Background: Effective emergency response plays a crucial role in ensuring patient safety, particularly in the management of acute stroke cases in Emergency Department (ED). Timely correct care is essential to mitigate adverse outcomes in stroke patient. Purpose: To investigates pre and in-hospital factors that influence acute stroke management in the ED. Method: A literature review method was employed to gather and analyze information from Scopus, Science Direct, and Google Scholar using the keyword stroke AND "Emergency Department" in the 2019-2024 period. As much as 333 articles are identified. A total of 10 articles that met the criteria were included in the study. The selected articles are then systematically reviewed and analyzed. Results: Factors that can affect prehospital delay consist of the use of Emergency Medical Services (EMS), patient characteristics, and geographical barriers. The factors that affect inhospital delay are communication with ED staff and ED officer knowledge. Conclusion: To improve the management of stroke patients, the participation of various parties is needed, not only within the hospital, but also the role of policy holders in the prehospital.