Background: Faster administration of tissue plasminogen activator (tPA) for patients with acute ischaemic stroke yields greater clinical benefits. We implemented door-to-needle (DTN) time reduction strategies at our centre and evaluated their short- and long-term effects on in-hospital treatment delays and clinical outcomes. Methods: Stroke team pre-notification, direct computed tomography (CT) transfer, not routinely waiting for labs and tPA delivery on CT table were implemented in June 2013. We included all thrombolysed patients admitted directly to our hospital between January 2012 and March 2015. In-hospital delays and clinical outcomes (Modified Rankin scale, mRS) at 3 months were compared between patients pre- and post-modification, and the latter period was divided into early and late phases to assess the durability of our modifications. Results: Forty-eight individuals were treated pre-modification, compared to 58 post-modification. The median DTN time was reduced from 75 (interquartile range: 60-93) minutes to 46 (33-59) minutes (p<0.0001). The median DTN time in the early and late post-modification phases was not different (41 versus 46 minutes, p=0.4085). Functional outcome at 3 months was not different in the two groups (proportion of mRS≤1: 34% versus 28%, p=0.882). Conclusions: We were able to decrease our DTN time for treatment of acute stroke by implementing simple modifications and these improvements persisted over time.