| Objective: To investigate the effect of the principled stratified transshipment program on the quality of in-hospital safety of patients with acute stroke in emergency department. Methods: Eighty-eight patients with acute stroke who were transferred to the hospital in the emergency department of our hospital in the past three years were selected as subjects. Among them, 32 patients with acute stroke from January 2017 to December 2017 were used as control group, from January 20 to July 2019. Fifty-six patients with acute stroke were included as observation groups. The control group performed routine transshipment, and the observation group implemented a hierarchical transshipment plan based on the principle of “downgrading plan, full evaluation, optimized grading, optimal path, and dynamic evaluation”. The in-hospital transport safety and quality evaluation indicators of the two groups were compared. Results: Both groups of patients were safely and quickly transported. After active and effective rescue, the patients' condition improved significantly. The average time taken from the observation group to the time of diagnosis, the time from diagnosis to the first aid treatment and the transfer of the hospital were significantly shorter than that of the control group. The scores of the transport quality control assessment of the observation group were significantly higher than those of the control group. The family members of the observation group were satisfied with the emergency care service. The satisfaction degree of the degree and delivery department was significantly higher than that of the control group, and the difference was statistically significant (P＜0.05). Conclusion: After the in-hospital transfer process of acute stroke patients is standardized and optimized, the patient's in-hospital transport safety and transfer quality are significantly improved. Patients are safely and quickly transported and actively and effectively rescued. The patient's rescue success rate and patient's family and related departments' emergency care services. Satisfaction is significantly improved.