Evidence has shown that the benefits of IV tPA and thrombectomy in acute ischemic stroke are time-dependent.  Therefore, AHA guidelines have made certain recommendations regarding door-to-needle and door-to-groin puncture time.  Despite this, the majority of acute ischemic patients who receive tPA and thrombectomy are not treated within this time.  Stroke quality programs have been shown to improve doo-to-needle and door-to-groin puncture time, thus improving outcomes in the care of acute ischemic stroke.  This program will discuss best practices in acute stroke care to assist healthcare professionals and hospital staff in optimizing protocols to improve door-to-needle and door-to-groin puncture times, thus improving patient outcomes after administration of thrombolytics and/or performing thrombectomy.