Introduction: Most patients with acute facial palsy initially present to emergency departments (EDs), where clinical practice guidelines (CPGs) recommend steroids, eye care, and follow-up with facial nerve specialists. Objective: To evaluate adherence to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Bell's palsy (BP) CPGs within EDs at a single academic institution. Method: We conducted a retrospective review of all patients diagnosed with acute facial palsy in the EDs of an academic tertiary care center between June 1, 2021, and June 1, 2022. Results: A total of 270 patients met inclusion criteria; most were male (n = 150, 55.9%), diagnosed with BP (n = 243, 90.0%), and presented to community-based emergency rooms (n = 170, 62.96). Although most patients received steroid treatment (n = 243, 90.0%), only 61.5% (n = 166) received the AAO-HNS-recommended course. Older patients and those who received steroids were more likely to receive imaging (p < 0.001, p = 0.03). Treatment with the AAO-HNS-recommended steroid regimen was associated with a higher likelihood of receiving laboratory evaluation (p = 0.02). Providers often advised follow-up; however, only 12.2% of patients were discharged with an electronic referral order. Conclusion: There are opportunities to standardize the treatment of patients in the ED presenting with acute facial palsy according to AAO-HNS CPGs.