District hospitals in Ethiopia face challenges in managing patient flow and risk assessment. A two-arm parallel-group randomized controlled trial was conducted with 120 hospitals, assessing intervention versus standard care. Key metrics included patient wait times and mortality rates. In the intervention group, median patient wait time decreased by 35% (95% CI: -40%, -30%) compared to a 10% decrease in the control group. The randomized field trial demonstrated significant improvements in operational efficiency and clinical outcomes with reduced risk factors among district hospitals. Implementing standardised protocols and training programmes can further enhance system performance and patient safety. District Hospitals, Risk Reduction, Randomized Field Trial, Operational Efficiency Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.