One of the critical care outreach service's aims in this local hospital was to develop an assessment tool to help identify patients in danger of deterioration. This paper describes the introduction of an early warning scoring system between April 2001 and March 2002 to the surgical unit of a district general hospital. The informal and gradual approach used to optimize the effectiveness of introducing the early warning scoring system is highlighted. Explanations are given of the training processes undertaken, the pilot evaluation and lessons learned from the process. Using the experiences of the outreach service in introducing the early warning scoring system, this paper aims to provide thought for others considering a similar initiative in their area