## 1 Introduction  
In Norway, 12,000 people suffer from stroke each year [1]. By giving stroke patients thrombol treatment in the acute phase, their prognoses are improved [2]. It is a national goal to provide more patients with thrombol treatment [2]. Thromolytic treatment should be given as soon as possible,but within 4/2 hours after the onset of symptoms [2]. As time matters, decisions about diagnosis must be made as soon as possible after the patient with a suspected stroke reaches the emergency unit at the referring hospital. The decision about starting thrombol treatment depends on several criteria, where are considered individually case-by-case. If the decision is to start thrombol treatment, it will be initiated and given under strict supervision from a specialist in neurology. Small hospitals do not have such competence, and in situations where a second opinion is necessary or thrombol treatment is given, practitioners need advice regarding treatment. Traditionally, such advice is sought over the telephone. This study takes place in Norway, where a hospital has implemented real-time videoconferencing (VC) to access specialist knowledge from a specialist hospital to discuss acute patients suffering a potential stroke. By using VC, the physicians, nurses and specialists are able to examine the patient in a collaborative process, which may be helpful when deciding if a patient needs advanced specialist neurological or neurosurgical emergency treatment. The knowledge is then shared and constructed between the specialists at the specialist hospital and the physicians at the referring hospital. In acute situations, when the time is limited, this collaborative process can shorten decision time and improve the outcome of treatment. Stroke is a condition with paralysis and confusion, and therefore a domain that particularly benefits from seeing the patient, instead of only hearing descriptions of the patient's condition. Although the decision to give thrombol treatment is comprehended as the end-point of the acute stroke consultation, it is just the beginning of care for the patient [3]. VC consultation may therefore also be useful in follow-up after the acute phase of a stroke patient. Post-thrombolytic care requires intensive cardiovascular and neurological monitoring, neurosurgical backup, and a decision whether to keep the patient or to \"drip-and-ship\". The VC process provides an opportunity to both see and hear the patient and the practitioners at the same time. This is an improvement compared to using an ordinary telephone, which provides only sound and one-to-one communication, _i.e._, between the specialist and the physician. In this manner, the use of VC supports knowledge-sharing in teams between professionals, both in acute and post-thrombolytic care. There is limited experience with use of VC in stroke treatment in Norway. Many hospitals use tele-radiology image transfer combined with telephone advice to support referring hospitals for stroke patients [2,4]. A VC stroke service established between Haukeland University Hospital and referring hospitals in Voss and in Forde reports an increase in thrombol treatment [5]. However, there is substantial scientific evidence of the medical impacts of the use of VC in stroke treatment; \"telestroke\" [3]. A meta-analysis shows that a telestroke network, where experienced stroke specialists perform an evaluation and examination of the patient via VC, and consider the indication for initiation of thrombol treatment, is comparable with face-to-face consultations [6]. There is also evidence that VC counseling is more effective than telephone counseling in the acute treatment of stroke. Several studies of telestroke solutions including video _versus_ solutions without video show that VC may (1) reduce the number of wrong diagnoses (7.1% _vs_. 17.6%, \(p\) < 0.05), (2) reduce death rate (1.3% _vs_. 6.8%, \(p\) < 0.05) (3) reduce needs for nursing homes (2.6% _vs_. 5.4%, \(p\) = 0.58) [7, 8, 9].