Stroke is the fourth leading cause of death in Japan, and physical and cognitive dysfunction following a stroke is the leading cause of long term care requirements. As the Japanese population is aging rapidly, the number of stroke patients is also increasing. The lack of coherent cooperation systems and expensive medical and long-term care insurance, are serious social problems facing elderly Japanese people.
 Tokushima University Hospital SCU was established in 1999. Between then and 2017, a total of 4,787 patients have been admitted. For accurate evaluation and proper assessment, emergency magnetic resonance imaging (3T) and/or computed tomography, angiography and ultrasound have been used since 1999. Additionally, the application of stroke telemedicine began in 2012 to administer appropriate treatments, especially for effective intervention with earlier intravenous thrombolysis and/or mechanical thrombectomy in acute ischemic stroke. The ratio of stroke patients among all admitted patients in the SCU was 0.88 in 2017, and further classified thus: cerebral infarction (58%), cerebral hemorrhage (23%), subarachnoid hemorrhage (16%), and transient ischemic attack (3%). Revascularization therapy for acute ischemic stroke was done in 21% of patients. 
 To improve clinical outcome, not only medical treatment, but also high-quality care is necessary. We have the inter-professional stroke team, composed of physicians, nurses, physiotherapists, nutritionists, and clinical social worker. The inter-professional team conducts weekly meetings to discuss progress and outstanding problems, and to foster mutual respect and understanding among team members. By strengthening our stroke team, we aim to focus on the establishment of regional networks.

Development and Future Prospects of Tokushima University Hospital Stroke Care Unit (SCU)