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Objectives: Monitoring critical time intervals in acute ischemic stroke treatment delivers metrics for quality of performance - the door-to-needle time being well-established. To resolve the conflict of self-reporting bias a "StrokeWatch" was designed - an instrument for objective standardized real-time measurement of procedural times., Materials and Methods: An observational, monocentric analysis of patients receiving intravenous thrombolysis for acute ischemic stroke between January 2018 and September 2019 was performed based on an ongoing investigator-initiated, prospective, and blinded endpoint registry. Patient data and treatment intervals before and after introduction of "StrokeWatch" were compared., Results: "StrokeWatch" was designed as a mobile board equipped with three digital stopwatches tracking door-to-needle, door-to-groin, and door-to-recanalization intervals as well as a form for standardized documentation. 118 patients before introduction of "StrokeWatch" (subgroup A) and 53 patients after introduction of "StrokeWatch" (subgroup B) were compared. There were no significant differences in baseline characteristics, procedural times, or clinical outcome. A non-significant increase in patients with door-to-needle intervals of 60 min or faster (93.2 vs 98.1%, p = 0.243) and good functional outcome (mRS d90 ≤ 2, 47.5 vs 58.5%, p = 0.218) as well as a significant increase in reports of delayed arrival of intra-hospital patient transport service (0.8 vs 13.2%, p = 0.001) were observed in subgroup B., Conclusions: The implementation of StrokeWatch for objective standardized real-time measurement of door-to-needle times is feasible in a real-life setting without negative impact on procedural times or outcome. It helped to reassure a high-quality treatment standard and reveal factors associated with procedural delays., Competing Interests: Declaration of Competing Interest M. Wiesmann reports grants and personal fees from Stryker Neurovascular, grants and personal fees from SilkRoad Medical, grants from Covidien, grants from Microvention, grants and personal fees from Bracco, grants and personal fees from Siemens, grants from AB Medica, grants from Acandis, grants from Codman Neurovascular, grants from Penumbra, grants from Phenox, grants from Abbott, grants from St. Jude, from B. Braun, outside the submitted work. All other authors declare no conflict of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)