Objective To explore the effects of refined time management combined with organized stroke management on intravenous thrombolysis in patients with acute ischemic stroke. Methods 500 patients with acute ischemic stroke were treated with recombinant tissue plasminogen activator thrombolytic therapy from April 2013 to April 2018. With October 2015 as the demarcation point, our hospital implemented two management modes of intravenous thrombolysis for stroke including organized stroke management group (control group, 219 cases) and refined time management combined with combined stroke management group (experimental group, 281 cases). The curative effect of 24 hours of intravenous thrombolysis, the time of each link of thrombolysis process and the rate of reaching the standard, the evaluation of 24 hours of intravenous thrombolysis after thrombolysis, the Barthel index score at discharge and 6 months of followup were compared between the two groups. The Barthel index score and other clinical outcome parameters were compared. Results The therapeutic effect of 24 hours intravenous thrombolysis in the observation group was significantly higher than that in the control group (P＜0.05). The rate of reaching the standard in each time in the observation group was significantly higher than that in the control group (P＜0.05). In the observation group, the hospitalization days, hospitalization expenses, conversion rate of bleeding, 6month mortality rate and 6month readmission rate were significantly lower than those in the control group (P＜005). The proportion of patients without dysfunction in the observation group after thrombolysis for 24 hours, discharge and discharge for 6 months was significantly higher than that in the control group (P＜0.05). The proportion of patients with moderate and severe dysfunction after 24 hours thrombolysis in the observation group was significantly lower than that in the control group (P＜0.05). Conclusion Implementation of refined time management combined with organized stroke management can significantly improve the efficacy of intravenous thrombolysis in patients with acute ischemic stroke