feature: qSOFA Scoring & Sepsis Bundle Compliance
This commit is contained in:
voltsrage
@@ -0,0 +1,7 @@
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{
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"permissions": {
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"allow": [
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"Bash(dotnet test *)"
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]
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}
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}
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@@ -6,11 +6,24 @@ public static class DbResetHelper
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// the database, and preserves the schema (migrations do not re-run).
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public static async Task ResetAsync(AppDbContext db)
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{
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await db.Database.ExecuteSqlRawAsync(@"
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TRUNCATE TABLE reconciliation_alerts, outbox_events, orders,
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clinical_alerts, news2_scores, observations, encounters,
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alert_thresholds, patients
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RESTART IDENTITY CASCADE;
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");
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for (var attempt = 0; ; attempt++)
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{
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try
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{
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await db.Database.ExecuteSqlRawAsync(@"
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SET lock_timeout = '3s';
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TRUNCATE TABLE sepsis_bundle_elements, sepsis_bundles,
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reconciliation_alerts, outbox_events, orders,
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clinical_alerts, news2_scores, observations, encounters,
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alert_thresholds, patients
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RESTART IDENTITY CASCADE;
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");
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return;
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}
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catch when (attempt < 5)
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{
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await Task.Delay(1000);
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}
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}
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}
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}
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@@ -0,0 +1,37 @@
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using FluentAssertions;
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using StackExchange.Redis;
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public class QsofaCalculatorTests
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{
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[Fact]
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public void MeetsCriterion_RespRate22_ReturnsTrue() =>
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QsofaCalculator.MeetsCriterion("RESP_RATE", 22m).Should().BeTrue();
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[Fact]
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public void MeetsCriterion_RespRate21_ReturnsFalse() =>
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QsofaCalculator.MeetsCriterion("RESP_RATE", 21m).Should().BeFalse();
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[Fact]
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public void MeetsCriterion_SystolicBp100_ReturnsTrue() =>
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QsofaCalculator.MeetsCriterion("SYSTOLIC_BP", 100m).Should().BeTrue();
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[Fact]
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public void MeetsCriterion_SystolicBp101_ReturnsFalse() =>
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QsofaCalculator.MeetsCriterion("SYSTOLIC_BP", 101m).Should().BeFalse();
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[Fact]
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public void MeetsCriterion_Avpu1_ReturnsTrue() =>
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QsofaCalculator.MeetsCriterion("AVPU", 1m).Should().BeTrue();
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[Fact]
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public void MeetsCriterion_Avpu0_ReturnsFalse() =>
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QsofaCalculator.MeetsCriterion("AVPU", 0m).Should().BeFalse();
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[Fact]
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public void CountActiveCriteria_TwoOfThree_Returns2()
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{
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var values = new RedisValue[] { "24", RedisValue.Null, "95" };
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QsofaCalculator.CountActiveCriteria(values).Should().Be(2);
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}
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}
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@@ -0,0 +1,166 @@
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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 QsofaDetectorTests : 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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public QsofaDetectorTests(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-QSOFA-001", FirstName = "qSOFA", LastName = "Test",
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DateOfBirth = new DateOnly(1960, 1, 1), Gender = "M",
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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. qSOFA", 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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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var cache = redis.GetDatabase();
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foreach (var key in QsofaCalculator.AllCriterionKeys(_encounterId))
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await cache.KeyDeleteAsync(key);
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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 OneCriterionMet_NoAlert()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "RESP_RATE", 24m);
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result.Outcome.Should().Be(QsofaOutcome.InsufficientCriteria);
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result.ActiveCriteria.Should().Be(1);
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var ttl = await redis.GetDatabase()
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.KeyTimeToLiveAsync(QsofaCalculator.CriterionKey(_encounterId, "RESP_RATE"));
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ttl.Should().NotBeNull().And.BeGreaterThan(TimeSpan.Zero);
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}
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[Fact]
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public async Task TwoCriteriaMet_CreatesAlert()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var r1 = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "RESP_RATE", 24m);
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r1.Outcome.Should().Be(QsofaOutcome.InsufficientCriteria);
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var r2 = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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r2.Outcome.Should().Be(QsofaOutcome.AlertCreated);
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.QsofaWarning);
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alert.Severity.Should().Be(AlertSeverity.Critical);
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alert.Status.Should().Be(AlertStatus.Open);
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alert.EncounterId.Should().Be(_encounterId);
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alert.PatientId.Should().Be(_patientId);
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alert.Details.Should().Contain("qSOFA score 2/3");
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var outbox = await db.OutboxEvents.SingleAsync();
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outbox.Topic.Should().Be("alert.generated");
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outbox.PartitionKey.Should().Be(_encounterId.ToString());
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}
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[Fact]
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public async Task CriterionNormalizes_KeyDeleted()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var cache = redis.GetDatabase();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "RESP_RATE", 18m);
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var respKeyExists = await cache.KeyExistsAsync(
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QsofaCalculator.CriterionKey(_encounterId, "RESP_RATE"));
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respKeyExists.Should().BeFalse("a normalized respiratory rate must clear the criterion key");
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var sbpKeyExists = await cache.KeyExistsAsync(
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QsofaCalculator.CriterionKey(_encounterId, "SYSTOLIC_BP"));
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sbpKeyExists.Should().BeTrue("the other active criterion must remain in Redis");
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result.Outcome.Should().Be(QsofaOutcome.InsufficientCriteria);
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result.ActiveCriteria.Should().Be(1);
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.Status.Should().Be(AlertStatus.Open,
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"the existing alert is not auto-resolved when criteria drop below 2");
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}
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[Fact]
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public async Task DuplicateAlert_Idempotent()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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var r3 = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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r3.Outcome.Should().Be(QsofaOutcome.AlertAlreadyOpen);
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var alertCount = await db.ClinicalAlerts.CountAsync();
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alertCount.Should().Be(1, "WHERE NOT EXISTS prevents duplicate QSOFA_WARNING while one is open");
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var outboxCount = await db.OutboxEvents.CountAsync();
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outboxCount.Should().Be(1, "outbox event must be written exactly once");
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}
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[Fact]
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public async Task NonQsofaCode_Ignored()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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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, "HEART_RATE", 95m);
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result.Outcome.Should().Be(QsofaOutcome.NotQsofaCode);
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foreach (var key in QsofaCalculator.AllCriterionKeys(_encounterId))
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{
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var exists = await redis.GetDatabase().KeyExistsAsync(key);
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exists.Should().BeFalse("non-qSOFA codes must not create Redis state");
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}
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}
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}
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@@ -0,0 +1,209 @@
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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 SepsisBundleTests : 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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public SepsisBundleTests(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-BUNDLE-001", FirstName = "Bundle", LastName = "Test",
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DateOfBirth = new DateOnly(1965, 3, 15), 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. Bundle", 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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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var cache = redis.GetDatabase();
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foreach (var key in QsofaCalculator.AllCriterionKeys(_encounterId))
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await cache.KeyDeleteAsync(key);
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foreach (var key in SirsEvaluator.AllCriterionKeys(_encounterId))
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await cache.KeyDeleteAsync(key);
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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 QsofaAlert_CreatesBundleWithFourOrders()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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var bundle = await db.SepsisBundles
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.Include(b => b.Elements)
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.SingleAsync(b => b.EncounterId == _encounterId);
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bundle.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.InProgress);
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bundle.TriggeringAlertType.Should().Be("QSOFA_WARNING");
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bundle.DeadlineAt.Should().BeCloseTo(bundle.RecognizedAt.AddHours(1), TimeSpan.FromSeconds(5));
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bundle.Elements.Should().HaveCount(4);
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var orders = await db.Orders
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.Where(o => o.EncounterId == _encounterId)
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.ToListAsync();
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orders.Should().HaveCount(4);
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orders.Should().AllSatisfy(o =>
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{
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o.Status.Should().Be(OrderStatus.Pending);
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o.Description.Should().StartWith("SEP-1:");
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o.OrderedBy.Should().Be("sepsis-bundle-engine");
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});
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var bundleOutbox = await db.OutboxEvents
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.Where(e => e.Topic == "sepsis.bundle.created")
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.SingleAsync();
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bundleOutbox.PartitionKey.Should().Be(_encounterId.ToString());
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}
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[Fact]
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public async Task SirsAlert_CreatesBundle()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m);
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var bundle = await db.SepsisBundles
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.Include(b => b.Elements)
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.SingleAsync(b => b.EncounterId == _encounterId);
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bundle.TriggeringAlertType.Should().Be("SEPSIS_WARNING");
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bundle.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.InProgress);
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bundle.Elements.Should().HaveCount(4);
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}
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[Fact]
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public async Task SecondAlert_IdempotentBundle()
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{
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using var scope = _fixture.Services.CreateScope();
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var qsofaDetector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var sirsDetector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await qsofaDetector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await qsofaDetector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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var bundleCountAfterFirst = await db.SepsisBundles.CountAsync(b => b.EncounterId == _encounterId);
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bundleCountAfterFirst.Should().Be(1);
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await sirsDetector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
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await sirsDetector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m);
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var bundleCount = await db.SepsisBundles.CountAsync(b => b.EncounterId == _encounterId);
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bundleCount.Should().Be(1, "a second bundle must not be created while one is IN_PROGRESS");
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var orderCount = await db.Orders.CountAsync(o => o.EncounterId == _encounterId);
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orderCount.Should().Be(4, "no additional orders should be created for the duplicate bundle attempt");
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}
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[Fact]
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public async Task OrderResulted_CompletesElement()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var bundleService = scope.ServiceProvider.GetRequiredService<ISepsisBundleService>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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var lactateElement = await db.SepsisBundleElements
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.Include(e => e.Order)
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.SingleAsync(e => e.ElementType == SepsisBundleElementType.SerumLactate);
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await bundleService.OnOrderResultedAsync(lactateElement.OrderId!.Value);
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var updated = await db.SepsisBundleElements
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.AsNoTracking()
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.SingleAsync(e => e.Id == lactateElement.Id);
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updated.Status.Should().Be(SepsisBundleElementStatus.Completed);
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updated.CompletedAt.Should().NotBeNull();
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var bundle = await db.SepsisBundles.AsNoTracking().SingleAsync();
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bundle.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.InProgress,
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"bundle should remain in progress until all 4 elements are completed");
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}
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[Fact]
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public async Task AllElementsResulted_BundleCompliant()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var bundleService = scope.ServiceProvider.GetRequiredService<ISepsisBundleService>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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var elements = await db.SepsisBundleElements.ToListAsync();
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foreach (var element in elements)
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await bundleService.OnOrderResultedAsync(element.OrderId!.Value);
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var bundle = await db.SepsisBundles.AsNoTracking().SingleAsync();
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bundle.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.Compliant);
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bundle.CompletedAt.Should().NotBeNull();
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bundle.CompletedAt.Should().BeBefore(bundle.DeadlineAt,
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"all elements completed within the 1-hour window");
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var outboxEvents = await db.OutboxEvents
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.Where(e => e.Topic == "sepsis.bundle.updated")
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.ToListAsync();
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outboxEvents.Should().HaveCount(4, "one outbox event per element completion");
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}
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[Fact]
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public async Task DeadlinePassed_CompletionMarksNonCompliant()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var bundleService = scope.ServiceProvider.GetRequiredService<ISepsisBundleService>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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||||
|
||||
await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
|
||||
await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
|
||||
|
||||
var bundle = await db.SepsisBundles.SingleAsync();
|
||||
bundle.DeadlineAt = DateTimeOffset.UtcNow.AddHours(-1);
|
||||
await db.SaveChangesAsync();
|
||||
|
||||
var elements = await db.SepsisBundleElements.ToListAsync();
|
||||
foreach (var element in elements)
|
||||
await bundleService.OnOrderResultedAsync(element.OrderId!.Value);
|
||||
|
||||
var updated = await db.SepsisBundles.AsNoTracking().SingleAsync();
|
||||
updated.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.NonCompliant);
|
||||
updated.CompletedAt.Should().NotBeNull();
|
||||
}
|
||||
}
|
||||
@@ -47,10 +47,12 @@ public class EsIndexerService : BackgroundService
|
||||
{
|
||||
_kafkaOptions.Topics.ObservationRecorded,
|
||||
_kafkaOptions.Topics.AlertGenerated,
|
||||
_kafkaOptions.Topics.EncounterStatusChanged
|
||||
_kafkaOptions.Topics.EncounterStatusChanged,
|
||||
_kafkaOptions.Topics.SepsisBundleCreated,
|
||||
_kafkaOptions.Topics.SepsisBundleUpdated
|
||||
});
|
||||
|
||||
_logger.LogInformation("EsIndexerService started. Subscribed to 3 topics.");
|
||||
_logger.LogInformation("EsIndexerService started. Subscribed to 5 topics.");
|
||||
|
||||
try
|
||||
{
|
||||
@@ -91,6 +93,10 @@ public class EsIndexerService : BackgroundService
|
||||
HandleObservationRecordedAsync(payload, ct),
|
||||
var t when t == _kafkaOptions.Topics.AlertGenerated =>
|
||||
HandleAlertGeneratedAsync(payload, ct),
|
||||
var t when t == _kafkaOptions.Topics.SepsisBundleCreated =>
|
||||
HandleSepsisBundleEventAsync(payload, ct),
|
||||
var t when t == _kafkaOptions.Topics.SepsisBundleUpdated =>
|
||||
HandleSepsisBundleEventAsync(payload, ct),
|
||||
_ => Task.CompletedTask
|
||||
};
|
||||
|
||||
@@ -260,4 +266,63 @@ public class EsIndexerService : BackgroundService
|
||||
_logger.LogWarning(
|
||||
"Could not update patient_encounters for alert on encounter {Id}", evt.EncounterId);
|
||||
}
|
||||
|
||||
// --- sepsis.bundle.created / sepsis.bundle.updated ---
|
||||
// Denormalizes bundle status onto the patient_encounters document so department
|
||||
// acuity dashboards can filter/sort by sepsis bundle compliance state.
|
||||
private async Task HandleSepsisBundleEventAsync(string payload, CancellationToken ct)
|
||||
{
|
||||
using var doc = JsonDocument.Parse(payload);
|
||||
var root = doc.RootElement;
|
||||
|
||||
var encounterId = root.GetProperty("encounterId").GetString()!;
|
||||
var complianceStatus = root.TryGetProperty("complianceStatus", out var cs)
|
||||
? cs.GetString() ?? "IN_PROGRESS"
|
||||
: "IN_PROGRESS";
|
||||
var deadlineAt = root.TryGetProperty("deadlineAt", out var dl) ? dl.GetString() : null;
|
||||
|
||||
var scriptLines = new List<string>
|
||||
{
|
||||
"ctx._source.sepsisBundleStatus = params.status",
|
||||
"ctx._source.sepsisBundleDeadlineAt = params.deadlineAt"
|
||||
};
|
||||
|
||||
var scriptParams = new Dictionary<string, object?>
|
||||
{
|
||||
["status"] = complianceStatus,
|
||||
["deadlineAt"] = deadlineAt
|
||||
};
|
||||
|
||||
if (root.TryGetProperty("elementStatus", out _))
|
||||
{
|
||||
scriptLines.Add("ctx._source.sepsisBundleElementsCompleted = params.elementsCompleted");
|
||||
scriptParams["elementsCompleted"] = root.TryGetProperty("elementsCompleted", out var ec)
|
||||
? ec.GetInt32()
|
||||
: (complianceStatus is "COMPLIANT" or "NON_COMPLIANT" ? 4 : 0);
|
||||
}
|
||||
else
|
||||
{
|
||||
scriptLines.Add("ctx._source.sepsisBundleElementsCompleted = 0");
|
||||
}
|
||||
|
||||
var updateResp = await _elastic.UpdateAsync<PatientEncounterDocument, object>(
|
||||
_esOptions.Indices.PatientEncounters,
|
||||
encounterId,
|
||||
u => u
|
||||
.Script(new Script(new InlineScript
|
||||
{
|
||||
Source = string.Join(";\n", scriptLines),
|
||||
Language = ScriptLanguage.Painless,
|
||||
Params = scriptParams!
|
||||
}))
|
||||
.RetryOnConflict(3),
|
||||
ct);
|
||||
|
||||
if (!updateResp.IsValidResponse && updateResp.Result != Result.NotFound)
|
||||
_logger.LogWarning(
|
||||
"Could not update patient_encounters bundle status for encounter {Id}", encounterId);
|
||||
|
||||
_logger.LogDebug("Updated patient_encounters bundle status for encounter {Id} → {Status}",
|
||||
encounterId, complianceStatus);
|
||||
}
|
||||
}
|
||||
@@ -25,7 +25,9 @@ public class KafkaTopicProvisioner : IHostedService
|
||||
_options.Topics.ObservationRecorded,
|
||||
_options.Topics.AlertGenerated,
|
||||
_options.Topics.AlertAcknowledged,
|
||||
_options.Topics.EncounterStatusChanged
|
||||
_options.Topics.EncounterStatusChanged,
|
||||
_options.Topics.SepsisBundleCreated,
|
||||
_options.Topics.SepsisBundleUpdated
|
||||
};
|
||||
|
||||
var specs = topicNames.Select(name => new TopicSpecification
|
||||
|
||||
@@ -54,24 +54,38 @@ public class SepsisEngineService : BackgroundService
|
||||
var evt = JsonSerializer.Deserialize<SepsisObservationEvent>(
|
||||
result.Message.Value, EventJsonOptions)!;
|
||||
|
||||
// Create a scope per message — SirsDetector is scoped and
|
||||
// owns a fresh DbContext for each observation processed.
|
||||
// Create a scope per message — both detectors are scoped and
|
||||
// each owns a fresh DbContext when creating alerts.
|
||||
using var scope = _services.CreateScope();
|
||||
var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
|
||||
var sirsDetector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
|
||||
var qsofaDetector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
|
||||
|
||||
var outcome = await detector.ProcessObservationAsync(
|
||||
var sirsOutcome = await sirsDetector.ProcessObservationAsync(
|
||||
evt.EncounterId,
|
||||
evt.PatientId,
|
||||
evt.ObservationCode,
|
||||
evt.Value,
|
||||
stoppingToken);
|
||||
|
||||
if (outcome.Outcome == SirsOutcome.AlertCreated)
|
||||
var qsofaOutcome = await qsofaDetector.ProcessObservationAsync(
|
||||
evt.EncounterId,
|
||||
evt.PatientId,
|
||||
evt.ObservationCode,
|
||||
evt.Value,
|
||||
stoppingToken);
|
||||
|
||||
if (sirsOutcome.Outcome == SirsOutcome.AlertCreated)
|
||||
_logger.LogWarning(
|
||||
"SEPSIS_WARNING created via SepsisEngine " +
|
||||
"— encounter={EncounterId} code={Code} value={Value}",
|
||||
evt.EncounterId, evt.ObservationCode, evt.Value);
|
||||
|
||||
if (qsofaOutcome.Outcome == QsofaOutcome.AlertCreated)
|
||||
_logger.LogWarning(
|
||||
"QSOFA_WARNING created via SepsisEngine " +
|
||||
"— encounter={EncounterId} code={Code} value={Value}",
|
||||
evt.EncounterId, evt.ObservationCode, evt.Value);
|
||||
|
||||
// Commit only after successful processing.
|
||||
consumer.Commit(result);
|
||||
}
|
||||
|
||||
@@ -4,4 +4,6 @@ public class KafkaTopicOptions
|
||||
public string AlertGenerated { get; set; } = "alert.generated";
|
||||
public string AlertAcknowledged { get; set; } = "alert.acknowledged";
|
||||
public string EncounterStatusChanged { get; set; } = "encounter.status.changed";
|
||||
public string SepsisBundleCreated { get; set; } = "sepsis.bundle.created";
|
||||
public string SepsisBundleUpdated { get; set; } = "sepsis.bundle.updated";
|
||||
}
|
||||
@@ -0,0 +1,42 @@
|
||||
using Microsoft.AspNetCore.Mvc;
|
||||
|
||||
/// <summary>
|
||||
/// Sepsis bundle compliance tracking: current bundle by encounter and bundle detail by id.
|
||||
/// </summary>
|
||||
[ApiController]
|
||||
[Produces("application/json")]
|
||||
public class SepsisBundlesController : ControllerBase
|
||||
{
|
||||
private readonly ISepsisBundleService _bundles;
|
||||
|
||||
public SepsisBundlesController(ISepsisBundleService bundles) => _bundles = bundles;
|
||||
|
||||
/// <summary>
|
||||
/// Returns the current (most recent) sepsis bundle for an encounter with elements and linked orders.
|
||||
/// </summary>
|
||||
/// <param name="encounterId">Encounter id.</param>
|
||||
[HttpGet("api/v1/encounters/{encounterId:guid}/sepsis-bundle/current")]
|
||||
[ProducesResponseType(typeof(ApiResponse<SepsisBundle>), StatusCodes.Status200OK)]
|
||||
[ProducesResponseType(typeof(ApiResponse<object>), StatusCodes.Status404NotFound)]
|
||||
public async Task<IActionResult> GetCurrentByEncounter(Guid encounterId)
|
||||
{
|
||||
var bundle = await _bundles.GetCurrentByEncounterAsync(encounterId);
|
||||
if (bundle is null)
|
||||
return NotFound(ApiResponse<object>.Fail(404, "No sepsis bundle exists for this encounter.", "BUNDLE_NOT_FOUND"));
|
||||
|
||||
return Ok(ApiResponse<SepsisBundle>.Ok(bundle));
|
||||
}
|
||||
|
||||
/// <summary>
|
||||
/// Returns a sepsis bundle by id with all elements and linked orders.
|
||||
/// </summary>
|
||||
/// <param name="id">Bundle id.</param>
|
||||
[HttpGet("api/v1/sepsis-bundles/{id:guid}")]
|
||||
[ProducesResponseType(typeof(ApiResponse<SepsisBundle>), StatusCodes.Status200OK)]
|
||||
[ProducesResponseType(typeof(ApiResponse<object>), StatusCodes.Status404NotFound)]
|
||||
public async Task<IActionResult> GetById(Guid id)
|
||||
{
|
||||
var bundle = await _bundles.GetByIdAsync(id);
|
||||
return Ok(ApiResponse<SepsisBundle>.Ok(bundle));
|
||||
}
|
||||
}
|
||||
@@ -13,6 +13,8 @@ public class AppDbContext : DbContext
|
||||
public DbSet<OutboxEvent> OutboxEvents => Set<OutboxEvent>();
|
||||
public DbSet<ReconciliationAlert> ReconciliationAlerts => Set<ReconciliationAlert>();
|
||||
public DbSet<News2Score> News2Scores => Set<News2Score>();
|
||||
public DbSet<SepsisBundle> SepsisBundles => Set<SepsisBundle>();
|
||||
public DbSet<SepsisBundleElement> SepsisBundleElements => Set<SepsisBundleElement>();
|
||||
|
||||
protected override void OnModelCreating(ModelBuilder modelBuilder)
|
||||
{
|
||||
|
||||
@@ -0,0 +1,47 @@
|
||||
using Microsoft.EntityFrameworkCore;
|
||||
using Microsoft.EntityFrameworkCore.Metadata.Builders;
|
||||
|
||||
public class SepsisBundleConfiguration : IEntityTypeConfiguration<SepsisBundle>
|
||||
{
|
||||
public void Configure(EntityTypeBuilder<SepsisBundle> builder)
|
||||
{
|
||||
builder.ToTable("sepsis_bundles", t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_sepsis_bundles_compliance_status",
|
||||
"compliance_status IN ('IN_PROGRESS', 'COMPLIANT', 'NON_COMPLIANT')");
|
||||
});
|
||||
|
||||
builder.HasKey(b => b.Id);
|
||||
builder.Property(b => b.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
|
||||
builder.Property(b => b.EncounterId).HasColumnName("encounter_id").IsRequired();
|
||||
builder.Property(b => b.TriggeringAlertId).HasColumnName("triggering_alert_id").IsRequired();
|
||||
builder.Property(b => b.TriggeringAlertType)
|
||||
.HasColumnName("triggering_alert_type")
|
||||
.HasMaxLength(50)
|
||||
.IsRequired();
|
||||
builder.Property(b => b.RecognizedAt).HasColumnName("recognized_at").IsRequired();
|
||||
builder.Property(b => b.DeadlineAt).HasColumnName("deadline_at").IsRequired();
|
||||
builder.Property(b => b.ComplianceStatus)
|
||||
.HasColumnName("compliance_status")
|
||||
.HasMaxLength(20)
|
||||
.HasConversion(
|
||||
v => v.ToDbString(),
|
||||
v => SepsisBundleComplianceStatusExtensions.FromDbString(v))
|
||||
.HasDefaultValueSql("'IN_PROGRESS'")
|
||||
.HasSentinel((SepsisBundleComplianceStatus)(-1));
|
||||
builder.Property(b => b.CompletedAt).HasColumnName("completed_at");
|
||||
|
||||
builder.HasOne(b => b.Encounter)
|
||||
.WithMany()
|
||||
.HasForeignKey(b => b.EncounterId)
|
||||
.OnDelete(DeleteBehavior.Restrict);
|
||||
|
||||
builder.HasOne(b => b.TriggeringAlert)
|
||||
.WithMany()
|
||||
.HasForeignKey(b => b.TriggeringAlertId)
|
||||
.OnDelete(DeleteBehavior.Restrict);
|
||||
|
||||
builder.HasIndex(b => new { b.EncounterId, b.RecognizedAt });
|
||||
builder.HasIndex(b => b.ComplianceStatus);
|
||||
}
|
||||
}
|
||||
@@ -0,0 +1,50 @@
|
||||
using Microsoft.EntityFrameworkCore;
|
||||
using Microsoft.EntityFrameworkCore.Metadata.Builders;
|
||||
|
||||
public class SepsisBundleElementConfiguration : IEntityTypeConfiguration<SepsisBundleElement>
|
||||
{
|
||||
public void Configure(EntityTypeBuilder<SepsisBundleElement> builder)
|
||||
{
|
||||
builder.ToTable("sepsis_bundle_elements", t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_sepsis_bundle_elements_element_type",
|
||||
"element_type IN ('BLOOD_CULTURES', 'SERUM_LACTATE', " +
|
||||
"'BROAD_SPECTRUM_ANTIBIOTICS', 'IV_FLUID_RESUSCITATION')");
|
||||
t.HasCheckConstraint("chk_sepsis_bundle_elements_status",
|
||||
"status IN ('PENDING', 'COMPLETED')");
|
||||
});
|
||||
|
||||
builder.HasKey(e => e.Id);
|
||||
builder.Property(e => e.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
|
||||
builder.Property(e => e.BundleId).HasColumnName("bundle_id").IsRequired();
|
||||
builder.Property(e => e.ElementType)
|
||||
.HasColumnName("element_type")
|
||||
.HasMaxLength(40)
|
||||
.HasConversion(
|
||||
v => v.ToDbString(),
|
||||
v => SepsisBundleElementTypeExtensions.FromDbString(v))
|
||||
.IsRequired();
|
||||
builder.Property(e => e.Status)
|
||||
.HasColumnName("status")
|
||||
.HasMaxLength(20)
|
||||
.HasConversion(
|
||||
v => v.ToDbString(),
|
||||
v => SepsisBundleElementStatusExtensions.FromDbString(v))
|
||||
.HasDefaultValueSql("'PENDING'")
|
||||
.HasSentinel((SepsisBundleElementStatus)(-1));
|
||||
builder.Property(e => e.OrderId).HasColumnName("order_id");
|
||||
builder.Property(e => e.CompletedAt).HasColumnName("completed_at");
|
||||
|
||||
builder.HasOne(e => e.Bundle)
|
||||
.WithMany(b => b.Elements)
|
||||
.HasForeignKey(e => e.BundleId)
|
||||
.OnDelete(DeleteBehavior.Cascade);
|
||||
|
||||
builder.HasOne(e => e.Order)
|
||||
.WithMany()
|
||||
.HasForeignKey(e => e.OrderId)
|
||||
.OnDelete(DeleteBehavior.SetNull);
|
||||
|
||||
builder.HasIndex(e => new { e.BundleId, e.ElementType }).IsUnique();
|
||||
}
|
||||
}
|
||||
@@ -0,0 +1,16 @@
|
||||
public class SepsisBundle
|
||||
{
|
||||
public Guid Id { get; set; }
|
||||
public Guid EncounterId { get; set; }
|
||||
public Guid TriggeringAlertId { get; set; }
|
||||
public string TriggeringAlertType { get; set; } = null!;
|
||||
public DateTimeOffset RecognizedAt { get; set; }
|
||||
public DateTimeOffset DeadlineAt { get; set; }
|
||||
public SepsisBundleComplianceStatus ComplianceStatus { get; set; } =
|
||||
SepsisBundleComplianceStatus.InProgress;
|
||||
public DateTimeOffset? CompletedAt { get; set; }
|
||||
|
||||
public Encounter Encounter { get; set; } = null!;
|
||||
public ClinicalAlert TriggeringAlert { get; set; } = null!;
|
||||
public ICollection<SepsisBundleElement> Elements { get; set; } = new List<SepsisBundleElement>();
|
||||
}
|
||||
@@ -0,0 +1,12 @@
|
||||
public class SepsisBundleElement
|
||||
{
|
||||
public Guid Id { get; set; }
|
||||
public Guid BundleId { get; set; }
|
||||
public SepsisBundleElementType ElementType { get; set; }
|
||||
public SepsisBundleElementStatus Status { get; set; } = SepsisBundleElementStatus.Pending;
|
||||
public Guid? OrderId { get; set; }
|
||||
public DateTimeOffset? CompletedAt { get; set; }
|
||||
|
||||
public SepsisBundle Bundle { get; set; } = null!;
|
||||
public Order? Order { get; set; }
|
||||
}
|
||||
@@ -29,6 +29,8 @@ public enum AlertType
|
||||
News2Emergency,
|
||||
|
||||
RapidDeterioration,
|
||||
|
||||
QsofaWarning,
|
||||
}
|
||||
|
||||
public static class AlertTypeExtensions
|
||||
@@ -60,6 +62,7 @@ public static class AlertTypeExtensions
|
||||
AlertType.News2Warning => "NEWS2_WARNING",
|
||||
AlertType.News2Emergency => "NEWS2_EMERGENCY",
|
||||
AlertType.RapidDeterioration => "RAPID_DETERIORATION",
|
||||
AlertType.QsofaWarning => "QSOFA_WARNING",
|
||||
_ => throw new ArgumentOutOfRangeException(nameof(t))
|
||||
};
|
||||
|
||||
@@ -90,6 +93,7 @@ public static class AlertTypeExtensions
|
||||
"NEWS2_WARNING" => AlertType.News2Warning,
|
||||
"NEWS2_EMERGENCY" => AlertType.News2Emergency,
|
||||
"RAPID_DETERIORATION" => AlertType.RapidDeterioration,
|
||||
"QSOFA_WARNING" => AlertType.QsofaWarning,
|
||||
_ => throw new ArgumentOutOfRangeException(nameof(v), $"Unknown alert type: '{v}'")
|
||||
};
|
||||
|
||||
@@ -136,7 +140,7 @@ public static class AlertTypeExtensions
|
||||
or AlertType.CriticalLactateMmolL or AlertType.CriticalAvpu
|
||||
or AlertType.CriticalGlucoseMgDl => false,
|
||||
AlertType.RapidDeterioration => false, // trajectory alerts are never suppressed
|
||||
_ => true // all Warning* types and News2Warning
|
||||
_ => true // all Warning* types, News2Warning, and QsofaWarning
|
||||
};
|
||||
|
||||
public static string? ObservationCodeForWarning(this AlertType t) => t switch
|
||||
|
||||
@@ -0,0 +1,25 @@
|
||||
public enum SepsisBundleComplianceStatus
|
||||
{
|
||||
InProgress,
|
||||
Compliant,
|
||||
NonCompliant
|
||||
}
|
||||
|
||||
public static class SepsisBundleComplianceStatusExtensions
|
||||
{
|
||||
public static string ToDbString(this SepsisBundleComplianceStatus s) => s switch
|
||||
{
|
||||
SepsisBundleComplianceStatus.InProgress => "IN_PROGRESS",
|
||||
SepsisBundleComplianceStatus.Compliant => "COMPLIANT",
|
||||
SepsisBundleComplianceStatus.NonCompliant => "NON_COMPLIANT",
|
||||
_ => throw new ArgumentOutOfRangeException(nameof(s))
|
||||
};
|
||||
|
||||
public static SepsisBundleComplianceStatus FromDbString(string v) => v switch
|
||||
{
|
||||
"IN_PROGRESS" => SepsisBundleComplianceStatus.InProgress,
|
||||
"COMPLIANT" => SepsisBundleComplianceStatus.Compliant,
|
||||
"NON_COMPLIANT" => SepsisBundleComplianceStatus.NonCompliant,
|
||||
_ => throw new ArgumentOutOfRangeException(nameof(v), $"Unknown compliance status: '{v}'")
|
||||
};
|
||||
}
|
||||
@@ -0,0 +1,22 @@
|
||||
public enum SepsisBundleElementStatus
|
||||
{
|
||||
Pending,
|
||||
Completed
|
||||
}
|
||||
|
||||
public static class SepsisBundleElementStatusExtensions
|
||||
{
|
||||
public static string ToDbString(this SepsisBundleElementStatus s) => s switch
|
||||
{
|
||||
SepsisBundleElementStatus.Pending => "PENDING",
|
||||
SepsisBundleElementStatus.Completed => "COMPLETED",
|
||||
_ => throw new ArgumentOutOfRangeException(nameof(s))
|
||||
};
|
||||
|
||||
public static SepsisBundleElementStatus FromDbString(string v) => v switch
|
||||
{
|
||||
"PENDING" => SepsisBundleElementStatus.Pending,
|
||||
"COMPLETED" => SepsisBundleElementStatus.Completed,
|
||||
_ => throw new ArgumentOutOfRangeException(nameof(v), $"Unknown bundle element status: '{v}'")
|
||||
};
|
||||
}
|
||||
@@ -0,0 +1,28 @@
|
||||
public enum SepsisBundleElementType
|
||||
{
|
||||
BloodCultures,
|
||||
SerumLactate,
|
||||
BroadSpectrumAntibiotics,
|
||||
IvFluidResuscitation
|
||||
}
|
||||
|
||||
public static class SepsisBundleElementTypeExtensions
|
||||
{
|
||||
public static string ToDbString(this SepsisBundleElementType t) => t switch
|
||||
{
|
||||
SepsisBundleElementType.BloodCultures => "BLOOD_CULTURES",
|
||||
SepsisBundleElementType.SerumLactate => "SERUM_LACTATE",
|
||||
SepsisBundleElementType.BroadSpectrumAntibiotics => "BROAD_SPECTRUM_ANTIBIOTICS",
|
||||
SepsisBundleElementType.IvFluidResuscitation => "IV_FLUID_RESUSCITATION",
|
||||
_ => throw new ArgumentOutOfRangeException(nameof(t))
|
||||
};
|
||||
|
||||
public static SepsisBundleElementType FromDbString(string v) => v switch
|
||||
{
|
||||
"BLOOD_CULTURES" => SepsisBundleElementType.BloodCultures,
|
||||
"SERUM_LACTATE" => SepsisBundleElementType.SerumLactate,
|
||||
"BROAD_SPECTRUM_ANTIBIOTICS" => SepsisBundleElementType.BroadSpectrumAntibiotics,
|
||||
"IV_FLUID_RESUSCITATION" => SepsisBundleElementType.IvFluidResuscitation,
|
||||
_ => throw new ArgumentOutOfRangeException(nameof(v), $"Unknown bundle element type: '{v}'")
|
||||
};
|
||||
}
|
||||
@@ -14,4 +14,7 @@ public class PatientEncounterDocument
|
||||
public int? News2Score { get; set; }
|
||||
public string? News2RiskLevel { get; set; }
|
||||
public DateTimeOffset? LastObservationAt { get; set; }
|
||||
public string? SepsisBundleStatus { get; set; }
|
||||
public int? SepsisBundleElementsCompleted { get; set; }
|
||||
public DateTimeOffset? SepsisBundleDeadlineAt { get; set; }
|
||||
}
|
||||
+867
@@ -0,0 +1,867 @@
|
||||
// <auto-generated />
|
||||
using System;
|
||||
using Microsoft.EntityFrameworkCore;
|
||||
using Microsoft.EntityFrameworkCore.Infrastructure;
|
||||
using Microsoft.EntityFrameworkCore.Migrations;
|
||||
using Microsoft.EntityFrameworkCore.Storage.ValueConversion;
|
||||
using Npgsql.EntityFrameworkCore.PostgreSQL.Metadata;
|
||||
|
||||
#nullable disable
|
||||
|
||||
namespace VigilCareClinicalAPI.Migrations
|
||||
{
|
||||
[DbContext(typeof(AppDbContext))]
|
||||
[Migration("20260618140336_AddQsofaWarningAlertType")]
|
||||
partial class AddQsofaWarningAlertType
|
||||
{
|
||||
/// <inheritdoc />
|
||||
protected override void BuildTargetModel(ModelBuilder modelBuilder)
|
||||
{
|
||||
#pragma warning disable 612, 618
|
||||
modelBuilder
|
||||
.HasAnnotation("ProductVersion", "8.0.4")
|
||||
.HasAnnotation("Relational:MaxIdentifierLength", 63);
|
||||
|
||||
NpgsqlModelBuilderExtensions.UseIdentityByDefaultColumns(modelBuilder);
|
||||
|
||||
modelBuilder.Entity("AlertThreshold", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<DateTimeOffset>("CreatedAt")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("created_at")
|
||||
.HasDefaultValueSql("NOW()");
|
||||
|
||||
b.Property<decimal?>("CriticalHigh")
|
||||
.HasColumnType("decimal(10,3)")
|
||||
.HasColumnName("critical_high");
|
||||
|
||||
b.Property<decimal?>("CriticalLow")
|
||||
.HasColumnType("decimal(10,3)")
|
||||
.HasColumnName("critical_low");
|
||||
|
||||
b.Property<string>("DisplayName")
|
||||
.IsRequired()
|
||||
.HasMaxLength(200)
|
||||
.HasColumnType("character varying(200)")
|
||||
.HasColumnName("display_name");
|
||||
|
||||
b.Property<string>("ObservationCode")
|
||||
.IsRequired()
|
||||
.HasMaxLength(50)
|
||||
.HasColumnType("character varying(50)")
|
||||
.HasColumnName("observation_code");
|
||||
|
||||
b.Property<int?>("SuppressionWindowMinutes")
|
||||
.HasColumnType("integer")
|
||||
.HasColumnName("suppression_window_minutes");
|
||||
|
||||
b.Property<string>("Unit")
|
||||
.IsRequired()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("unit");
|
||||
|
||||
b.Property<decimal?>("WarningHigh")
|
||||
.HasColumnType("decimal(10,3)")
|
||||
.HasColumnName("warning_high");
|
||||
|
||||
b.Property<decimal?>("WarningLow")
|
||||
.HasColumnType("decimal(10,3)")
|
||||
.HasColumnName("warning_low");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("ObservationCode")
|
||||
.IsUnique();
|
||||
|
||||
b.ToTable("alert_thresholds", (string)null);
|
||||
});
|
||||
|
||||
modelBuilder.Entity("ClinicalAlert", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<DateTimeOffset?>("AcknowledgedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("acknowledged_at");
|
||||
|
||||
b.Property<string>("AcknowledgedBy")
|
||||
.HasMaxLength(200)
|
||||
.HasColumnType("character varying(200)")
|
||||
.HasColumnName("acknowledged_by");
|
||||
|
||||
b.Property<string>("AlertType")
|
||||
.IsRequired()
|
||||
.HasMaxLength(50)
|
||||
.HasColumnType("character varying(50)")
|
||||
.HasColumnName("alert_type");
|
||||
|
||||
b.Property<string>("Details")
|
||||
.IsRequired()
|
||||
.HasColumnType("text")
|
||||
.HasColumnName("details");
|
||||
|
||||
b.Property<Guid>("EncounterId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("encounter_id");
|
||||
|
||||
b.Property<Guid?>("ObservationId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("observation_id");
|
||||
|
||||
b.Property<Guid>("PatientId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("patient_id");
|
||||
|
||||
b.Property<DateTimeOffset?>("ResolvedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("resolved_at");
|
||||
|
||||
b.Property<string>("Severity")
|
||||
.IsRequired()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("severity");
|
||||
|
||||
b.Property<string>("Status")
|
||||
.IsRequired()
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("status")
|
||||
.HasDefaultValueSql("'OPEN'");
|
||||
|
||||
b.Property<DateTimeOffset>("TriggeredAt")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("triggered_at")
|
||||
.HasDefaultValueSql("NOW()");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("EncounterId", "TriggeredAt");
|
||||
|
||||
b.HasIndex("PatientId", "TriggeredAt");
|
||||
|
||||
b.HasIndex("Severity", "TriggeredAt")
|
||||
.HasFilter("status = 'OPEN'");
|
||||
|
||||
b.ToTable("clinical_alerts", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_clinical_alerts_alert_type", "alert_type IN ('SEPSIS_WARNING', 'CRITICAL_HEART_RATE', 'CRITICAL_TEMP_C', 'CRITICAL_POTASSIUM_MEQ_L', 'CRITICAL_SPO2', 'CRITICAL_RESP_RATE', 'CRITICAL_WBC_K_UL')");
|
||||
|
||||
t.HasCheckConstraint("chk_clinical_alerts_severity", "severity IN ('WARNING', 'CRITICAL')");
|
||||
|
||||
t.HasCheckConstraint("chk_clinical_alerts_status", "status IN ('OPEN', 'ACKNOWLEDGED', 'RESOLVED', 'ESCALATED')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Encounter", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<string>("AdmissionReason")
|
||||
.HasMaxLength(500)
|
||||
.HasColumnType("character varying(500)")
|
||||
.HasColumnName("admission_reason");
|
||||
|
||||
b.Property<DateTimeOffset>("AdmittedAt")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("admitted_at")
|
||||
.HasDefaultValueSql("NOW()");
|
||||
|
||||
b.Property<string>("AttendingPhysician")
|
||||
.IsRequired()
|
||||
.HasMaxLength(200)
|
||||
.HasColumnType("character varying(200)")
|
||||
.HasColumnName("attending_physician");
|
||||
|
||||
b.Property<DateTimeOffset>("CreatedAt")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("created_at")
|
||||
.HasDefaultValueSql("NOW()");
|
||||
|
||||
b.Property<string>("Department")
|
||||
.IsRequired()
|
||||
.HasMaxLength(100)
|
||||
.HasColumnType("character varying(100)")
|
||||
.HasColumnName("department");
|
||||
|
||||
b.Property<string>("DischargeDiagnosis")
|
||||
.HasMaxLength(500)
|
||||
.HasColumnType("character varying(500)")
|
||||
.HasColumnName("discharge_diagnosis");
|
||||
|
||||
b.Property<DateTimeOffset?>("DischargedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("discharged_at");
|
||||
|
||||
b.Property<string>("EncounterType")
|
||||
.IsRequired()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("encounter_type");
|
||||
|
||||
b.Property<Guid>("PatientId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("patient_id");
|
||||
|
||||
b.Property<string>("RoomBed")
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("room_bed");
|
||||
|
||||
b.Property<string>("Status")
|
||||
.IsRequired()
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("status")
|
||||
.HasDefaultValueSql("'SCHEDULED'");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("PatientId", "AdmittedAt");
|
||||
|
||||
b.HasIndex("Status", "AdmittedAt")
|
||||
.HasFilter("status = 'ACTIVE'");
|
||||
|
||||
b.ToTable("encounters", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_encounters_department", "department IN ('ICU', 'GENERAL_MEDICINE', 'EMERGENCY', 'CARDIOLOGY', 'SURGERY', 'PEDIATRICS')");
|
||||
|
||||
t.HasCheckConstraint("chk_encounters_encounter_type", "encounter_type IN ('INPATIENT', 'OUTPATIENT', 'EMERGENCY')");
|
||||
|
||||
t.HasCheckConstraint("chk_encounters_status", "status IN ('SCHEDULED', 'ACTIVE', 'DISCHARGED', 'CANCELLED')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("News2Score", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<DateTimeOffset>("CalculatedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("calculated_at");
|
||||
|
||||
b.Property<int>("ConsciousnessScore")
|
||||
.HasColumnType("integer")
|
||||
.HasColumnName("consciousness_score");
|
||||
|
||||
b.Property<Guid>("EncounterId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("encounter_id");
|
||||
|
||||
b.Property<bool>("HasSingleParamThree")
|
||||
.HasColumnType("boolean")
|
||||
.HasColumnName("has_single_param_three");
|
||||
|
||||
b.Property<int>("HeartRateScore")
|
||||
.HasColumnType("integer")
|
||||
.HasColumnName("heart_rate_score");
|
||||
|
||||
b.Property<Guid>("PatientId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("patient_id");
|
||||
|
||||
b.Property<int>("RespRateScore")
|
||||
.HasColumnType("integer")
|
||||
.HasColumnName("resp_rate_score");
|
||||
|
||||
b.Property<string>("RiskLevel")
|
||||
.IsRequired()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("risk_level");
|
||||
|
||||
b.Property<int>("Spo2Score")
|
||||
.HasColumnType("integer")
|
||||
.HasColumnName("spo2_score");
|
||||
|
||||
b.Property<int>("SupplementalO2Score")
|
||||
.HasColumnType("integer")
|
||||
.HasColumnName("supplemental_o2_score");
|
||||
|
||||
b.Property<int>("SystolicBpScore")
|
||||
.HasColumnType("integer")
|
||||
.HasColumnName("systolic_bp_score");
|
||||
|
||||
b.Property<int>("TemperatureScore")
|
||||
.HasColumnType("integer")
|
||||
.HasColumnName("temperature_score");
|
||||
|
||||
b.Property<int>("TotalScore")
|
||||
.HasColumnType("integer")
|
||||
.HasColumnName("total_score");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("EncounterId", "CalculatedAt");
|
||||
|
||||
b.HasIndex("PatientId", "CalculatedAt");
|
||||
|
||||
b.ToTable("news2_scores", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_news2_scores_risk_level", "risk_level IN ('LOW', 'LOW_MEDIUM', 'MEDIUM', 'HIGH')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Observation", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<DateTimeOffset>("CreatedAt")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("created_at")
|
||||
.HasDefaultValueSql("NOW()");
|
||||
|
||||
b.Property<Guid>("EncounterId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("encounter_id");
|
||||
|
||||
b.Property<string>("IdempotencyKey")
|
||||
.HasMaxLength(100)
|
||||
.HasColumnType("character varying(100)")
|
||||
.HasColumnName("idempotency_key");
|
||||
|
||||
b.Property<string>("ObservationCode")
|
||||
.IsRequired()
|
||||
.HasMaxLength(50)
|
||||
.HasColumnType("character varying(50)")
|
||||
.HasColumnName("observation_code");
|
||||
|
||||
b.Property<DateTimeOffset>("RecordedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("recorded_at");
|
||||
|
||||
b.Property<string>("Source")
|
||||
.IsRequired()
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("source")
|
||||
.HasDefaultValueSql("'MANUAL'");
|
||||
|
||||
b.Property<string>("Unit")
|
||||
.IsRequired()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("unit");
|
||||
|
||||
b.Property<decimal>("Value")
|
||||
.HasColumnType("decimal(10,3)")
|
||||
.HasColumnName("value");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("IdempotencyKey")
|
||||
.IsUnique()
|
||||
.HasFilter("idempotency_key IS NOT NULL");
|
||||
|
||||
b.HasIndex("EncounterId", "ObservationCode", "RecordedAt");
|
||||
|
||||
b.ToTable("observations", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_observations_source", "source IN ('MANUAL', 'DEVICE', 'LAB')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Order", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<string>("Description")
|
||||
.IsRequired()
|
||||
.HasColumnType("text")
|
||||
.HasColumnName("description");
|
||||
|
||||
b.Property<Guid>("EncounterId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("encounter_id");
|
||||
|
||||
b.Property<string>("OrderType")
|
||||
.IsRequired()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("order_type");
|
||||
|
||||
b.Property<DateTimeOffset>("OrderedAt")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("ordered_at")
|
||||
.HasDefaultValueSql("NOW()");
|
||||
|
||||
b.Property<string>("OrderedBy")
|
||||
.IsRequired()
|
||||
.HasMaxLength(200)
|
||||
.HasColumnType("character varying(200)")
|
||||
.HasColumnName("ordered_by");
|
||||
|
||||
b.Property<string>("ResultSummary")
|
||||
.HasColumnType("text")
|
||||
.HasColumnName("result_summary");
|
||||
|
||||
b.Property<DateTimeOffset?>("ResultedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("resulted_at");
|
||||
|
||||
b.Property<string>("Status")
|
||||
.IsRequired()
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("status")
|
||||
.HasDefaultValueSql("'PENDING'");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("EncounterId", "OrderedAt");
|
||||
|
||||
b.HasIndex("Status", "OrderedAt")
|
||||
.HasFilter("status IN ('PENDING', 'IN_PROGRESS')");
|
||||
|
||||
b.ToTable("orders", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_orders_order_type", "order_type IN ('LAB', 'IMAGING', 'MEDICATION', 'PROCEDURE')");
|
||||
|
||||
t.HasCheckConstraint("chk_orders_status", "status IN ('PENDING', 'IN_PROGRESS', 'RESULTED', 'CANCELLED')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("OutboxEvent", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<DateTimeOffset>("CreatedAt")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("created_at")
|
||||
.HasDefaultValueSql("NOW()");
|
||||
|
||||
b.Property<string>("PartitionKey")
|
||||
.HasMaxLength(36)
|
||||
.HasColumnType("character varying(36)")
|
||||
.HasColumnName("partition_key");
|
||||
|
||||
b.Property<string>("Payload")
|
||||
.IsRequired()
|
||||
.HasColumnType("jsonb")
|
||||
.HasColumnName("payload");
|
||||
|
||||
b.Property<DateTimeOffset?>("ProcessedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("processed_at");
|
||||
|
||||
b.Property<string>("Topic")
|
||||
.IsRequired()
|
||||
.HasMaxLength(200)
|
||||
.HasColumnType("character varying(200)")
|
||||
.HasColumnName("topic");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("CreatedAt")
|
||||
.HasFilter("processed_at IS NULL");
|
||||
|
||||
b.ToTable("outbox_events", (string)null);
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Patient", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<string>("Allergies")
|
||||
.HasColumnType("text")
|
||||
.HasColumnName("allergies");
|
||||
|
||||
b.Property<string>("BloodType")
|
||||
.HasMaxLength(5)
|
||||
.HasColumnType("character varying(5)")
|
||||
.HasColumnName("blood_type");
|
||||
|
||||
b.Property<DateTimeOffset>("CreatedAt")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("created_at")
|
||||
.HasDefaultValueSql("NOW()");
|
||||
|
||||
b.Property<DateOnly>("DateOfBirth")
|
||||
.HasColumnType("date")
|
||||
.HasColumnName("date_of_birth");
|
||||
|
||||
b.Property<string>("EmergencyContactName")
|
||||
.HasMaxLength(200)
|
||||
.HasColumnType("character varying(200)")
|
||||
.HasColumnName("emergency_contact_name");
|
||||
|
||||
b.Property<string>("EmergencyContactPhone")
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("emergency_contact_phone");
|
||||
|
||||
b.Property<string>("FirstName")
|
||||
.IsRequired()
|
||||
.HasMaxLength(100)
|
||||
.HasColumnType("character varying(100)")
|
||||
.HasColumnName("first_name");
|
||||
|
||||
b.Property<string>("Gender")
|
||||
.IsRequired()
|
||||
.HasMaxLength(10)
|
||||
.HasColumnType("character varying(10)")
|
||||
.HasColumnName("gender");
|
||||
|
||||
b.Property<string>("LastName")
|
||||
.IsRequired()
|
||||
.HasMaxLength(100)
|
||||
.HasColumnType("character varying(100)")
|
||||
.HasColumnName("last_name");
|
||||
|
||||
b.Property<string>("Mrn")
|
||||
.IsRequired()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("mrn");
|
||||
|
||||
b.Property<string>("Status")
|
||||
.IsRequired()
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasDefaultValue("active")
|
||||
.HasColumnName("status");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("Mrn")
|
||||
.IsUnique();
|
||||
|
||||
b.ToTable("patients", (string)null);
|
||||
});
|
||||
|
||||
modelBuilder.Entity("ReconciliationAlert", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<string>("CheckType")
|
||||
.IsRequired()
|
||||
.HasMaxLength(50)
|
||||
.HasColumnType("character varying(50)")
|
||||
.HasColumnName("check_type");
|
||||
|
||||
b.Property<DateTimeOffset>("CreatedAt")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("created_at")
|
||||
.HasDefaultValueSql("NOW()");
|
||||
|
||||
b.Property<string>("Details")
|
||||
.IsRequired()
|
||||
.HasColumnType("text")
|
||||
.HasColumnName("details");
|
||||
|
||||
b.Property<Guid?>("EncounterId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("encounter_id");
|
||||
|
||||
b.Property<Guid?>("PatientId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("patient_id");
|
||||
|
||||
b.Property<DateTimeOffset?>("ResolvedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("resolved_at");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("EncounterId");
|
||||
|
||||
b.HasIndex("PatientId");
|
||||
|
||||
b.HasIndex("CheckType", "EncounterId")
|
||||
.HasFilter("resolved_at IS NULL");
|
||||
|
||||
b.ToTable("reconciliation_alerts", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_reconciliation_alerts_check_type", "check_type IN ('UNACKNOWLEDGED_CRITICAL_ALERT', 'PENDING_ORDER_NO_RESULT', 'ACTIVE_INPATIENT_NO_OBSERVATION')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundle", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<DateTimeOffset?>("CompletedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("completed_at");
|
||||
|
||||
b.Property<string>("ComplianceStatus")
|
||||
.IsRequired()
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("compliance_status")
|
||||
.HasDefaultValueSql("'IN_PROGRESS'");
|
||||
|
||||
b.Property<DateTimeOffset>("DeadlineAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("deadline_at");
|
||||
|
||||
b.Property<Guid>("EncounterId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("encounter_id");
|
||||
|
||||
b.Property<DateTimeOffset>("RecognizedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("recognized_at");
|
||||
|
||||
b.Property<Guid>("TriggeringAlertId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("triggering_alert_id");
|
||||
|
||||
b.Property<string>("TriggeringAlertType")
|
||||
.IsRequired()
|
||||
.HasMaxLength(50)
|
||||
.HasColumnType("character varying(50)")
|
||||
.HasColumnName("triggering_alert_type");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("ComplianceStatus");
|
||||
|
||||
b.HasIndex("TriggeringAlertId");
|
||||
|
||||
b.HasIndex("EncounterId", "RecognizedAt");
|
||||
|
||||
b.ToTable("sepsis_bundles", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_sepsis_bundles_compliance_status", "compliance_status IN ('IN_PROGRESS', 'COMPLIANT', 'NON_COMPLIANT')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundleElement", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<Guid>("BundleId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("bundle_id");
|
||||
|
||||
b.Property<DateTimeOffset?>("CompletedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("completed_at");
|
||||
|
||||
b.Property<string>("ElementType")
|
||||
.IsRequired()
|
||||
.HasMaxLength(40)
|
||||
.HasColumnType("character varying(40)")
|
||||
.HasColumnName("element_type");
|
||||
|
||||
b.Property<Guid?>("OrderId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("order_id");
|
||||
|
||||
b.Property<string>("Status")
|
||||
.IsRequired()
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("status")
|
||||
.HasDefaultValueSql("'PENDING'");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("OrderId");
|
||||
|
||||
b.HasIndex("BundleId", "ElementType")
|
||||
.IsUnique();
|
||||
|
||||
b.ToTable("sepsis_bundle_elements", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_sepsis_bundle_elements_element_type", "element_type IN ('BLOOD_CULTURES', 'SERUM_LACTATE', 'BROAD_SPECTRUM_ANTIBIOTICS', 'IV_FLUID_RESUSCITATION')");
|
||||
|
||||
t.HasCheckConstraint("chk_sepsis_bundle_elements_status", "status IN ('PENDING', 'COMPLETED')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("ClinicalAlert", b =>
|
||||
{
|
||||
b.HasOne("Encounter", "Encounter")
|
||||
.WithMany("Alerts")
|
||||
.HasForeignKey("EncounterId")
|
||||
.OnDelete(DeleteBehavior.Restrict)
|
||||
.IsRequired();
|
||||
|
||||
b.Navigation("Encounter");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Encounter", b =>
|
||||
{
|
||||
b.HasOne("Patient", "Patient")
|
||||
.WithMany("Encounters")
|
||||
.HasForeignKey("PatientId")
|
||||
.OnDelete(DeleteBehavior.Restrict)
|
||||
.IsRequired();
|
||||
|
||||
b.Navigation("Patient");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("News2Score", b =>
|
||||
{
|
||||
b.HasOne("Encounter", "Encounter")
|
||||
.WithMany()
|
||||
.HasForeignKey("EncounterId")
|
||||
.OnDelete(DeleteBehavior.Restrict)
|
||||
.IsRequired();
|
||||
|
||||
b.Navigation("Encounter");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Observation", b =>
|
||||
{
|
||||
b.HasOne("Encounter", "Encounter")
|
||||
.WithMany("Observations")
|
||||
.HasForeignKey("EncounterId")
|
||||
.OnDelete(DeleteBehavior.Restrict)
|
||||
.IsRequired();
|
||||
|
||||
b.Navigation("Encounter");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Order", b =>
|
||||
{
|
||||
b.HasOne("Encounter", "Encounter")
|
||||
.WithMany("Orders")
|
||||
.HasForeignKey("EncounterId")
|
||||
.OnDelete(DeleteBehavior.Restrict)
|
||||
.IsRequired();
|
||||
|
||||
b.Navigation("Encounter");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("ReconciliationAlert", b =>
|
||||
{
|
||||
b.HasOne("Encounter", "Encounter")
|
||||
.WithMany()
|
||||
.HasForeignKey("EncounterId")
|
||||
.OnDelete(DeleteBehavior.SetNull);
|
||||
|
||||
b.HasOne("Patient", "Patient")
|
||||
.WithMany()
|
||||
.HasForeignKey("PatientId")
|
||||
.OnDelete(DeleteBehavior.SetNull);
|
||||
|
||||
b.Navigation("Encounter");
|
||||
|
||||
b.Navigation("Patient");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundle", b =>
|
||||
{
|
||||
b.HasOne("Encounter", "Encounter")
|
||||
.WithMany()
|
||||
.HasForeignKey("EncounterId")
|
||||
.OnDelete(DeleteBehavior.Restrict)
|
||||
.IsRequired();
|
||||
|
||||
b.HasOne("ClinicalAlert", "TriggeringAlert")
|
||||
.WithMany()
|
||||
.HasForeignKey("TriggeringAlertId")
|
||||
.OnDelete(DeleteBehavior.Restrict)
|
||||
.IsRequired();
|
||||
|
||||
b.Navigation("Encounter");
|
||||
|
||||
b.Navigation("TriggeringAlert");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundleElement", b =>
|
||||
{
|
||||
b.HasOne("SepsisBundle", "Bundle")
|
||||
.WithMany("Elements")
|
||||
.HasForeignKey("BundleId")
|
||||
.OnDelete(DeleteBehavior.Cascade)
|
||||
.IsRequired();
|
||||
|
||||
b.HasOne("Order", "Order")
|
||||
.WithMany()
|
||||
.HasForeignKey("OrderId")
|
||||
.OnDelete(DeleteBehavior.SetNull);
|
||||
|
||||
b.Navigation("Bundle");
|
||||
|
||||
b.Navigation("Order");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Encounter", b =>
|
||||
{
|
||||
b.Navigation("Alerts");
|
||||
|
||||
b.Navigation("Observations");
|
||||
|
||||
b.Navigation("Orders");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Patient", b =>
|
||||
{
|
||||
b.Navigation("Encounters");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundle", b =>
|
||||
{
|
||||
b.Navigation("Elements");
|
||||
});
|
||||
#pragma warning restore 612, 618
|
||||
}
|
||||
}
|
||||
}
|
||||
@@ -0,0 +1,129 @@
|
||||
using System;
|
||||
using Microsoft.EntityFrameworkCore.Migrations;
|
||||
|
||||
#nullable disable
|
||||
|
||||
namespace VigilCareClinicalAPI.Migrations
|
||||
{
|
||||
/// <inheritdoc />
|
||||
public partial class AddQsofaWarningAlertType : Migration
|
||||
{
|
||||
/// <inheritdoc />
|
||||
protected override void Up(MigrationBuilder migrationBuilder)
|
||||
{
|
||||
migrationBuilder.Sql("""
|
||||
ALTER TABLE clinical_alerts DROP CONSTRAINT chk_clinical_alerts_alert_type;
|
||||
ALTER TABLE clinical_alerts ADD CONSTRAINT chk_clinical_alerts_alert_type
|
||||
CHECK (alert_type IN (
|
||||
'SEPSIS_WARNING',
|
||||
'CRITICAL_HEART_RATE', 'CRITICAL_TEMP_C', 'CRITICAL_POTASSIUM_MEQ_L',
|
||||
'CRITICAL_SPO2', 'CRITICAL_RESP_RATE', 'CRITICAL_WBC_K_UL',
|
||||
'CRITICAL_SYSTOLIC_BP', 'CRITICAL_DIASTOLIC_BP', 'CRITICAL_LACTATE_MMOL_L',
|
||||
'CRITICAL_AVPU', 'CRITICAL_GLUCOSE_MG_DL',
|
||||
'WARNING_HEART_RATE', 'WARNING_TEMP_C', 'WARNING_POTASSIUM_MEQ_L',
|
||||
'WARNING_SPO2', 'WARNING_RESP_RATE', 'WARNING_WBC_K_UL',
|
||||
'WARNING_SYSTOLIC_BP', 'WARNING_DIASTOLIC_BP', 'WARNING_LACTATE_MMOL_L',
|
||||
'WARNING_GLUCOSE_MG_DL', 'NEWS2_WARNING', 'NEWS2_EMERGENCY',
|
||||
'RAPID_DETERIORATION', 'QSOFA_WARNING'
|
||||
));
|
||||
""");
|
||||
|
||||
migrationBuilder.CreateTable(
|
||||
name: "sepsis_bundles",
|
||||
columns: table => new
|
||||
{
|
||||
id = table.Column<Guid>(type: "uuid", nullable: false, defaultValueSql: "gen_random_uuid()"),
|
||||
encounter_id = table.Column<Guid>(type: "uuid", nullable: false),
|
||||
triggering_alert_id = table.Column<Guid>(type: "uuid", nullable: false),
|
||||
triggering_alert_type = table.Column<string>(type: "character varying(50)", maxLength: 50, nullable: false),
|
||||
recognized_at = table.Column<DateTimeOffset>(type: "timestamp with time zone", nullable: false),
|
||||
deadline_at = table.Column<DateTimeOffset>(type: "timestamp with time zone", nullable: false),
|
||||
compliance_status = table.Column<string>(type: "character varying(20)", maxLength: 20, nullable: false, defaultValueSql: "'IN_PROGRESS'"),
|
||||
completed_at = table.Column<DateTimeOffset>(type: "timestamp with time zone", nullable: true)
|
||||
},
|
||||
constraints: table =>
|
||||
{
|
||||
table.PrimaryKey("PK_sepsis_bundles", x => x.id);
|
||||
table.CheckConstraint("chk_sepsis_bundles_compliance_status", "compliance_status IN ('IN_PROGRESS', 'COMPLIANT', 'NON_COMPLIANT')");
|
||||
table.ForeignKey(
|
||||
name: "FK_sepsis_bundles_clinical_alerts_triggering_alert_id",
|
||||
column: x => x.triggering_alert_id,
|
||||
principalTable: "clinical_alerts",
|
||||
principalColumn: "id",
|
||||
onDelete: ReferentialAction.Restrict);
|
||||
table.ForeignKey(
|
||||
name: "FK_sepsis_bundles_encounters_encounter_id",
|
||||
column: x => x.encounter_id,
|
||||
principalTable: "encounters",
|
||||
principalColumn: "id",
|
||||
onDelete: ReferentialAction.Restrict);
|
||||
});
|
||||
|
||||
migrationBuilder.CreateTable(
|
||||
name: "sepsis_bundle_elements",
|
||||
columns: table => new
|
||||
{
|
||||
id = table.Column<Guid>(type: "uuid", nullable: false, defaultValueSql: "gen_random_uuid()"),
|
||||
bundle_id = table.Column<Guid>(type: "uuid", nullable: false),
|
||||
element_type = table.Column<string>(type: "character varying(40)", maxLength: 40, nullable: false),
|
||||
status = table.Column<string>(type: "character varying(20)", maxLength: 20, nullable: false, defaultValueSql: "'PENDING'"),
|
||||
order_id = table.Column<Guid>(type: "uuid", nullable: true),
|
||||
completed_at = table.Column<DateTimeOffset>(type: "timestamp with time zone", nullable: true)
|
||||
},
|
||||
constraints: table =>
|
||||
{
|
||||
table.PrimaryKey("PK_sepsis_bundle_elements", x => x.id);
|
||||
table.CheckConstraint("chk_sepsis_bundle_elements_element_type", "element_type IN ('BLOOD_CULTURES', 'SERUM_LACTATE', 'BROAD_SPECTRUM_ANTIBIOTICS', 'IV_FLUID_RESUSCITATION')");
|
||||
table.CheckConstraint("chk_sepsis_bundle_elements_status", "status IN ('PENDING', 'COMPLETED')");
|
||||
table.ForeignKey(
|
||||
name: "FK_sepsis_bundle_elements_orders_order_id",
|
||||
column: x => x.order_id,
|
||||
principalTable: "orders",
|
||||
principalColumn: "id",
|
||||
onDelete: ReferentialAction.SetNull);
|
||||
table.ForeignKey(
|
||||
name: "FK_sepsis_bundle_elements_sepsis_bundles_bundle_id",
|
||||
column: x => x.bundle_id,
|
||||
principalTable: "sepsis_bundles",
|
||||
principalColumn: "id",
|
||||
onDelete: ReferentialAction.Cascade);
|
||||
});
|
||||
|
||||
migrationBuilder.CreateIndex(
|
||||
name: "IX_sepsis_bundle_elements_bundle_id_element_type",
|
||||
table: "sepsis_bundle_elements",
|
||||
columns: new[] { "bundle_id", "element_type" },
|
||||
unique: true);
|
||||
|
||||
migrationBuilder.CreateIndex(
|
||||
name: "IX_sepsis_bundle_elements_order_id",
|
||||
table: "sepsis_bundle_elements",
|
||||
column: "order_id");
|
||||
|
||||
migrationBuilder.CreateIndex(
|
||||
name: "IX_sepsis_bundles_compliance_status",
|
||||
table: "sepsis_bundles",
|
||||
column: "compliance_status");
|
||||
|
||||
migrationBuilder.CreateIndex(
|
||||
name: "IX_sepsis_bundles_encounter_id_recognized_at",
|
||||
table: "sepsis_bundles",
|
||||
columns: new[] { "encounter_id", "recognized_at" });
|
||||
|
||||
migrationBuilder.CreateIndex(
|
||||
name: "IX_sepsis_bundles_triggering_alert_id",
|
||||
table: "sepsis_bundles",
|
||||
column: "triggering_alert_id");
|
||||
}
|
||||
|
||||
/// <inheritdoc />
|
||||
protected override void Down(MigrationBuilder migrationBuilder)
|
||||
{
|
||||
migrationBuilder.DropTable(
|
||||
name: "sepsis_bundle_elements");
|
||||
|
||||
migrationBuilder.DropTable(
|
||||
name: "sepsis_bundles");
|
||||
}
|
||||
}
|
||||
}
|
||||
@@ -626,6 +626,111 @@ namespace VigilCareClinicalAPI.Migrations
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundle", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<DateTimeOffset?>("CompletedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("completed_at");
|
||||
|
||||
b.Property<string>("ComplianceStatus")
|
||||
.IsRequired()
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("compliance_status")
|
||||
.HasDefaultValueSql("'IN_PROGRESS'");
|
||||
|
||||
b.Property<DateTimeOffset>("DeadlineAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("deadline_at");
|
||||
|
||||
b.Property<Guid>("EncounterId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("encounter_id");
|
||||
|
||||
b.Property<DateTimeOffset>("RecognizedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("recognized_at");
|
||||
|
||||
b.Property<Guid>("TriggeringAlertId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("triggering_alert_id");
|
||||
|
||||
b.Property<string>("TriggeringAlertType")
|
||||
.IsRequired()
|
||||
.HasMaxLength(50)
|
||||
.HasColumnType("character varying(50)")
|
||||
.HasColumnName("triggering_alert_type");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("ComplianceStatus");
|
||||
|
||||
b.HasIndex("TriggeringAlertId");
|
||||
|
||||
b.HasIndex("EncounterId", "RecognizedAt");
|
||||
|
||||
b.ToTable("sepsis_bundles", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_sepsis_bundles_compliance_status", "compliance_status IN ('IN_PROGRESS', 'COMPLIANT', 'NON_COMPLIANT')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundleElement", b =>
|
||||
{
|
||||
b.Property<Guid>("Id")
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("id")
|
||||
.HasDefaultValueSql("gen_random_uuid()");
|
||||
|
||||
b.Property<Guid>("BundleId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("bundle_id");
|
||||
|
||||
b.Property<DateTimeOffset?>("CompletedAt")
|
||||
.HasColumnType("timestamp with time zone")
|
||||
.HasColumnName("completed_at");
|
||||
|
||||
b.Property<string>("ElementType")
|
||||
.IsRequired()
|
||||
.HasMaxLength(40)
|
||||
.HasColumnType("character varying(40)")
|
||||
.HasColumnName("element_type");
|
||||
|
||||
b.Property<Guid?>("OrderId")
|
||||
.HasColumnType("uuid")
|
||||
.HasColumnName("order_id");
|
||||
|
||||
b.Property<string>("Status")
|
||||
.IsRequired()
|
||||
.ValueGeneratedOnAdd()
|
||||
.HasMaxLength(20)
|
||||
.HasColumnType("character varying(20)")
|
||||
.HasColumnName("status")
|
||||
.HasDefaultValueSql("'PENDING'");
|
||||
|
||||
b.HasKey("Id");
|
||||
|
||||
b.HasIndex("OrderId");
|
||||
|
||||
b.HasIndex("BundleId", "ElementType")
|
||||
.IsUnique();
|
||||
|
||||
b.ToTable("sepsis_bundle_elements", null, t =>
|
||||
{
|
||||
t.HasCheckConstraint("chk_sepsis_bundle_elements_element_type", "element_type IN ('BLOOD_CULTURES', 'SERUM_LACTATE', 'BROAD_SPECTRUM_ANTIBIOTICS', 'IV_FLUID_RESUSCITATION')");
|
||||
|
||||
t.HasCheckConstraint("chk_sepsis_bundle_elements_status", "status IN ('PENDING', 'COMPLETED')");
|
||||
});
|
||||
});
|
||||
|
||||
modelBuilder.Entity("ClinicalAlert", b =>
|
||||
{
|
||||
b.HasOne("Encounter", "Encounter")
|
||||
@@ -698,6 +803,43 @@ namespace VigilCareClinicalAPI.Migrations
|
||||
b.Navigation("Patient");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundle", b =>
|
||||
{
|
||||
b.HasOne("Encounter", "Encounter")
|
||||
.WithMany()
|
||||
.HasForeignKey("EncounterId")
|
||||
.OnDelete(DeleteBehavior.Restrict)
|
||||
.IsRequired();
|
||||
|
||||
b.HasOne("ClinicalAlert", "TriggeringAlert")
|
||||
.WithMany()
|
||||
.HasForeignKey("TriggeringAlertId")
|
||||
.OnDelete(DeleteBehavior.Restrict)
|
||||
.IsRequired();
|
||||
|
||||
b.Navigation("Encounter");
|
||||
|
||||
b.Navigation("TriggeringAlert");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundleElement", b =>
|
||||
{
|
||||
b.HasOne("SepsisBundle", "Bundle")
|
||||
.WithMany("Elements")
|
||||
.HasForeignKey("BundleId")
|
||||
.OnDelete(DeleteBehavior.Cascade)
|
||||
.IsRequired();
|
||||
|
||||
b.HasOne("Order", "Order")
|
||||
.WithMany()
|
||||
.HasForeignKey("OrderId")
|
||||
.OnDelete(DeleteBehavior.SetNull);
|
||||
|
||||
b.Navigation("Bundle");
|
||||
|
||||
b.Navigation("Order");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("Encounter", b =>
|
||||
{
|
||||
b.Navigation("Alerts");
|
||||
@@ -711,6 +853,11 @@ namespace VigilCareClinicalAPI.Migrations
|
||||
{
|
||||
b.Navigation("Encounters");
|
||||
});
|
||||
|
||||
modelBuilder.Entity("SepsisBundle", b =>
|
||||
{
|
||||
b.Navigation("Elements");
|
||||
});
|
||||
#pragma warning restore 612, 618
|
||||
}
|
||||
}
|
||||
|
||||
@@ -0,0 +1,7 @@
|
||||
public enum QsofaOutcome
|
||||
{
|
||||
NotQsofaCode,
|
||||
InsufficientCriteria,
|
||||
AlertCreated,
|
||||
AlertAlreadyOpen
|
||||
}
|
||||
@@ -0,0 +1,11 @@
|
||||
// Discriminated result — allows tests and callers to assert the exact outcome
|
||||
// without inspecting PostgreSQL or Redis directly.
|
||||
public record QsofaResult(QsofaOutcome Outcome, int ActiveCriteria = 0)
|
||||
{
|
||||
public static readonly QsofaResult NotQsofaCode = new(QsofaOutcome.NotQsofaCode);
|
||||
public static readonly QsofaResult AlertCreated = new(QsofaOutcome.AlertCreated);
|
||||
public static readonly QsofaResult AlertAlreadyOpen = new(QsofaOutcome.AlertAlreadyOpen);
|
||||
|
||||
public static QsofaResult InsufficientCriteria(int count) =>
|
||||
new(QsofaOutcome.InsufficientCriteria, count);
|
||||
}
|
||||
@@ -11,7 +11,7 @@ public sealed class ClinicalMetrics
|
||||
"Total observations ingested, labeled by observation code and source.",
|
||||
labelNames: new[] { "observation_code", "source" });
|
||||
|
||||
// Labeled by alert_type (THRESHOLD_BREACH, SEPSIS_WARNING) and severity
|
||||
// Labeled by alert_type (THRESHOLD_BREACH, SEPSIS_WARNING, QSOFA_WARNING) and severity
|
||||
// (Critical, Warning) so the dashboard can show Critical vs Warning rates separately.
|
||||
public readonly Counter ClinicalAlertsTotal = Metrics.CreateCounter(
|
||||
"clinical_alerts_total",
|
||||
@@ -46,6 +46,15 @@ public sealed class ClinicalMetrics
|
||||
"Total alert suppression windows set after acknowledgment.",
|
||||
labelNames: new[] { "alert_type" });
|
||||
|
||||
public readonly Counter QsofaDetectionsTotal = Metrics.CreateCounter(
|
||||
"qsofa_detections_total",
|
||||
"Total QSOFA_WARNING alerts generated by the qSOFA scoring engine.");
|
||||
|
||||
public readonly Counter SepsisBundleComplianceTotal = Metrics.CreateCounter(
|
||||
"sepsis_bundle_compliance_total",
|
||||
"Sepsis bundle compliance outcomes.",
|
||||
labelNames: new[] { "status" });
|
||||
|
||||
// --- Histograms ---
|
||||
|
||||
// Measures the full ingest transaction: Redis cache lookup + alert evaluation +
|
||||
|
||||
@@ -80,7 +80,10 @@ try
|
||||
builder.Services.AddScoped<IOrderService, OrderService>();
|
||||
builder.Services.AddScoped<IAnalyticsService, AnalyticsService>();
|
||||
builder.Services.AddScoped<INews2Service, News2Service>();
|
||||
builder.Services.AddScoped<ISepsisBundleService, SepsisBundleService>();
|
||||
builder.Services.AddScoped<SepsisAlertHandler>();
|
||||
builder.Services.AddScoped<SirsDetector>();
|
||||
builder.Services.AddScoped<QsofaDetector>();
|
||||
builder.Services.AddScoped<UnacknowledgedAlertsCheck>();
|
||||
builder.Services.AddScoped<PendingOrdersCheck>();
|
||||
builder.Services.AddScoped<DisconnectedMonitorsCheck>();
|
||||
|
||||
@@ -0,0 +1,34 @@
|
||||
using StackExchange.Redis;
|
||||
|
||||
public static class QsofaCalculator
|
||||
{
|
||||
public static readonly IReadOnlyList<string> QsofaCodes = new[]
|
||||
{
|
||||
"RESP_RATE", "SYSTOLIC_BP", "AVPU"
|
||||
};
|
||||
|
||||
public static readonly IReadOnlySet<string> QsofaCodeSet =
|
||||
new HashSet<string>(QsofaCodes);
|
||||
|
||||
// qSOFA criteria (Sepsis-3 consensus):
|
||||
// - Respiratory rate ≥ 22 breaths/min
|
||||
// - Systolic blood pressure ≤ 100 mmHg
|
||||
// - Altered mentation: AVPU score ≥ 1 (any non-Alert state)
|
||||
public static bool MeetsCriterion(string observationCode, decimal value) =>
|
||||
observationCode switch
|
||||
{
|
||||
"RESP_RATE" => value >= 22m,
|
||||
"SYSTOLIC_BP" => value <= 100m,
|
||||
"AVPU" => value >= 1m,
|
||||
_ => false
|
||||
};
|
||||
|
||||
public static string CriterionKey(Guid encounterId, string code) =>
|
||||
$"qsofa:{encounterId}:{code}";
|
||||
|
||||
public static RedisKey[] AllCriterionKeys(Guid encounterId) =>
|
||||
QsofaCodes.Select(c => (RedisKey)CriterionKey(encounterId, c)).ToArray();
|
||||
|
||||
public static int CountActiveCriteria(RedisValue[] values) =>
|
||||
values.Count(v => v.HasValue);
|
||||
}
|
||||
@@ -0,0 +1,160 @@
|
||||
using System.Text.Json;
|
||||
using Microsoft.EntityFrameworkCore;
|
||||
using Serilog.Context;
|
||||
using StackExchange.Redis;
|
||||
|
||||
public class QsofaDetector
|
||||
{
|
||||
// 30 minutes in seconds — same sliding window as SIRS.
|
||||
private const int QsofaTtlSeconds = 1800;
|
||||
|
||||
private readonly IConnectionMultiplexer _redis;
|
||||
private readonly IServiceProvider _services;
|
||||
private readonly ILogger<QsofaDetector> _logger;
|
||||
private readonly ClinicalMetrics _metrics;
|
||||
|
||||
public QsofaDetector(
|
||||
IConnectionMultiplexer redis,
|
||||
IServiceProvider services,
|
||||
ILogger<QsofaDetector> logger,
|
||||
ClinicalMetrics metrics)
|
||||
{
|
||||
_redis = redis;
|
||||
_services = services;
|
||||
_logger = logger;
|
||||
_metrics = metrics;
|
||||
}
|
||||
|
||||
public async Task<QsofaResult> ProcessObservationAsync(
|
||||
Guid encounterId,
|
||||
Guid patientId,
|
||||
string observationCode,
|
||||
decimal value,
|
||||
CancellationToken ct = default)
|
||||
{
|
||||
if (!QsofaCalculator.QsofaCodeSet.Contains(observationCode))
|
||||
return QsofaResult.NotQsofaCode;
|
||||
|
||||
var cache = _redis.GetDatabase();
|
||||
var key = QsofaCalculator.CriterionKey(encounterId, observationCode);
|
||||
|
||||
if (QsofaCalculator.MeetsCriterion(observationCode, value))
|
||||
{
|
||||
await cache.StringSetAsync(
|
||||
key, value.ToString(), TimeSpan.FromSeconds(QsofaTtlSeconds));
|
||||
|
||||
_logger.LogDebug("qSOFA criterion set: {Key}={Value} (TTL={Ttl}s)",
|
||||
key, value, QsofaTtlSeconds);
|
||||
}
|
||||
else
|
||||
{
|
||||
await cache.KeyDeleteAsync(key);
|
||||
|
||||
_logger.LogDebug("qSOFA criterion cleared: {Key}", key);
|
||||
}
|
||||
|
||||
var allKeys = QsofaCalculator.AllCriterionKeys(encounterId);
|
||||
var values = await cache.StringGetAsync(allKeys);
|
||||
var activeCount = QsofaCalculator.CountActiveCriteria(values);
|
||||
|
||||
_logger.LogDebug(
|
||||
"qSOFA state for encounter {Id}: {Active}/3 criteria active after {Code}={Value}",
|
||||
encounterId, activeCount, observationCode, value);
|
||||
|
||||
if (activeCount < 2)
|
||||
return QsofaResult.InsufficientCriteria(activeCount);
|
||||
|
||||
var created = await TryCreateAlertAsync(encounterId, patientId, activeCount, values, ct);
|
||||
return created ? QsofaResult.AlertCreated : QsofaResult.AlertAlreadyOpen;
|
||||
}
|
||||
|
||||
private async Task<bool> TryCreateAlertAsync(
|
||||
Guid encounterId,
|
||||
Guid patientId,
|
||||
int activeCount,
|
||||
RedisValue[] criterionValues,
|
||||
CancellationToken ct)
|
||||
{
|
||||
using var scope = _services.CreateScope();
|
||||
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
|
||||
|
||||
await using var tx = await db.Database.BeginTransactionAsync(ct);
|
||||
|
||||
var alertId = Guid.NewGuid();
|
||||
var triggeredAt = DateTimeOffset.UtcNow;
|
||||
var details = BuildDetails(activeCount, criterionValues);
|
||||
|
||||
var affected = await db.Database.ExecuteSqlInterpolatedAsync($"""
|
||||
INSERT INTO clinical_alerts
|
||||
(id, encounter_id, patient_id, alert_type, severity, details, status, triggered_at)
|
||||
SELECT {alertId}, {encounterId}, {patientId},
|
||||
'QSOFA_WARNING', 'CRITICAL', {details}, 'OPEN', {triggeredAt}
|
||||
WHERE NOT EXISTS (
|
||||
SELECT 1 FROM clinical_alerts
|
||||
WHERE encounter_id = {encounterId}
|
||||
AND alert_type = 'QSOFA_WARNING'
|
||||
AND status IN ('OPEN', 'ESCALATED')
|
||||
)
|
||||
""", ct);
|
||||
|
||||
if (affected == 0)
|
||||
{
|
||||
await tx.RollbackAsync(ct);
|
||||
_logger.LogDebug(
|
||||
"QSOFA_WARNING already open for encounter {Id} — no new alert", encounterId);
|
||||
return false;
|
||||
}
|
||||
|
||||
db.OutboxEvents.Add(new OutboxEvent
|
||||
{
|
||||
Id = Guid.NewGuid(),
|
||||
Topic = "alert.generated",
|
||||
Payload = JsonSerializer.Serialize(new
|
||||
{
|
||||
alertId,
|
||||
encounterId,
|
||||
patientId,
|
||||
alertType = AlertType.QsofaWarning.ToDbString(),
|
||||
severity = "Critical",
|
||||
details,
|
||||
triggeredAt,
|
||||
partitionKey = encounterId.ToString()
|
||||
}),
|
||||
PartitionKey = encounterId.ToString(),
|
||||
CreatedAt = DateTimeOffset.UtcNow
|
||||
});
|
||||
|
||||
await db.SaveChangesAsync(ct);
|
||||
await tx.CommitAsync(ct);
|
||||
|
||||
_metrics.QsofaDetectionsTotal.Inc();
|
||||
_metrics.ClinicalAlertsTotal
|
||||
.WithLabels(AlertType.QsofaWarning.ToDbString(), AlertSeverity.Critical.ToDbString())
|
||||
.Inc();
|
||||
|
||||
using (LogContext.PushProperty("EncounterId", encounterId))
|
||||
using (LogContext.PushProperty("PatientId", patientId))
|
||||
{
|
||||
_logger.LogWarning(
|
||||
"QSOFA_WARNING created. ActiveCriteriaCount={Count} AlertId={AlertId}",
|
||||
activeCount, alertId);
|
||||
}
|
||||
|
||||
var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
|
||||
await handler.OnSepsisAlertCreatedAsync(encounterId, alertId, AlertType.QsofaWarning, ct);
|
||||
|
||||
return true;
|
||||
}
|
||||
|
||||
private static string BuildDetails(int activeCount, RedisValue[] values)
|
||||
{
|
||||
var activeParts = new List<string>();
|
||||
for (var i = 0; i < QsofaCalculator.QsofaCodes.Count; i++)
|
||||
{
|
||||
if (values[i].HasValue)
|
||||
activeParts.Add($"{QsofaCalculator.QsofaCodes[i]}={values[i]}");
|
||||
}
|
||||
|
||||
return $"qSOFA score {activeCount}/3: {string.Join(", ", activeParts)}";
|
||||
}
|
||||
}
|
||||
@@ -0,0 +1,22 @@
|
||||
public class SepsisAlertHandler
|
||||
{
|
||||
private readonly ISepsisBundleService _bundleService;
|
||||
private readonly ILogger<SepsisAlertHandler> _logger;
|
||||
|
||||
public SepsisAlertHandler(ISepsisBundleService bundleService, ILogger<SepsisAlertHandler> logger)
|
||||
{
|
||||
_bundleService = bundleService;
|
||||
_logger = logger;
|
||||
}
|
||||
|
||||
public async Task OnSepsisAlertCreatedAsync(
|
||||
Guid encounterId, Guid alertId, AlertType alertType, CancellationToken ct)
|
||||
{
|
||||
var bundle = await _bundleService.TryCreateBundleAsync(encounterId, alertId, alertType, ct);
|
||||
|
||||
if (bundle is not null)
|
||||
_logger.LogInformation(
|
||||
"Sepsis bundle {BundleId} created for encounter {EncounterId} (trigger={AlertType})",
|
||||
bundle.Id, encounterId, alertType.ToDbString());
|
||||
}
|
||||
}
|
||||
@@ -169,6 +169,9 @@ public class SirsDetector
|
||||
activeCount, alertId);
|
||||
}
|
||||
|
||||
var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
|
||||
await handler.OnSepsisAlertCreatedAsync(encounterId, alertId, AlertType.SepsisWarning, ct);
|
||||
|
||||
return true;
|
||||
}
|
||||
}
|
||||
@@ -0,0 +1,8 @@
|
||||
public interface ISepsisBundleService
|
||||
{
|
||||
Task<SepsisBundle?> TryCreateBundleAsync(
|
||||
Guid encounterId, Guid triggeringAlertId, AlertType alertType, CancellationToken ct = default);
|
||||
Task<SepsisBundle?> GetCurrentByEncounterAsync(Guid encounterId);
|
||||
Task<SepsisBundle> GetByIdAsync(Guid id);
|
||||
Task OnOrderResultedAsync(Guid orderId, CancellationToken ct = default);
|
||||
}
|
||||
@@ -11,8 +11,13 @@ public class OrderService : IOrderService
|
||||
};
|
||||
|
||||
private readonly AppDbContext _db;
|
||||
private readonly IServiceProvider _serviceProvider;
|
||||
|
||||
public OrderService(AppDbContext db) => _db = db;
|
||||
public OrderService(AppDbContext db, IServiceProvider serviceProvider)
|
||||
{
|
||||
_db = db;
|
||||
_serviceProvider = serviceProvider;
|
||||
}
|
||||
|
||||
public async Task<Order> CreateAsync(Guid encounterId, CreateOrderRequest req)
|
||||
{
|
||||
@@ -109,6 +114,8 @@ public class OrderService : IOrderService
|
||||
order.ResultSummary = req.ResultSummary;
|
||||
|
||||
await _db.SaveChangesAsync();
|
||||
var bundleService = _serviceProvider.GetRequiredService<ISepsisBundleService>();
|
||||
await bundleService.OnOrderResultedAsync(order.Id);
|
||||
return order;
|
||||
}
|
||||
}
|
||||
@@ -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);
|
||||
}
|
||||
|
||||
}
|
||||
Reference in New Issue
Block a user