Feasibility and Reliability of a Novel Tele-stroke Care Unit System in a Japanese Hospital

Stroke care units, which provide intensive management for acute stroke, are widely used in Japan. However, recent legal restrictions on physicians' overtime may challenge continuous specialist coverage, particularly in resource-limited settings. To address this issue, we developed a tele-stroke care units system that provides remote support from stroke specialists. We aimed to evaluate the feasibility and reliability of this system for remote neurological assessment. The system integrates live-streaming and medical image viewing between a local stroke care unit and a remote university hospital through the International Organization for Standardization 27001-compliant Join LiveView application (Allm, Inc., Japan). Remote physicians accessed real-time videos through ceiling-mounted pan-tilt-zoom cameras and communicated bidirectionally using a wireless speaker. We assessed the audiovisual quality, conducted remote National Institutes of Health Stroke Scale examinations in 20 patients with stroke, and compared the results with those of bedside assessments. Remote physicians successfully evaluated all National Institutes of Health Stroke Scale categories using camera-zoom functions, with or without local staff assistance. Video and audio quality were sufficient for clinical assessment and communication. Median total National Institutes of Health Stroke Scale scores were 7.5 (bedside) and 6.5 (remote). Excellent or perfect inter-rater reliability was observed in all 13 categories, with a total score correlation coefficient of 0.998 (p < 0.0001). The tele-stroke care unit system showed sufficient audiovisual quality for effective remote neurological assessment and may serve as a practical solution for acute stroke management in facilities facing workforce shortages, thereby contributing to sustainable stroke care.