Abstract: Objective To investigate the effect of prehospital procedure optimization on treatment delay and clinical outcome of ischemic stroke. Methods We searched PubMed，Embase，Cochrane Library，Web of Science， China Biomedical Literature Database，Wanfang data knowledge service platform，China National Knowledge Infrastructure，VIP database to collect intervention studies or cohort studies related to pre-hospital workflow optimization. The search period was from the database establishment to November 2022. Two evidence-based trained researchers independently screened literature，extracted data，and evaluated quality according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3 software. Results Twenty-four literatures with a total of 197 154 patients were included. The results showed that prehospital procedure optimization could improve the rate of reperfusion therapy in patients with ischemic stroke[OR=1.98，95%CI（1.57，2.49），Z=5.75，P<0.001］ and shorten the time from symptom onset to thrombolytic therapy[WMD=-21.64，95%CI（-33.32，-9.97），Z=3.63，P<0.001］， the time from ambulance call to thrombolytic therapy[WMD=-30.29，95%CI（-44.14，-16.45），Z=4.29，P<0.001］ and the time of intra-hospital thrombolytic therapy or intravascular therapy to improve the clinical outcome of patients [OR=1.99，95%CI（1.29，3.05），Z=3.12，P=0.002］，but had no significant effect on the improvement of entry time from symptom onset to emergency room[WMD=-6.88，95%CI（-16.62，2.86），Z=1.38，P=0.17］. Conclusion Prehospital procedure optimization can effectively improve the reperfusion treatment rate and prognosis of patients with ischemic stroke，but the improvement of prehospital time is small，suggesting that the prehospital process needs to be further optim

Key words: Ischemic Stroke, Procedure Optimization, Emergency Medical Services, Prehospital Delay, Meta-Analysis as Topic