96 lines
3.5 KiB
C#
96 lines
3.5 KiB
C#
using Microsoft.EntityFrameworkCore;
|
|
using Microsoft.Extensions.Options;
|
|
|
|
public sealed class DisconnectedMonitorsCheck
|
|
{
|
|
public static readonly ReconciliationCheckType CheckType = ReconciliationCheckType.ActiveInpatientNoObservation;
|
|
|
|
private readonly AppDbContext _db;
|
|
private readonly ReconciliationPublisher _publisher;
|
|
private readonly ReconciliationJobOptions _opts;
|
|
private readonly ILogger<DisconnectedMonitorsCheck> _logger;
|
|
|
|
public DisconnectedMonitorsCheck(
|
|
AppDbContext db,
|
|
ReconciliationPublisher publisher,
|
|
IOptions<ReconciliationJobOptions> opts,
|
|
ILogger<DisconnectedMonitorsCheck> logger)
|
|
{
|
|
_db = db;
|
|
_publisher = publisher;
|
|
_opts = opts.Value;
|
|
_logger = logger;
|
|
}
|
|
|
|
public async Task<int> RunAsync(CancellationToken ct)
|
|
{
|
|
var cutoff = DateTimeOffset.UtcNow
|
|
.AddHours(-_opts.NoObservationThresholdHours);
|
|
|
|
// Limitation: this check detects absence of recorded observations, not absence
|
|
// of actual clinical monitoring. A nurse who took manual vitals but did not
|
|
// enter them into the system would still trigger a reconciliation alert.
|
|
// This is a known gap; the check errs on the side of false positives.
|
|
var candidates = await _db.Encounters
|
|
.Where(e => e.Status == EncounterStatus.Active
|
|
&& e.EncounterType == EncounterType.Inpatient)
|
|
.Select(e => new
|
|
{
|
|
EncounterId = e.Id,
|
|
e.PatientId,
|
|
LastObservationAt = e.Observations
|
|
.OrderByDescending(o => o.RecordedAt)
|
|
.Select(o => (DateTimeOffset?)o.RecordedAt)
|
|
.FirstOrDefault(),
|
|
})
|
|
.ToListAsync(ct);
|
|
|
|
var stale = candidates
|
|
.Where(e => e.LastObservationAt == null || e.LastObservationAt < cutoff)
|
|
.ToList();
|
|
|
|
if (!stale.Any())
|
|
{
|
|
_logger.LogDebug("[RECONCILIATION] Check3 — all active inpatients have recent observations");
|
|
return 0;
|
|
}
|
|
|
|
var inserted = 0;
|
|
foreach (var enc in stale)
|
|
{
|
|
var alreadyOpen = await _db.ReconciliationAlerts
|
|
.AnyAsync(r => r.CheckType == CheckType
|
|
&& r.EncounterId == enc.EncounterId
|
|
&& r.ResolvedAt == null, ct);
|
|
if (alreadyOpen) continue;
|
|
|
|
var lastObs = enc.LastObservationAt.HasValue
|
|
? $"last observation {enc.LastObservationAt:u}"
|
|
: "no observations ever recorded";
|
|
var details = $"Active inpatient encounter {enc.EncounterId} has no recent observations "
|
|
+ $"({lastObs}). Monitor may be disconnected.";
|
|
|
|
var rec = new ReconciliationAlert
|
|
{
|
|
Id = Guid.NewGuid(),
|
|
CheckType = CheckType, // ReconciliationCheckType enum
|
|
EncounterId = enc.EncounterId,
|
|
PatientId = enc.PatientId,
|
|
Details = details,
|
|
CreatedAt = DateTimeOffset.UtcNow,
|
|
};
|
|
|
|
_db.ReconciliationAlerts.Add(rec);
|
|
await _db.SaveChangesAsync(ct);
|
|
await _publisher.PublishAsync(rec, ct);
|
|
|
|
_logger.LogWarning(
|
|
"[RECONCILIATION] {CheckType} — encounter {EncounterId}: {LastObs}",
|
|
CheckType, enc.EncounterId, lastObs);
|
|
|
|
inserted++;
|
|
}
|
|
|
|
return inserted;
|
|
}
|
|
} |