feature: Trend Detection & Alert Suppression Windows
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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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