Abstract Body: Introduction: Delays in IV thrombolysis (IVT) via telestroke may occur because of limited access to direct communication between providers. A direct secure messaging system between requesting telestroke sites and telestroke physicians may streamline the process. Methods: Retrospective analysis of telestroke patients treated with IVT in the emergency department across twenty hospitals between June 2018 and June 2024. A direct secure messaging system was implemented in December 2023, which allowed requesting hospital staff the ability to directly page and message the telestroke physician obviating the need for phone calls to coordinate care. Summary statistics and outcomes compared telestroke notifications via a call center (phone) to a direct secure messaging system (direct message). Patients that developed disabling symptoms after arrival and with missing data were excluded. Primary outcome compared telestroke paging times and secondary outcomes compared page to video and door to needle (DTN) times with quantile (median) regression analyses adjusted for variables identified in univariate analyses: average telestroke volume, age, NIHSS and time of day. DTN time was also adjusted for door to telestroke request times and delays in treating IVT due to hypertension. Subgroup analysis evaluated differences in door in door out time between groups. Results: In the seven months after implementing a direct messaging system, 2435 (1739 initial telestroke requests and 696 follow-up communications) messages were sent directly to telestroke physicians from telestroke sites, reducing 3131 calls to and from the call center. A total of 829 patients were treated with IVT during the entire study period and after exclusions, 777 (93.7%) were included in the study. Median paging times via direct message were quicker than via phone by 1.86 minutes [95% Confidence Interval (CI) 1.47, 2.24], p<0.001. Page to video times were similar between groups, median difference was 1.48 minutes [95%CI -0.98, 3.94], p=0.24. Median DTN time in patients paged through direct message was quicker than phone paging by 10.03 minutes [95% CI 5.36, 14.70], p<0.001. The median difference in door in door out times was similar, -1.61 [95% -17.85, 14.63], p=0.85. Conclusion: Implementation of a direct messaging system reduced paging and door to needle times. Automating the telestroke paging process reduced call-center burden and facilitated a streamlined process in stroke care across telestroke sites.