Acute ischemic stroke affects 696,000 people annually and is a leading cause of disability in the United States. Tissue plasminogen activator (tPA) is the mainstay of treatment with earlier administration associated with improved benefits. Despite this, less than one third of patients in the United States are treated with tPA in less than 60 minutes from presentation. With significant improvements in multiple stroke outcomes appreciated with each 15-minute improvement in door to needle (DTN) time, reduction of DTN is essential to improve outcomes and reduce disability. Stroke related disability imposes a significant economic burden, further supporting the need to decrease treatment times and improve stroke outcomes. Telestroke technology was placed within the Computed Tomography (CT) imaging suites at two institutions to improve DTN times when a stroke neurologist is not on-site. A retrospective review of the Providence Stroke Registry was conducted to determine median DTN time for patients treated with tPA in the emergency department.