Time is of the essence in the treatment of acute stroke; however, there are wide variations, across and within countries, in the ability to hospitalize, scan, diagnose, and treat acute stroke patients rapidly within the accepted time window of 4.5 hours. Door-to-needle (DTN) time is an important performance indicator that illustrates the speed and operational efficiency of stoke units. Significant progress is being made; DTNs often exceeded an hour only a few years ago, but can now be achieved in under seven minutes in leading stroke units. This symposium examined the strategies and contributory factors that result in reduced DTN times, and how these strategies can be more widely implemented. The Quality in Acute Stroke Care (QASC) programme in Australia has shown the incorporation of standardized nurse-led treatment protocols for the management of fever, hyperglycaemia, and dysphagia (FeSS protocols) significantly improve outcomes for stroke patients. European evaluation of these protocols, in collaboration with ESO and the ANGELS initiative, and potentially leading to their adoption in European acute stroke treatment practice is discussed.