Impact of an Evidence-Based Emergency Department Order Set on Clinical Management of Bell's Palsy

Abstract

Objective

To assess the impact of an evidence-based emergency department (ED) order set on the clinical management of patients presenting with Bell's palsy.

Methods

This study included adult patients diagnosed with Bell's palsy in the ED before and after the institution of a new order set, which mirrors the AAO-HNSF Clinical Practice Guidelines. Data were extracted on demographics, steroid and antiviral prescribing, eye protection, and referrals and analyzed using descriptive statistics.

Results

Two cohorts of patients diagnosed with Bell's palsy in the ED were compared: those managed prior to the institution of the order set (n = 27, April 2020 to August 2023) and those managed under the new order set (n = 29, September 2023 to November 2025). Demographics were similar across cohorts, with median ages of 50 years in the prior group versus 54 years in the order set group. Use of a tapering steroid regimen increased with the updated order set (79.3% vs. 0%). Eye protection was provided to 89.7% of patients in the updated order set group compared to 85.2% prior. Referrals to otolaryngology increased to 89.7% with the order set compared to 0% prior.

Conclusion

Implementation of an order set in accordance with the AAO-HNSF Clinical Practice Guidelines on Bell's palsy improved adherence to best practices, particularly regarding steroid tapers, eye protection, and referral to otolaryngology. These findings suggest that structured ED order sets may enhance the quality and consistency of Bell's palsy care.

Level of Evidence

3.