ABSTRACT Objectives Over-testing andover-treatment are common in children with croup at pediatric emergencydepartments (PED). The objective of the study was to improve care for childrenwith croup. Methods In this qualityimprovement (QI) initiative, all pediatric residents starting their rotation inthe PED attended an informative presentation about croup and were providedreminders throughout their rotation. The primary outcome of this QI initiative wasto reduce nebulized epinephrine (NE) use among children with mild croup by 50%over 7 months. The secondary outcome was to reduce X-rays by 50% over 7 months.Other outcomes included the administration of dexamethasone to all childrenwith croup, reduction of antibiotics, laboratory tests, and revisits, andshortening the duration between physical examination and dexamethasone and NEtreatments, and the length of stay (LOS) at the PED. Results NE administration topatients with mild croup decreased from 80.2% to 36.3% (p < 0.001). The proportion of children with X-rays decreased from37.4% to 17.1% (p < 0.001). There was a significant increase indexamethasone administration, and significant decreases in laboratory bloodtests, and expanded viral PCR panel tests, and antibiotic prescription among allcroup cases (p < 0.001). Revisit rates were not significantly different(p > 0.05). Time to dexamethasone and LOS shortened significantly(p < 0.001). Conclusion With this QI intervention,decreases in the rate of administration of NE to mild croup cases, antibioticprescription, X-ray, laboratory blood and respiratory PCR panel tests in allcroup cases were achieved without an increase in revisits. However, unnecessaryNE, antibiotic, and X-ray rates are still high.