Acute type A aortic dissection (TAAD) is a surgical emergency in which mortality increases in a time-dependent manner. The estimated risk of death has historically been 1–2% per hour without surgical management, with significantly better outcomes achieved through surgical intervention within the first 4 h [[1], [2], [3]]. For hospitals that do not have the capabilities to provide definitive surgical care, it is imperative that rapid transfer out of the emergency department occur as soon as the initial evaluation and treatment has happened. Once diagnosis, resuscitation, and transport has occurred, time spent on arrival in receiving hospital locations other than the operating room (such as an intensive care unit (ICU) or a second emergency department) adds little value to the care of patients needing definitive surgical treatment and can contribute to delays. Streamlining processes to allow patients to go directly from a referring hospital emergency department to the receiving hospital operating room could improve outcomes. We started a direct-to-OR (DOR) external transfer program for aortic emergencies with the aim to reduce time from diagnosis by emergency physicians to definitive surgical care. We hypothesized that this program would reduce time from diagnosis to surgery and expedite interfacility transfer of patients with TAAD. In this study, we evaluated the results of TAAD repair before and after implementation of our DOR program.