@peopl-health/nexus 5.66.0 → 5.67.0-dev.11670

package/lib/clinical/services/clinicalPatternFloorService.js

@@ -10,8 +10,19 @@ const { logger } = require('../../utils/logger');
 const { redactDirectIdentifiers } = require('../../utils/sanitizerUtils');
 const { withTimeout } = require('../../utils/timeoutUtils');
 
-const PATTERNS = ['posquirurgico_abdominal', 'toxicidad_gi_quimioterapia', 'toxicidad_gi_inmunoterapia', 'fiebre_quimioterapia'];
 const FLOOR_LEVELS = ['asap', 'stat'];
+const PATTERN_NAME = /^[a-z0-9_]{1,64}$/;
+const UNLABELLED_PATTERN = 'sin_etiqueta';
+const MAX_TEXT_LENGTH = 500;
+
+const degraded = (reason) => ({ floor: null, degraded: reason });
+
+function normalizePattern(raw) {
+  const name = typeof raw === 'string' ? raw.trim().toLowerCase() : '';
+  return PATTERN_NAME.test(name) ? name : UNLABELLED_PATTERN;
+}
+
+const clippedText = (value) => cleanText(value)?.slice(0, MAX_TEXT_LENGTH) || null;
 
 function buildPatternInput({ profile, details, justification, today }) {
   const indicators = Array.isArray(details.indicators) ? details.indicators.filter((item) => typeof item === 'string' && item.trim()) : [];
@@ -36,30 +47,41 @@ async function evaluatePatternFloor({ code, turnId, details, justification, prov
   const { presetId } = await getEscalationPatternFloor();
   if (!presetId) {
     logger.info('[clinicalPatternFloor] No preset is configured; the check is skipped', { turnId });
-    return null;
+    return degraded('no_preset');
   }
   const profile = await readClinicalProfile(code);
   if (!profile) {
-    logger.warn('[clinicalPatternFloor] The clinical profile is missing or unreadable; the check is skipped', { turnId, profile: profile === undefined ? 'unreadable' : 'missing_or_unparseable' });
-    return null;
+    const reason = profile === undefined ? 'profile_unreadable' : 'profile_missing';
+    logger.warn('[clinicalPatternFloor] The clinical profile is missing or unreadable; the check is skipped', { turnId, profile: reason });
+    return degraded(reason);
   }
   const result = await (provider || requireGatewayProvider()).runStructured({
     presetId,
     input: [{ role: 'user', content: buildPatternInput({ profile, details, justification, today: now.toISOString().slice(0, 10) }) }],
     metadata: { subAgent: 'escalation-pattern-floor', turnId },
   });
-  if (result?.status && result.status !== 'completed') throw new Error(`pattern floor incomplete: status=${result.status}`);
+  if (result?.status && result.status !== 'completed') {
+    logger.warn('[clinicalPatternFloor] The pattern check did not complete', { turnId, status: result.status });
+    return degraded('incomplete');
+  }
   const parsed = safeParse(readStructuredText(result), null);
   if (!isPlainObject(parsed)) {
     logger.warn('[clinicalPatternFloor] The pattern check did not return a JSON object', { turnId });
-    return null;
+    return degraded('malformed_output');
+  }
+  if (parsed.min_level == null) {
+    if (parsed.pattern == null) return { floor: null, degraded: null };
+    logger.warn('[clinicalPatternFloor] The pattern check named a pattern without a level', { turnId, pattern: parsed.pattern });
+    return degraded('missing_level');
   }
-  if (parsed.min_level == null && parsed.pattern == null) return null;
-  if (!FLOOR_LEVELS.includes(parsed.min_level) || !PATTERNS.includes(parsed.pattern)) {
-    logger.warn('[clinicalPatternFloor] The pattern check returned an unsupported level or pattern', { turnId, minLevel: parsed.min_level, pattern: parsed.pattern });
-    return null;
+  if (!FLOOR_LEVELS.includes(parsed.min_level)) {
+    logger.warn('[clinicalPatternFloor] The pattern check returned an unsupported level', { turnId, minLevel: parsed.min_level, pattern: parsed.pattern });
+    return degraded('unsupported_level');
   }
-  return { level: parsed.min_level, pattern: parsed.pattern, evidence: cleanText(parsed.evidence), reason: cleanText(parsed.reason) };
+  return {
+    floor: { level: parsed.min_level, pattern: normalizePattern(parsed.pattern), evidence: clippedText(parsed.evidence), reason: clippedText(parsed.reason) },
+    degraded: null,
+  };
 }
 
 async function clinicalPatternFloor({ code, turnId = null, details = {}, justification = null, provider = null, now = new Date() }) {
@@ -70,11 +92,12 @@ async function clinicalPatternFloor({ code, turnId = null, details = {}, justifi
       'clinical pattern floor',
     );
   } catch (error) {
+    const timedOut = /timed out after/.test(error?.message || '');
     logger.error('[clinicalPatternFloor] The clinical pattern check failed', {
       turnId, error: error.message, stack: redactDirectIdentifiers(String(error?.stack || '')),
     });
-    return null;
+    return degraded(timedOut ? 'timeout' : 'error');
   }
 }
 
-module.exports = { clinicalPatternFloor, buildPatternInput, PATTERNS };
+module.exports = { clinicalPatternFloor, buildPatternInput };

package/lib/clinical/services/triageGateFloorService.js

@@ -5,8 +5,10 @@ const { redactDirectIdentifiers } = require('../../utils/sanitizerUtils');
 
 const HOUR_MS = 60 * 60 * 1000;
 const LOOKBACK_MS = 24 * HOUR_MS;
-const FLOOR_LEVEL = 'asap';
+const ROUTE_FLOOR = { emergencia: 'stat', urgencias: 'asap', equipo_tratante_hoy: 'asap' };
+const DEFAULT_FLOOR = 'asap';
 const PROMPT_ROUTES = ['urgencias', 'emergencia'];
+const NO_FLOOR = { floor: null, degraded: null };
 
 const settledAt = (event) => new Date(event.createdAt).getTime();
 const gateTime = (event) => Math.min(new Date(event.triageAuthoredAt || event.createdAt).getTime(), settledAt(event));
@@ -19,25 +21,28 @@ async function activeTriageGateFloor(code, now = new Date()) {
       .lean();
     const latest = gates.reduce((best, event) => (!best || gateTime(event) > gateTime(best)
       || (gateTime(event) === gateTime(best) && settledAt(event) > settledAt(best)) ? event : best), null);
-    if (!latest?.urgentUnder24h) return null;
+    if (!latest?.urgentUnder24h) return NO_FLOOR;
 
     const hours = Number.isFinite(latest.maxActionTimeHours) ? latest.maxActionTimeHours : null;
     const promptRoute = PROMPT_ROUTES.includes(latest.escalationRoute);
-    if (!promptRoute && (hours === null || hours > triageGateFloorMaxHours())) return null;
+    if (!promptRoute && (hours === null || hours > triageGateFloorMaxHours())) return NO_FLOOR;
 
-    const windowMs = (hours ?? 24) * HOUR_MS;
-    if (now.getTime() - gateTime(latest) > windowMs) return null;
+    const windowMs = Math.max(hours ?? 24, 1) * HOUR_MS;
+    if (now.getTime() - gateTime(latest) > windowMs) return NO_FLOOR;
 
     return {
-      level: FLOOR_LEVEL,
-      runId: latest.runId,
-      triageRecordId: latest.triageRecordId,
-      escalationRoute: latest.escalationRoute,
-      maxActionTimeHours: hours,
+      floor: {
+        level: ROUTE_FLOOR[latest.escalationRoute] || DEFAULT_FLOOR,
+        runId: latest.runId,
+        triageRecordId: latest.triageRecordId,
+        escalationRoute: latest.escalationRoute,
+        maxActionTimeHours: hours,
+      },
+      degraded: null,
     };
   } catch (error) {
     logger.error('[triageGateFloor] The latest triage gate could not be read', { error: error.message, stack: redactDirectIdentifiers(String(error?.stack || '')) });
-    return null;
+    return { floor: null, degraded: 'read_failed' };
   }
 }
 

package/lib/clinical/tools/reportMedicalEscalationTool.js

@@ -313,12 +313,14 @@ async function handler(args, context = {}) {
     const anchor = updateMode && review ? escalationAnchorOf(review, alarmId) : null;
     const keptOpenLevel = Boolean(anchor) && (URGENCY_RANK[anchor.urgencyLevel] || 0) > (URGENCY_RANK[requestedLevel] || 0);
     const agentLevel = keptOpenLevel ? anchor.urgencyLevel : requestedLevel;
-    const gateFloor = triageGateFloorLive() && runtime.patientCode ? await activeTriageGateFloor(runtime.patientCode) : null;
+    const gateCheck = triageGateFloorLive() && runtime.patientCode ? await activeTriageGateFloor(runtime.patientCode) : null;
+    const gateFloor = gateCheck?.floor || null;
     const raisedByGate = Boolean(gateFloor) && (URGENCY_RANK[gateFloor.level] || 0) > (URGENCY_RANK[agentLevel] || 0);
     const flooredLevel = raisedByGate ? gateFloor.level : agentLevel;
-    const patternFloor = clinicalPatternFloorLive() && runtime.patientCode && (URGENCY_RANK[flooredLevel] || 0) < URGENCY_RANK.stat
+    const patternCheck = clinicalPatternFloorLive() && runtime.patientCode && (URGENCY_RANK[flooredLevel] || 0) < URGENCY_RANK.stat
       ? await clinicalPatternFloor({ code: runtime.patientCode, turnId: runtime.turnId, details, justification: args?.urgency_justification })
       : null;
+    const patternFloor = patternCheck?.floor || null;
     const raisedByPattern = Boolean(patternFloor) && (URGENCY_RANK[patternFloor.level] || 0) > (URGENCY_RANK[flooredLevel] || 0);
     const urgencyLevel = raisedByPattern ? patternFloor.level : flooredLevel;
     const raisesOpen = !anchor || (URGENCY_RANK[urgencyLevel] || 0) > (URGENCY_RANK[anchor.urgencyLevel] || 0);
@@ -345,6 +347,8 @@ async function handler(args, context = {}) {
         ...(clinicalAssessment ? { clinicalAssessment } : {}),
         ...(gateFloor ? { triageGateFloor: { ...gateFloor, raised: raisedByGate } } : {}),
         ...(patternFloor ? { clinicalPatternFloor: { ...patternFloor, raised: raisedByPattern } } : {}),
+        ...(gateCheck?.degraded ? { triageGateFloorDegraded: gateCheck.degraded } : {}),
+        ...(patternCheck?.degraded ? { clinicalPatternFloorDegraded: patternCheck.degraded } : {}),
       },
     });
 
@@ -398,11 +402,12 @@ async function handler(args, context = {}) {
           onRecorded: (recordId) => { emergencyRecordId = recordId; },
         });
         if (review && emergencyRecordId) await attachEmergencyRow({ reviewId: review._id, alarmId, emergencyRecordId, appliedLevel: urgencyLevel });
-        if (agentLevel !== 'routine') {
+        const netLevel = raisedByGate || raisedByPattern ? urgencyLevel : agentLevel;
+        if (netLevel !== 'routine') {
           try {
             const net = queued ? await armEscalationNet({
               patientCode: runtime.patientCode,
-              urgencyLevel: agentLevel,
+              urgencyLevel: netLevel,
               symptom: details.symptom || '',
               suspectedCondition: details.suspected_condition || null,
               checkIn: args?.patient_check_in || null,

package/package.json

@@ -1,6 +1,6 @@
 {
   "name": "@peopl-health/nexus",
-  "version": "5.66.0",
+  "version": "5.67.0-dev.11670",
   "description": "Core messaging and assistant library for WhatsApp communication platforms",
   "keywords": [
     "whatsapp",