Fix for Incorrect Discharge Reasons in Patient Transfers and Readmiss…

…ions (#1712)

* Add discharge reason to PatientTransferSerializer
and handle patient transfer validation

* remove bed on transfer

* Migration for beds attached to discharged patients

* Apply suggestions from code review

Co-authored-by: Aakash Singh <mail@singhaakash.dev>

* Update patient.py

* lint

* atomic transaction

* add tests

---------

Co-authored-by: Aakash Singh <mail@singhaakash.dev>

care/facility/api/serializers/patient.py

@@ -3,7 +3,7 @@
 from django.conf import settings
 from django.db import transaction
 from django.db.models import Q
-from django.utils.timezone import localtime, make_aware, now
+from django.utils.timezone import make_aware, now
 from rest_framework import serializers
 
 from care.abdm.api.serializers.abhanumber import AbhaNumberSerializer
@@ -27,6 +27,7 @@
     PatientNotes,
     PatientRegistration,
 )
+from care.facility.models.bed import ConsultationBed
 from care.facility.models.notification import Notification
 from care.facility.models.patient_base import (
     BLOOD_GROUP_CHOICES,
@@ -453,10 +454,22 @@ def create(self, validated_data):
 
     def save(self, **kwargs):
         self.instance.facility = self.validated_data["facility"]
-        PatientConsultation.objects.filter(
-            patient=self.instance, discharge_date__isnull=True
-        ).update(discharge_date=localtime(now()))
-        self.instance.save()
+
+        with transaction.atomic():
+            consultation = PatientConsultation.objects.filter(
+                patient=self.instance, discharge_date__isnull=True
+            ).first()
+
+            if consultation:
+                consultation.discharge_date = now()
+                consultation.discharge_reason = "REF"
+                consultation.current_bed = None
+                consultation.save()
+
+                ConsultationBed.objects.filter(
+                    consultation=consultation, end_date__isnull=True
+                ).update(end_date=now())
+                self.instance.save()
 
 
 class PatientNotesSerializer(serializers.ModelSerializer):

care/facility/api/viewsets/patient.py

@@ -426,10 +426,21 @@ def list(self, request, *args, **kwargs):
     @action(detail=True, methods=["POST"])
     def transfer(self, request, *args, **kwargs):
         patient = PatientRegistration.objects.get(external_id=kwargs["external_id"])
+        facility = Facility.objects.get(external_id=request.data["facility"])
+
+        if patient.is_active and facility == patient.facility:
+            return Response(
+                {
+                    "Patient": "Patient transfer cannot be completed because the patient has an active consultation in the same facility"
+                },
+                status=status.HTTP_406_NOT_ACCEPTABLE,
+            )
 
         if patient.allow_transfer is False:
             return Response(
-                {"Patient": "Cannot Transfer Patient , Source Facility Does Not Allow"},
+                {
+                    "Patient": "Patient transfer cannot be completed because the source facility does not permit it"
+                },
                 status=status.HTTP_406_NOT_ACCEPTABLE,
             )
         patient.allow_transfer = False

care/facility/migrations/0394_auto_20231114_2219.py

@@ -0,0 +1,28 @@
+# Generated by Django 4.2.6 on 2023-11-14 16:49
+
+from django.db import migrations
+
+
+def free_discharged_beds(apps, schema_editor):
+    PatientConsultation = apps.get_model("facility", "PatientConsultation")
+    ConsultationBed = apps.get_model("facility", "ConsultationBed")
+
+    for consultation in PatientConsultation.objects.filter(
+        discharge_date__isnull=False
+    ):
+        ConsultationBed.objects.filter(
+            consultation=consultation, end_date__isnull=True
+        ).update(end_date=consultation.discharge_date)
+
+
+class Migration(migrations.Migration):
+    dependencies = [
+        (
+            "facility",
+            "0393_rename_diagnosis_patientconsultation_deprecated_diagnosis_and_more",
+        ),
+    ]
+
+    operations = [
+        migrations.RunPython(free_discharged_beds, migrations.RunPython.noop),
+    ]

care/facility/tests/test_patient_api.py

@@ -244,3 +244,98 @@ def test_filter_by_location(self):
         self.assertEqual(
             response.data["results"][0]["id"], str(self.patient.external_id)
         )
+
+
+class PatientTransferTestCase(TestUtils, APITestCase):
+    @classmethod
+    def setUpTestData(cls):
+        cls.state = cls.create_state()
+        cls.district = cls.create_district(cls.state)
+        cls.local_body = cls.create_local_body(cls.district)
+        cls.super_user = cls.create_super_user("su", cls.district)
+        cls.facility = cls.create_facility(cls.super_user, cls.district, cls.local_body)
+        cls.destination_facility = cls.create_facility(
+            cls.super_user, cls.district, cls.local_body, name="Facility 2"
+        )
+        cls.location = cls.create_asset_location(cls.facility)
+        cls.user = cls.create_user(
+            "doctor1", cls.district, home_facility=cls.facility, user_type=15
+        )
+        cls.patient = cls.create_patient(cls.district, cls.facility)
+        cls.consultation = cls.create_consultation(
+            patient_no="IP5678",
+            patient=cls.patient,
+            facility=cls.facility,
+            created_by=cls.user,
+            suggestion="A",
+            admission_date=now(),
+            discharge_date=None,  # Patient is currently admitted
+            discharge_reason=None,
+        )
+        cls.bed = cls.create_bed(cls.facility, cls.location)
+        cls.consultation_bed = cls.create_consultation_bed(cls.consultation, cls.bed)
+        cls.consultation.current_bed = cls.consultation_bed
+        cls.consultation.save()
+        cls.patient.last_consultation = cls.consultation
+        cls.patient.save()
+
+    def test_patient_transfer(self):
+        self.client.force_authenticate(user=self.super_user)
+        response = self.client.post(
+            f"/api/v1/patient/{self.patient.external_id}/transfer/",
+            {
+                "date_of_birth": "1992-04-01",
+                "facility": self.destination_facility.external_id,
+            },
+        )
+        self.assertEqual(response.status_code, status.HTTP_200_OK)
+
+        # Refresh patient data
+        self.patient.refresh_from_db()
+        self.consultation.refresh_from_db()
+
+        # Assert the patient's facility has been updated
+        self.assertEqual(self.patient.facility, self.destination_facility)
+
+        # Assert the consultation discharge reason and date are set correctly
+        self.assertEqual(self.consultation.discharge_reason, "REF")
+        self.assertIsNotNone(self.consultation.discharge_date)
+
+    def test_transfer_with_active_consultation_same_facility(self):
+        # Set the patient's facility to allow transfers
+        self.patient.allow_transfer = True
+        self.patient.save()
+
+        # Ensure transfer fails if the patient has an active consultation
+        self.client.force_authenticate(user=self.super_user)
+        response = self.client.post(
+            f"/api/v1/patient/{self.patient.external_id}/transfer/",
+            {
+                "date_of_birth": "1992-04-01",
+                "facility": self.facility.external_id,
+            },
+        )
+        self.assertEqual(response.status_code, status.HTTP_406_NOT_ACCEPTABLE)
+        self.assertEqual(
+            response.data["Patient"],
+            "Patient transfer cannot be completed because the patient has an active consultation in the same facility",
+        )
+
+    def test_transfer_disallowed_by_facility(self):
+        # Set the patient's facility to disallow transfers
+        self.patient.allow_transfer = False
+        self.patient.save()
+
+        self.client.force_authenticate(user=self.super_user)
+        response = self.client.post(
+            f"/api/v1/patient/{self.patient.external_id}/transfer/",
+            {
+                "date_of_birth": "1992-04-01",
+                "facility": self.destination_facility.external_id,
+            },
+        )
+        self.assertEqual(response.status_code, status.HTTP_406_NOT_ACCEPTABLE)
+        self.assertEqual(
+            response.data["Patient"],
+            "Patient transfer cannot be completed because the source facility does not permit it",
+        )

care/utils/tests/test_utils.py

@@ -78,8 +78,6 @@ class TestUtils:
     Base class for tests, handles most of the test setup and tools for setting up data
     """
 
-    maxDiff = None
-
     def setUp(self) -> None:
         self.client.force_login(self.user)