Objective To investigate whether the adoption of 120 transfer (an emergency medical service in China) combined with pre-hospital notification procedure can shorten the onset-to-needle time (ONT) and improve the prognosis of patients receiving intravenous thrombolysis with recombinant human tissue plasminogen activator (rt-PA). Methods Data were retrospectively collected from patients with acute ischemic stroke who had received intravenous thrombolysis with rt-PA from January to June, 2018 in the People's Hospital of Hechi, Guangxi Zhuang Autonomous Region, China; the patients were divided into self-arranged transfer without pre-hospital notification group (group A) and 120 transfer combined with pre-hospital notification procedure group (group B). The two groups were compared for ONT, door-to-needle time, and proportion of patients with modified Rankin Scale (mRS) score ≤ 2 on day 90. Results Among the 57 patients enrolled in the study, 27 (47.4%) adopted 120 transfer combined with pre-hospital notification procedure, and 30 (52.6%) adopted self-arranged transfer without pre-hospital notification. Compared with group A, group B had a significantly shorter median ONT (190 minutes vs 116 minutes, P=0.009) and a significantly higher proportion of patients with mRS score ≤ 2 (56.7% vs 88.9%, P=0.007). A regression analysis using a model adjusted for age, sex, and baseline NIHSS score indicated that the adoption of 120 transfer combined with pre-hospital notification procedure significantly shortened ONT by 76.3 minutes (95% confidence interval:36.4-116.3, P<0.001). Conclusions The adoption of 120 transfer combined with pre-hospital notification procedure can significantly shorten the ONT and improve the prognosis of patients receiving intravenous thrombolysis with rt-PA.