Aim To adapt and promote a relevant track and trigger system based on modified early warning systems (MEWS) for use in rural community hospitals in Powys, Wales.

Method Track and trigger systems, including MEWS, were reviewed, compared and developed by senior nursing and medical staff using PDSA (Plan Do Study Act) cycles.

Results A track and trigger system was developed, piloted and rolled out to all ten community hospitals in Powys. The system is not only used to monitor inpatients, but is also useful in determining appropriateness of patient transfer to district general hospitals.

Conclusion The track and trigger scoring system has proved useful in assessing patients and alerting staff if their condition is deteriorating. It has ensured, when necessary, timely, appropriate and safe transfer of patients to the district general hospital. The scoring system has been extended to determine appropriateness of accepting patients from the district general hospital to the community hospital.