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1. Transfer to the ward following a period in intensive care may cause stress for patients. 2. A review of the literature reveals that this phenomenon has been described in a number of different ways, such as transfer stress, transfer anxiety, translocation syndrome and, more recently, relocation stress. 3. This paper reviews the various concepts before arriving at a more operational definition of the phenomenon. 4. It attempts to reveal what causes this phenomenon and to what extent it exists. 5. Patients' responses to transfer are identified and the physical and psychological problems that have been associated with discharge from intensive care are discussed. 6. Lists of interventions that the literature suggests may reduce or prevent this phenomenon from occurring are reviewed. 7. Recommendations for practice development and further research are made.

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Background Despite the introduction of rapid response systems and early warning scores, clinical deterioration that is not recognised or responded to early enough prevails in acute care areas. One intervention that aims to address this issue and that is gaining increased attention is patient- and family-initiated escalation of care schemes. Existing systematic review evidence to date has tended to focus on identifying the impact or effectiveness of these schemes in practice. However, they have not tended to focus on qualitative evidence to consider the experience of deterioration and the factors that may promote or hinder engagement with these schemes in the practice setting. This systematic review will address this gap. The aim of this review is to explore patients’, relatives’ and healthcare professionals’ experiences of deterioration and their perceptions of the barriers or facilitators to patient and family-initiated escalation of care in acute adult hospital wards. Methods We will search Medline, CINAHL, Embase and PsycINFO databases using free-text and MESH terms relating to deterioration, family-initiated rapid response, families, patients, healthcare staff, hospital and experiences. We will search grey literature and reference lists of included studies for further published and unpublished literature. All studies with a qualitative design or method will be included. Two reviewers will independently assess studies for eligibility, extract data and appraise the quality of included studies. Data will be synthesised using a thematic synthesis approach, and findings will be presented narratively. Discussion Patient- and family-initiated escalation of care schemes have been developed and implemented in several countries including the United States, the United Kingdom and Australia, but there is limited evidence regarding patients’ or families’ perceptions of deterioration or the barriers and facilitators to using these schemes in practice, particularly in acute adult areas. This systematic review will provide evidence for the development of a patient and family escalation of care scheme that can be tested in a feasibility study. Systematic review registration PROSPERO CRD42018106952 Electronic supplementary material The online version of this article (10.1186/s13643-019-1010-z) contains supplementary material, which is available to authorized users.