset.UtcNow,
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CreatedAt = DateTimeOffset.UtcNow
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};
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db.Patients.Add(patient);
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db.Encounters.Add(encounter);
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await db.SaveChangesAsync();
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_patientId = patient.Id;
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_encounterId = encounter.Id;
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await ClearTrendHistoryAsync(scope.ServiceProvider);
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}
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public Task DisposeAsync() => Task.CompletedTask;
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[Fact]
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public async Task RapidHeartRateClimb_CreatesAlert()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
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await detector.ProcessObservationAsync(
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_encounterId, _patientId, "HEART_RATE", 72m, BaseTime);
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "HEART_RATE", 95m, BaseTime.AddMinutes(10));
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result.Outcome.Should().Be(TrendOutcome.RapidDeterioration);
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result.AlertCreated.Should().BeTrue();
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result.RatePerMinute.Should().Be(2.3m);
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.RapidDeterioration);
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alert.Severity.Should().Be(AlertSeverity.Warning);
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alert.Details.Should().Contain("HEART_RATE");
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}
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[Fact]
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public async Task StableHighHeartRate_NoTrendAlert()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
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await detector.ProcessObservationAsync(
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_encounterId, _patientId, "HEART_RATE", 95m, BaseTime);
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await detector.ProcessObservationAsync(
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_encounterId, _patientId, "HEART_RATE", 95m, BaseTime.AddMinutes(10));
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "HEART_RATE", 95m, BaseTime.AddMinutes(20));
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result.Outcome.Should().Be(TrendOutcome.Stable);
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result.AlertCreated.Should().BeFalse();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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(await db.ClinicalAlerts.CountAsync()).Should().Be(0);
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}
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[Fact]
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public async Task InsufficientHistory_NoAlert()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "HEART_RATE", 72m, BaseTime);
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result.Outcome.Should().Be(TrendOutcome.InsufficientHistory);
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result.AlertCreated.Should().BeFalse();
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}
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[Fact]
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public async Task NonTrendCode_Ignored()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "POTASSIUM_MEQ_L", 4.0m, BaseTime);
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result.Outcome.Should().Be(TrendOutcome.NotTrendCode);
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var key = TrendCalculator.HistoryKey(_encounterId, "POTASSIUM_MEQ_L");
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(await redis.GetDatabase().KeyExistsAsync(key)).Should().BeFalse();
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}
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[Fact]
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public async Task DuplicateTrendAlert_Idempotent()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(
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_encounterId, _patientId, "HEART_RATE", 72m, BaseTime);
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await detector.ProcessObservationAsync(
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_encounterId, _patientId, "HEART_RATE", 95m, BaseTime.AddMinutes(10));
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var second = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "HEART_RATE", 98m, BaseTime.AddMinutes(20));
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second.Outcome.Should().Be(TrendOutcome.AlertAlreadyOpen);
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second.AlertCreated.Should().BeFalse();
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(await db.ClinicalAlerts.CountAsync()).Should().Be(1,
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"second rapid climb must not duplicate while first RAPID_DETERIORATION is open");
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}
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private async Task ClearTrendHistoryAsync(IServiceProvider services)
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{
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var redis = services.GetRequiredService<IConnectionMultiplexer>();
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var cache = redis.GetDatabase();
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foreach (var key in TrendCalculator.AllHistoryKeys(_encounterId))
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await cache.KeyDeleteAsync(key);
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}
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}
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