feature: qSOFA Scoring & Sepsis Bundle Compliance

2026-06-18 22:52:43 +08:00
parent 3c54feb38a
commit 4b46c09f90
34 changed files with 2351 additions and 18 deletions
@@ -0,0 +1,160 @@
+using System.Text.Json;
+using Microsoft.EntityFrameworkCore;
+
+public class SepsisBundleService : ISepsisBundleService
+{
+    private readonly AppDbContext _db;
+    private readonly IOrderService _orderService;
+    private readonly ClinicalMetrics _metrics;
+
+    public SepsisBundleService(AppDbContext db, IOrderService orderService, ClinicalMetrics metrics)
+    {
+        _db = db;
+        _orderService = orderService;
+        _metrics = metrics;
+    }
+
+    public async Task<SepsisBundle?> TryCreateBundleAsync(
+        Guid encounterId, Guid triggeringAlertId, AlertType alertType, CancellationToken ct = default)
+    {
+        var exists = await _db.SepsisBundles
+            .AnyAsync(b => b.EncounterId == encounterId
+                && b.ComplianceStatus == SepsisBundleComplianceStatus.InProgress, ct);
+
+        if (exists)
+            return null;
+
+        var recognizedAt = DateTimeOffset.UtcNow;
+        var bundle = new SepsisBundle
+        {
+            Id = Guid.NewGuid(),
+            EncounterId = encounterId,
+            TriggeringAlertId = triggeringAlertId,
+            TriggeringAlertType = alertType.ToDbString(),
+            RecognizedAt = recognizedAt,
+            DeadlineAt = recognizedAt.AddHours(1),
+            ComplianceStatus = SepsisBundleComplianceStatus.InProgress
+        };
+
+        var elementDefs = new (SepsisBundleElementType Type, OrderType OrderType, string Description)[]
+        {
+            (SepsisBundleElementType.BloodCultures,            OrderType.Lab,        "SEP-1: Blood cultures"),
+            (SepsisBundleElementType.SerumLactate,             OrderType.Lab,        "SEP-1: Serum lactate"),
+            (SepsisBundleElementType.BroadSpectrumAntibiotics, OrderType.Medication, "SEP-1: Broad-spectrum antibiotics"),
+            (SepsisBundleElementType.IvFluidResuscitation,     OrderType.Procedure,  "SEP-1: IV fluid bolus"),
+        };
+
+        foreach (var (elementType, orderType, description) in elementDefs)
+        {
+            var order = await _orderService.CreateAsync(encounterId, new CreateOrderRequest(
+                orderType, description, "sepsis-bundle-engine"));
+
+            bundle.Elements.Add(new SepsisBundleElement
+            {
+                Id = Guid.NewGuid(),
+                ElementType = elementType,
+                Status = SepsisBundleElementStatus.Pending,
+                OrderId = order.Id
+            });
+        }
+
+        _db.SepsisBundles.Add(bundle);
+
+        _db.OutboxEvents.Add(new OutboxEvent
+        {
+            Id = Guid.NewGuid(),
+            Topic = "sepsis.bundle.created",
+            Payload = JsonSerializer.Serialize(new
+            {
+                bundleId = bundle.Id,
+                encounterId,
+                triggeringAlertId,
+                triggeringAlertType = alertType.ToDbString(),
+                recognizedAt,
+                deadlineAt = bundle.DeadlineAt,
+                partitionKey = encounterId.ToString()
+            }),
+            PartitionKey = encounterId.ToString(),
+            CreatedAt = DateTimeOffset.UtcNow
+        });
+
+        await _db.SaveChangesAsync(ct);
+        return bundle;
+    }
+
+    public async Task<SepsisBundle?> GetCurrentByEncounterAsync(Guid encounterId)
+    {
+        return await _db.SepsisBundles
+            .AsNoTracking()
+            .Include(b => b.Elements)
+                .ThenInclude(e => e.Order)
+            .Where(b => b.EncounterId == encounterId)
+            .OrderByDescending(b => b.RecognizedAt)
+            .FirstOrDefaultAsync();
+    }
+
+    public async Task<SepsisBundle> GetByIdAsync(Guid id)
+    {
+        var bundle = await _db.SepsisBundles
+            .AsNoTracking()
+            .Include(b => b.Elements)
+                .ThenInclude(e => e.Order)
+            .FirstOrDefaultAsync(b => b.Id == id);
+
+        if (bundle is null)
+            throw new NotFoundException("Sepsis bundle not found.", "BUNDLE_NOT_FOUND");
+
+        return bundle;
+    }
+
+    public async Task OnOrderResultedAsync(Guid orderId, CancellationToken ct = default)
+    {
+        var element = await _db.SepsisBundleElements
+            .Include(e => e.Bundle)
+            .FirstOrDefaultAsync(e => e.OrderId == orderId, ct);
+
+        if (element is null || element.Status == SepsisBundleElementStatus.Completed)
+            return;
+
+        element.Status = SepsisBundleElementStatus.Completed;
+        element.CompletedAt = DateTimeOffset.UtcNow;
+
+        var bundle = element.Bundle;
+        var allComplete = await _db.SepsisBundleElements
+            .Where(e => e.BundleId == bundle.Id && e.Id != element.Id)
+            .AllAsync(e => e.Status == SepsisBundleElementStatus.Completed, ct);
+
+        if (allComplete)
+        {
+            bundle.CompletedAt = DateTimeOffset.UtcNow;
+            bundle.ComplianceStatus = bundle.CompletedAt <= bundle.DeadlineAt
+                ? SepsisBundleComplianceStatus.Compliant
+                : SepsisBundleComplianceStatus.NonCompliant;
+
+            _metrics.SepsisBundleComplianceTotal
+                .WithLabels(bundle.ComplianceStatus.ToDbString()).Inc();
+        }
+
+        _db.OutboxEvents.Add(new OutboxEvent
+        {
+            Id = Guid.NewGuid(),
+            Topic = "sepsis.bundle.updated",
+            Payload = JsonSerializer.Serialize(new
+            {
+                bundleId = bundle.Id,
+                encounterId = bundle.EncounterId,
+                elementId = element.Id,
+                elementType = element.ElementType.ToDbString(),
+                elementStatus = element.Status.ToDbString(),
+                complianceStatus = bundle.ComplianceStatus.ToDbString(),
+                completedAt = element.CompletedAt,
+                partitionKey = bundle.EncounterId.ToString()
+            }),
+            PartitionKey = bundle.EncounterId.ToString(),
+            CreatedAt = DateTimeOffset.UtcNow
+        });
+
+        await _db.SaveChangesAsync(ct);
+    }
+    
+}