This article correlates quality of care with cost of care. The authors describe their experience in developing an internal measure of quality and two surrogates for cost. They examine archival data for 3,671 patients in the emergency department of a large community teaching hospital. Their results indicate statistically significant differences among emergent, urgent, and routine care assessments by triage staff, nurses, and physicians. Only 56 percent of the assessments were consistent. Triage was significantly less predictive of nursing acuity assessments than physician resource-based relative value scale codes. The authors conclude that by reducing process variation in patient acuity assessments, health care managers can improve quality of care while managing costs.