Objective To shorten door-to-physician and door-to-needle time (the interval between arriving at the hospital and starting thrombolytic treatment) in patients with acute ischemic stroke (AIS) and to enhance rescue rate. Methods A total of 544 AIS patients received physician-initiated management protocol and 1 036 counterparts were subjected to triage nurse-initiated management protocol. The accuracy of assessment, rate of thrombolytic treatment, and door-to-needle time were compared between the two groups. Results There were no significant differences between the two groups in the accuracy of assessment and rate of thrombolytic treatment (P＞0.05 for both）.Door-to-physician, door-to-venipuncture, door-to-sample-arrival, and door-to-needle in nurse-initiated group were significantly shortened than physician-initiated group （P＜0.01 for all）. Conclusion Triage nurse-initiated management of AIS would decrease door-to-needle time and increase the effectiveness of thrombolytic treatment.