Abstract Body: BACKGROUND: Stroke is a leading cause of disability and death. The use of intravenous (IV) thrombolytics, such as alteplase and tenecteplase (TNKase), for acute ischemic stroke (AIS) is a standard of care. Tenecteplase has been recommended as an alternative agent to alteplase. In November 2020, the use of IV TNKase for AIS at a standard 0.25mg/kg dose was implemented at a small community hospital within a large integrated healthcare system. The use of TNKase without the required infusion may expedite admission to the intensive care unit (ICU). PURPOSE: The aim of this retrospective comparative review was to ascertain the effects of IV TNKase, compared to IV alteplase, on average length of stay (LOS) in the emergency department (ED) and time of ED to admission to the ICU (ED to floor). METHODS: A total of 155 electronic patient charts were reviewed from January 2018 to June 2024. An unpaired t-test was used to determine the p value. The p value of < 0.05 was considered statistically significant. RESULTS: There were no significant differences in the age and sex between the alteplase and TNKase patients. The average LOS and ED to floor measure were also not significant between the two groups (3.24 versus 2.87 hours, p = 0.11; 79.7 versus 63.4 minutes, p = 0.20, respectively). When examining the ED to floor measure from a different perspective, there was a significant improvement in the percentage of patients admitted to the ICU within 60 minutes – 54.3% (2018 – 2020) to 72.7% (2021 – 2023) to 85.7% in 2024. CONCLUSION: There have been numerous trials and studies published on the use of IV TNKase for AIS with promising results. The single bolus IV TNKase dose given over 5 seconds is an attractive nursing workflow. Without the use an infusion, post-TNKase patients may be admitted sooner to ICU. Reducing ED LOS improved throughput in a small often overcrowded ED. Additional in-depth reviews and data analysis would be needed to examine patient characteristics and clinical conditions, variations in workflow, operational needs, staffing, and documentation accuracy contributing to ED LOS and ED to floor measure.