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Vital signs assess overall health. They give clues to disease and demonstrate signs of recovery. Next to heart rate, blood pressure, and temperature, we propose elevating cost to the sixth vital sign. Using institutional specific data for cost integrated into the EHR, a physician can examine a running flow sheet for bed, pharmaceutical, and lab/diagnostic costs. Summarized by day or cumulative totals, a cost flowsheet provides quick visibility. This promotes patient-centered decisions that take into account the economic burden distributed to families and the health care system while reinforcing the link between intervention and expense. Potential outcomes include decreased length of stay, decreased exposure to harm due to unnecessary interventions, and greater institutional awareness of cost factors in the management of hospitalized patients. Ultimately increased visibility can lead to developing standardized cost models for uncomplicated patients with straightforward diagnoses.